RESUMO
BACKGROUND: Randomized trials have demonstrated coronary artery bypass surgery (CABG) to be superior to percutaneous coronary intervention with respect to long-term mortality and morbidity from myocardial infarction within specific high-risk cohorts. The purpose of this study was to analyze the spatial distribution of coronary artery bypass graft anastomoses relative to acute thromboses in native coronary arteries. We hypothesized that insertion sites of bypass grafts are located distal to sites of acute thrombosis and consequently decrease cardiac morbidity and mortality associated with plaque rupture. METHODS: We analyzed 168 patients with prior CABG and 208 patients with ST-segment elevation myocardial infarctions (STEMI) presenting to the Brigham and Women's Hospital who underwent coronary angiography. We constructed a spatial map of the coronary arterial bypass graft insertion sites and compared these locations to sites of acute thrombosis leading to STEMI. RESULTS: Graft insertion sites were consistently located distal to acute thrombosis sites (left anterior descending artery median graft insertion versus median thrombosis site = 72 versus 34 mm, right coronary artery 91 versus 42 mm, left circumflex artery 44 versus 37 mm). Greater than 97% of thrombosis sites were located proximal to 75% of graft insertion sites. CONCLUSIONS: Coronary arterial bypass grafts provide the coverage of anatomic zones at risk for STEMI. The superior performance of CABG in high risk patients may be attributed to targeting of proximal coronary locations where thrombosis risk is clustered.
Assuntos
Ponte de Artéria Coronária/métodos , Trombose Coronária/cirurgia , Infarto do Miocárdio/cirurgia , Idoso , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Desenho de Prótese , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularization and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide the training of female interventional cardiologists.
Assuntos
Cardiologia , Doenças Cardiovasculares/terapia , Disparidades em Assistência à Saúde , Revascularização Miocárdica , Saúde da Mulher , Cardiologia/educação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/mortalidade , Escolha da Profissão , Educação Médica , Medicina Baseada em Evidências , Feminino , Hormônios Esteroides Gonadais/metabolismo , Humanos , Masculino , Mentores , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/educação , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
Cardiovascular disease is the leading cause of mortality in women yet studies have suggested it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularization and use of evidence-based medications. The Women in Innovations group of cardiologists, aims to highlight these issues and change perceptions to optimize the treatment of female patients with cardiovascular disease, support future research, and encourage and guide the training of female interventional cardiologists.
Assuntos
Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Mulheres , Doenças Cardiovasculares/terapia , Consenso , Ponte de Artéria Coronária/estatística & dados numéricos , Difusão de Inovações , Feminino , Hormônios Esteroides Gonadais/fisiologia , Humanos , Masculino , Revascularização Miocárdica/estatística & dados numéricos , Fatores SexuaisRESUMO
Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularisation and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide training of female interventional cardiologists.