AIM: To evaluate the survival benefit from myocardial revascularization in diabetic patients with critical limb ischemia and coronary artery disease (CAD) in a consecutive series of 564 diabetic patients hospitalized from 1999 to 2003 and followed up until December 2005. METHODS: Three hundred and thirteen patients had a history of CAD, 60 of them (19.2%) with previous myocardial revascularization. Sixty-one patients with an ejection fraction of 40% or less underwent subsequent myocardial revascularization. Five hundred and fifty-seven patients (98.8%) were followed up until December 2005, including 310 of the 313 patients with a history of CAD. RESULTS: One hundred and ten patients died because of CAD, 25 of the 251 patients without a history of CAD and 85 of the 313 patients with a history of CAD. Specifically, 74 (86.9%) of these 85 deaths occurred in the 192 patients without previous myocardial revascularization, nine (10.7%) in the 60 patients with previous myocardial revascularization, and ...
Although the appropriateness of MPS as a surveillance tool to assess for residual or recurrent ischemia post-revascularization is uncertain, it is often used routinely for this purpose (5). The underlying assumption is that the identification of post-revascularization ischemia would be an adverse prognostic finding, and the corollary belief is that repeat revascularization would be of benefit in reducing subsequent clinical events such as myocardial infarction or death. In this study, asymptomatic patients with MPS-proven ischemia after previous revascularization (PCI or CABG) who underwent repeat revascularization realized no survival benefit over those who received MT either in propensity-matched groups or unadjusted and adjusted analyses. In contrast, age and hypercholesterolemia were strongly associated with all-cause mortality.. Many studies have examined the clinical outcomes derived from myocardial revascularization in patients undergoing MPS. Generally, these studies have examined ...
The benefits of complete revascularization emerged shortly after the index procedure and were apparent in the prespecified subgroups, including the number of significantly affected vessels, sex, and age.. The authors were encouraged by the fact that hard events were reduced in similar proportion to the softer endpoint of repeat revascularization. The result "suggests this strategy may need to be considered by future STEMI guideline committees," they said.. The previous PRAMI trial had been criticized because of some trial design issues, said CvLPRIT investigator Anthony Gershlick. "As a result, PRAMI has not led to widespread changes in clinical practice, with IRA-only revascularization at P-PCI remaining by far the more common practice.". In an interview, Eliot Antman said that he was particularly struck by the apparent lack of harm in the complete revascularization group, since it has been the fear of causing harm that has been the main reason not to perform more complete revascularization. ...
Women had more angina than men during follow-up, and at certain times, this difference reached statistical significance. Perhaps this is accounted for by the use of fewer internal mammary artery conduits and less complete revascularization in women than men in the CABG group, as noted previously,24 and is related to a higher likelihood of a woman undergoing subsequent revascularization procedures after an initial strategy of CABG. The relative risk of undergoing subsequent revascularization after initial PTCA was lower in women. Perhaps this is due to more complete revascularization with PTCA compared with men. However, this remains speculative because more complete revascularization could be expected to result in a higher incidence of restenosis.. It is remarkable that at an average of 5.4 years after revascularization, mortality and mortality plus myocardial infarction were the same for women and men in both treatment strategies. In addition, women fared equally well with an initial strategy ...
Background: Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients location and the closest specialized cardiology center (SCC), remains on a long term basis. Methods: We conducted a population-based cohort study using data from the Quebecs hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC ...
The coronary artery disease (CAD) is one of the most important health problem in contemporary society. The high prevalence of CAD makes recognition, management and prevention of this disease very important end-points. Fortunately, in the past three decades encouraging reductions in the consequences of CAD have been reported. Multiple causes may have contributed to this favorable trend, including: reduction of risk factors, great diffusion of intensive care units and new methods of diagnosis and treatment. The current approaches to CAD therapy are represented by: modification of life style, reduction of risk factors, medical management and myocardial revascularization. The latter, including PTCA and coronary artery bypass grafting, is indicated in patients with refractory symptoms or ischemia despite optimal medical therapy; it should also be carried out in high-risk patients identified by current methods and in those with occupations or life styles that indicate a more aggressive approach. Since ...
Endovascular revascularization of the superficial femoral artery (SFA) has become one of the most commonly performed endovascular procedures.The ability to offer the patient an alternative to surgical revascularization, limited by significant morbidity and mortality, with a same-day outpatient percutaneous procedure underlies the popularity of the endovascular approach. Although surgical bypass of the SFA remains the gold standard for revascularization, it is associated with significant morbidity and mortality.Comparative data between cryoplasty, angioplasty or stenting of the SFA will ultimately be required to provide more robust evidence of the efficacy of each mode of therapy.This registry is designed to determine the efficacy of three different percutaneous revascularization strategies (Cryoplasty vs. Stent Placement vs. Atherectomy) in the treatment of lifestyle limiting lower extremity claudication ...
The method for intra-operative myocardial revascularization of a human heart includes a inserting a portion of an elongated flexible lasing apparatus into the chest cavity of a patient, and lasing channels from the epicardium through the myocardium of the heart, without mechanical tearing of the heart tissue. The apparatus is guided to an area exterior to a ventricle of the patients heart, and the distal end of the optical fiber apparatus is directed to an area of interest where the exterior wall of the heart is irradiated with laser energy to form a channel through the myocardium.
Myocardial revascularization is performed by an apparatus and method which forms channels in the myocardium from inside the ventricular cavity without penetrating the full thickness of the ventricular wall. A catheter has a fiber optic connected at its handling end to a laser, and terminates at the insertable end of the catheter. A servomotor controls the advancing of the fiber to stop positions relative to the catheter. At each stop position another channel is created. An aiming beam aids in directing the channel forming fiber end to different desired channel positions.
A laser treatment device provides an output operating laser beam having a single wavelength which is highly absorbed by tissue of a patient and which beam is non-diverging. The laser treatment device may be a catheter which is inserted into a patient for performing endovascular myocardial revascularization (i.e., creating new channels for blood flow from within the interior of the patients heart). The use of the highly absorbed wavelength and the non-diverging character of the beam are possible by having a distal laser at a distal end of the catheter. The distal laser is pumped by a source of laser energy supplied by an array of diode lasers and passed along an optical fiber from a proximal end of the catheter.
A system and method of marking percutaneous myocardial revascularization channels in a human heart and introducing into the channels a therapeutic or diagnostic agent by inserting a catheter system into the left ventricle of a heart, applying tissue ablative energy through the catheter to create a channel into the heart wall, introducing an imaging medium to the heart wall proximate the channel for marking the position of that channel for imaging, and introducing in or proximate the channel a therapeutic or diagnostic agent.
Elderly patient with stable angina, two angiographically tight stenoses in left anterior descending and left circumflex and a myocardial perfusion ...
Aortocoronary bypass grafting today plays a fixed role in the therapeutic approach to coronary artery disease. That it improves quality of life by increased angina-free working tolerance [1, 5, 7, 9]...
Eligible patients will be recruited after a having a stress imaging test that was necessary for their routine care, that was ordered by their physician if they are found to have at least moderate ischemia (decreased blood flow to the heart muscle) on the test. Patients will then be assigned to one of two groups, based on a "flip of the coin" process called, randomization. Both groups will have cardiac catheterization (a test to evaluate the condition of the coronary arteries) and both groups will also have optimal medical therapy (prescribed medication) treatment. The invasive management group (INV) participants will receive a coronary revascularization procedure. Coronary revascularization is the process of restoring the flow of blood to the heart. This is done by removing or bypassing (going around) blockages in coronary arteries caused by atherosclerosis (the build-up of plaque in the inner lining of an artery). The conservative group (CON) participants will possibly receive a coronary ...
DISCUSSION. The main barrier in the reference process of the individual with CABG cardiopathy/indication is the access to the health services evidenced in this study due to the difficulty in scheduling consultation with the family doctor in the PHC and lack of specialists in the medium complexity, in this case, the cardiologist.. The study states that the limits on accessibility to PHC are related to delays in marking consultations for family doctors and specialists, as well as inadequate service provision due to the suppressed demand at this point(11). In this sense, when analyzing the decentralization of health management in the municipalities and its implications for the access of users in Brazil, the need for a greater number of professionals and family health teams to improve access to PHC was identified(12). Moreover, in the United States, a study revealed the lack of physicians as a barrier to the populations access to health care at PHC, suggesting that the work of a multi-professional ...
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Lee, C.H.,Wong, H.B.,Tan, H.C.,Zhang, J.J.,Teo, S.G.,Ong, H.Y.,Low, A.,Sutandar, A.,Lim, Y.T. (2005). Impact of reversibility of no reflow phenomenon on 30-day mortality following percutaneous revascularization for acute myocardial infarction - Insights from a 1,328 patient registry. Journal of Interventional Cardiology 18 (4) : 261-266. [email protected] Repository. https://doi.org/10.1111/j.1540-8183.2005.00041.x ...
Need for further revascularization clinically indicated at the time the patient is assessed for participation in the clinical trial. This will be determined by a cardiologist who is not an investigator in the clinical trial. No further revascularization may be indicated by no arteries with significant stenosis, the location, and extent of any stenosis may not be suitable for angioplasty, the distal vessels may not be suitable for placement of bypass grafts, and/or the patient declines angioplasty or bypass surgery ...
... (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical...
Totally Endoscopic and Robot-Assisted Transmyocardial Revascularization New codes have been proposed in subcategory 36.3, Other heart revascularization, to differentiate between endoscopic and percutaneous transmyocardial revascularization. According to the proposal, the description of code 36.32 would be revised to state "endoscopic transmyocardial revascularization" and new codes would be created for percutaneous transmyocardial revascularization and other transmyocardial revascularization. The traditional approach to transmyocardial revascularization (TMR) is through an anterolateral thoracotomy. TMR is a surgical technique that uses a laser to bore holes through the myocardium of the heart in an attempt to restore perfusion to areas of the heart not being reached by diseased or clogged arteries. This technique is used as a late or last resort for relief of symptoms of severe angina in patients with ischemic heart disease not amenable to direct coronary revascularization interventions, such ...
TY - JOUR. T1 - Transmyocardial revascularization ameliorates ischemia by attenuating paradoxical catecholamine-induced vasoconstriction. AU - Le, Dai-Trang (Elizabeth). AU - Powers, Eric R.. AU - Bin, Jian Ping. AU - Leong-Poi, Howard. AU - Goodman, N. Craig. AU - Kaul, Sanjiv. PY - 2007/4. Y1 - 2007/4. N2 - Background: The mechanism by which transmyocardial revascularization (TMR) offers clinical benefit is controversial. We hypothesized that TMR ameliorates ischemia by reversing paradoxical catecholamine-induced vasoconstriction. Methods and Results: Chronic ischemic cardiomyopathy was created in 11 dogs by placing ameroid constrictors on the proximal coronary arteries and their major branches. Six weeks later, 35 channels were created percutaneously in the left circumflex artery region, with the left anterior descending artery region serving as control. At rest, wall thickening and myocardial blood flow did not change in the treated region, whereas they deteriorated in the control bed. ...
Looking for online definition of Arterial Revascularization Therapy Study in the Medical Dictionary? Arterial Revascularization Therapy Study explanation free. What is Arterial Revascularization Therapy Study? Meaning of Arterial Revascularization Therapy Study medical term. What does Arterial Revascularization Therapy Study mean?
Looking for online definition of Arterial Revascularization Therapy Study-CK-MB in the Medical Dictionary? Arterial Revascularization Therapy Study-CK-MB explanation free. What is Arterial Revascularization Therapy Study-CK-MB? Meaning of Arterial Revascularization Therapy Study-CK-MB medical term. What does Arterial Revascularization Therapy Study-CK-MB mean?
Backgrounds: Acute myocardial infarction (AMI) is the most common cause of sudden cardiac arrest. ILCOR has suggested that AMI patients with post cardiac arrest should undergo emergency coronary angiography, with subsequent revascularization therapy (Circulation 2008; 118:2452-2483). AHA guidelines for AMI have recommended early coronary revascularization for patients with cardiogenic shock complicating AMI (Circulation 2004;110: 586-636). We investigated whether emergency coronary revascularization therapy had survival benefits for AMI patients with post-cardiac arrest.. Methods: We did a multicenter observation study of emergency cardiovascular care in the Tokyo CCU Network. Of the AMI patients who admitted the CCU, patients with post cardiac arrest syndrome or cardiogenic shock were enrolled in this study. The primary endpoint was survival to hospital discharge.. Results: Of the 5,337 AMI patients who admitted the CCU, 413 were enrolled in this study; 142 was post cardiac arrest (Arrest ...
TY - JOUR. T1 - Influence of complete revascularization on chronic mesenteric ischemia. AU - McAfee, Molly K.. AU - Cherry, Kenneth J.. AU - Naessens, James M. AU - Pairolero, Peter C.. AU - Hallett, John W.. AU - Gloviczki, Peter. AU - Bower, Thomas C.. PY - 1992. Y1 - 1992. N2 - Complete revascularization for chronic intestinalischemia is controversial. Fifty-eight patients (119 arteries) underwent mesenteric revascularization between 1981 and 1988. There were 46 women and 12 men (mean age: 63 years). Sixty percent of patients had three-vessel disease. Twenty-one patients underwent concomitant aortic reconstruction. Operative mortality was 10%. Four of the six deaths occurred in patients undergoing aortic surgery. Late graft failure occurred in five patients (10%). Five-year survival for patients with three-vessel involvement who underwent three-vessel repair was 73%, compared with 57% for two-vessel repair and 0% for one-vessel repair (p=NS). Similarly, graft patency in patients with ...
Background The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). Methods and Results In the randomized PCI cohort of the SYNTAX Trial (n=903), the baseline and residual SYNTAX Scores were calculated. Subjects with a residual SYNTAX Score of 0 were defined as having undergone complete revascularization (CR), and a residual SYNTAX Score ,0 as incomplete revascularization (ICR). Five-year clinical outcomes were stratified by CR and ICR (tertiles of the residual SYNTAX Score: ,0-4, ,4-8, and ,8). In the PCI cohort, the mean baseline and residual SYNTAX Scores were 28.4 +/- 11.5 and 4.5 +/- 6.9, respectively. The mean SYNTAX Score (representative of the burden of disease removed by PCI) was 23.8 +/- 10.9. The residual SYNTAX Score was distributed as follows: CR, 0 (n=386, 42.7%); ICR, ,0 to 4 (n=184, 20.4%), ,4 to 8 (n=167, ...
The modern era of myocardial revascularization with cardiopulmonary bypass began in 1954 when Dr. John Gibbon reported the development of the cardiopulmonary bypass machine.6 An additional seminal advance occurred with the development of coronary angiography by Mason Sones at the Cleveland Clinic in 1957, which opened the door to the elective treatment of coronary atherosclerosis by means of direct revascularization.7 Initial reports by Rene Favaloro and Donald B. Effler on their techniques to treat clinical events associated with stenotic lesions of the coronary arteries culminated in the first large series of aorto-to-coronary artery venous grafts reported in 1969.8 Simultaneously Dudley Johnson of Milwaukee published a series of 301 patients in 1969.9 The success of these techniques was soon demonstrated in larger series initiating the modern era of coronary artery surgery. ...
Investigators laid out a revascularization strategy for 1,075 consecutive patients based on the results of diagnostic angiography at 20 centers in France. The "a priori" strategy included medical therapy for 55 percent, percutaneous coronary intervention (PCI) for 38 percent and coronary artery bypass graft surgery (CABG) for 7 percent. Based on FFR findings, 43 percent of patients were reclassified from one revascularization strategy to another. Final treatment included medical therapy for 58 percent of patients, PCI for 32 percent and CABG for 10 percent.. There was no difference in survival free of MACE at one year between patients classified or not reclassified. Angina status was somewhat improved at one month and six months for reclassified patients and numerically better at one year, but there was no statistically significant difference in angina status between the two groups at one year.. Recent data suggest that FFR can be useful in guiding coronary revascularization in PCI patients, but ...
Treatment selection for stable ischemic heart disease patients remains a work in progress. The stable ischemic heart disease guidelines published in 2012 (1) address 2 pathways to progress from medical therapy only toward revascularization: unsatisfactorily controlled symptoms or high-risk features on the basis of noninvasive testing. For patients without compelling symptoms, the risk stratification by noninvasive ischemia testing provides the gateway to move beyond medical therapy only. The ongoing ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial (2) is using this measure in an attempt to identify a relatively high-risk group in whom revascularization may be beneficial. Much of the rationale for the trial springs from the failure of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial (3) or the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (4) to show a ...
The study population consisted of 2,768,007 records. This study found that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60,405-106,495) had been more than offset by the decrease in PCI admissions (363,384-295,434) during the study period. There also were over 18,000 fewer CABG admissions in 2012 than in 2008. This study found lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any CABG surgery, and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also found a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCI; and 19 (1.6%) more sites were performing CABG surgery.. ...
The results of this exploratory trial suggest that perioperative infusion of nesiritide might have favorable effects in patients with LV dysfunction undergoing CABG using CPB. Patients receiving nesiritide had better overall preservation of GFR, lower peak increase in SCr levels, and greater urine output in the immediate postoperative period compared with patients receiving placebo. These beneficial effects were preserved, if not enhanced, in high-risk patients with preexisting renal dysfunction.. Short- and medium-term outcomes after surgical myocardial revascularization are affected adversely by both chronic and acute renal insufficiency. More than 75% of patients undergoing CABG in the U.S. have abnormal renal function at baseline; this is associated with an increased risk-adjusted mortality odds ratio that ranges from 1.55 (95% CI 1.45 to 1.65) for patients with moderate dysfunction to 3.82 (95% CI 3.45 to 4.25) for patients who are dialysis dependent (14). In addition, depending on ...
Background Ethnicity has a significant impact on coronary artery disease (CAD). This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups. Methods and Results We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto) and the Texas (US) Heart Institute Research Database (THIRDBase) registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6-4.3) and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8-6.5) who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY:. • Six- Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin: The Randomized, Multicenter ITALIC Trial (doi:10.1016/j.jacc.2014.11.008) - Conclusion: Rates of bleeding and thrombotic events were not significantly different according to six- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders.. • Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease: The CvLPRIT Trial (doi:10.1016/j.jacc.2014.12.038) - Conclusion: In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to ...
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY:. • Six- Versus 24-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents in Patients Nonresistant to Aspirin: The Randomized, Multicenter ITALIC Trial (doi:10.1016/j.jacc.2014.11.008) - Conclusion: Rates of bleeding and thrombotic events were not significantly different according to six- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders.. • Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease: The CvLPRIT Trial (doi:10.1016/j.jacc.2014.12.038) - Conclusion: In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to ...
As cardiologists, naturally the physicians at HeartWell are accustomed to seeing patients with various heart issues. But no two patients are exactly alike - and therefore, no two treatment programs are identical.. HeartWell has established a CHIP program - Complete revascularization for High-risk Indicated Patients - that identifies patients who are at high risk for revascularization of their coronary artery blockages and work to establish a personalized treatment program to help by other means.. "We see patients that may have already had surgery, and cant handle another one, or may be too frail to sustain a surgical procedure due to their low ejection fraction, so our goal is to work as a team in a multidisciplinary approach with other cardiac specialists to formulate the right protocol for these patients," said Dr. Ramon Lloret, who is spearheading the CHIP program. Lloret says that he, as an interventional cardiologist, consults with other doctors such as cardiovascular surgeons, heart ...
In this study we demonstrate that, in patients with coronary artery disease undergoing elective coronary revascularisation, even small amounts of revascularisation-related myocardial necrosis identified by CMR have strong and independent prognostic values. Patients who had evidence of new myocardial hyperenhancement after coronary revascularisation had a threefold higher risk of the primary endpoint of death, non-fatal myocardial infarction or a major cardiovascular event compared to those without any evidence of new myonecrosis. The predictive value of new hyperenhancement was much stronger than that of established risk factors such as cardiac troponin levels or left ventricular dysfunction.. Cardiac biomarkers are readily available and thus have been widely used in previous studies that have evaluated the significance of post-procedural myocardial infarction. As stated above, however, there are several limitations inherent in the use of biomarkers in this setting that might explain why ...
Trials in the 1970s clearly showed that CABG reduces mortality in patients with extensive CAD (1). More recent trials in patients with less extensive CAD have shown no difference for cardiac events after revascularization or MT (2). A limitation of revascularization is that it addresses only the most narrowed coronary segments, yet most MIs arise from rupture of nonobstructive coronary plaques. The results of the MASS-II trial are consistent with other studies: Medically treated patients had more angina and PCI-treated patients had more repeated procedures, but the groups did not differ for mortality. In MASS-II, more Q-wave MIs occurred than expected after PCI. However, it isnt clear how many of these MIs were procedure-related. Revascularization procedures clearly precipitate some cardiac events, which is acceptable only if they substantially reduce long-term risk. The 1-year follow-up in MASS-II is too brief to assess the effect of revascularization on subsequent cardiac risk. Because ...
Context - Many studies have found that patients with acute myocardial infarction (AMI) who are admitted to hospitals with on-site revascularization facilities have higher rates of invasive cardiac procedures and better outcomes than patients in hospitals without such facilities. Whether such differences are due to invasive procedure rates alone or to other patient, physician, and hospital characteristics is unknown.. Objective - To determine whether invasive procedural rate variations alone account for outcome differences in patients with AMI admitted to hospitals with or without on-site revascularization facilities.. Design - Retrospective, observational cohort study using linked population-based administrative data from a universal health insurance system.. Setting - One hundred ninety acute care hospitals in Ontario, 9 of which offered invasive procedures.. Patients - A total of 25 697 patients hospitalized with AMI between April 1, 1992, and December 31, 1993, of whom 2832 (11%) were in ...
When are cardiac bypass procedures and catheter procedures appropriate? A new document - "Appropriateness Criteria for Coronary Revascularization" - gives guidance for 180 clinical scenarios that patients present to their cardiologists and that physicians present to insurers.. In a process that took more than a year, a 17-member panel of general cardiologists, interventional cardiologists, cardiac surgeons, and others scored each scenario to judge whether coronary revascularization was appropriate, inappropriate, or uncertain.. For example, the panel ruled that revascularization would be inappropriate in a patient who had plaque build-up in one or two arteries, experienced symptoms only during heavy exercise, had a small amount of heart muscle at risk, and was not taking medication to help control symptoms. For a similar patient who had severe symptoms despite taking the appropriate medication, revascularization was deemed appropriate.. The appropriateness criteria - the first to focus on ...
Focusing on reducing inappropriate use of interventional procedures may be doing a disservice to patients who may be helped by revascularization, according to a presentation at the American College of Cardiology 2016 Scientific Session.. "Lost in this overemphasis of reducing inappropriate cases also is this issue of patients who ought to come to the cath lab never making it there at all," said Ajay J. Kirtane, MD, SM, of NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City.. Dr. Kirtane outlined the premise for CHIP (Complete Revascularization for Higher-Risk Indicated Patients), noting that some patients may be undertreated based on their risk due to comorbidities or the complexity of their anatomy.. "Im not talking about PCI versus medical therapy," said Dr. Kirtane. "Im talking about revascularization versus no revascularization. In these cohorts, PCI may have a role, particularly for those who are not surgical candidates.". Patients may, legitimately, wonder ...
Expert discussion: Comparative cost effectiveness of the instantaneous wave-free ratio vs fractional flow reserve in coronary revascularization decision-making (DEFINE-FLAIR)
The study of immediate and mid-term results revealed the lack of significant differences in the clinical course of patients who received urgent revascularization within the first hours after the onset of the disease and those who underwent this procedure within up to 15 days after the onset of angina attack. Meanwhile, functional capacities of the left ventricle seem preferable in patients who underwent the procedure within the early stage of the disease. Hence, the earlier is endovascular myocardial revascularization performed in non-STEMI patients, the higher is the probability of the preservation of the viability of a larger part of the myocardium and, thus, of the improvement of the left ventricular functionality ...
Rajiv Gulati, M.D., Ph.D., Alberto Pochettino, M.D., and Charanjit S. Rihal, M.D., cardiologists at Mayo Clinics campus in Rochester, Minnesota, discuss revascularization options in patients with multivessel disease, left main and diabetes. This video was first shown on Medscape Cardiology.. ...
This analogy also helps another money spinner of coronary revascularisation. Lay people think that blocked coronaries are like blocked toilet pipes to be bypassed. Never do they realize that the body has its own wisdom to compensate for those long standing blocks, many of which start in early childhood, by providing collateral vessels and also remodeling the blocked vessels.. The blood supply to the heart muscle does not as much depend on the blocked four large coronaries on the surface of the heart that your doctor shows you on the x-ray(angiogram) as it does on the capacity of the millions of small vessels going directly into the muscle of the heart having a wide capacity to dilate excessively in case of reducewd supply from the larger vessels. This Flow Fraction Ration (FFR) is called CORONARY RESERVE, the latter could vary from one to another, the large surface vessel patency notwithstanding!. It is not the science of medicine that is bad but it is the "scientist" that twists the facts to ...
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By Lakshmi Tummala, MD Faculty Peer Reviewed First up, the debate between coronary revascularization and optimal medical management continues. Over t...
The Bradley Lowery Foundation, named after the 5-year-old boy fighting a rare form of cancer, has already exceeded its £700,000 funding target