Procedure For Coronary Artery Disease Research Articles

The risk factors associated with complications of coronary angiogram: A cross-sectional observational study

Background: Over the years, coronary angiogram (CAG) has evolved to become indispensable diagnostic and therapeutic procedure for coronary artery disease (CAD). The procedure even though minimally invasive with shorter length of hospital stay and low cost has some risk for morbidity and even mortality. Large extents of the risks are dependent on the clinical status of the patient at the time of the study and comorbid illness. Aims: The present study was planned to assess the complications and to identify the risk factors associated with complications among patients undergoing CAG for CAD. Methods: A cross-sectional observational design was used in 250 patients who underwent diagnostic or interventional procedure of CAG through either transradial or femoral route. The convenience sampling technique was used to select the study sample. Results: Majority (32.8%) of the patients were in the age group of 50-59 years, followed by 28.0% of the patients in the age group of 60-69 years. Male preponderance was noted (87.6%). About 6.8% of the participants had developed complications, among them 4.4% had hematoma, 1.2% had vasovagal reactions, and 1.2% had periprocedural myocardial infarction. History of current smoking was identified as risk factor for complications (P< 0.05). The risk of complications was higher in percutaneous coronary intervention (PCI) patients, (odds ratio 6.21 [1.96-19.68] at 95% confidence interval) and who had femoral access site (P< 0.05). Conclusion: Even as the improved patient outcome is seen with cardiac catheterization, it is not totally free from risk. Newer strategies such as radial approach have managed to reduce the risks considerably. History of smoking, femoral access, and PCI were identified as risk factor for complications following CAG.

Concomitant procedure for coronary artery disease and aorto iliac vessel block with an non - healing ulcer over the foot

The prevalence of Coronary artery disease (CAD) in patients with peripheral vascular disease (PVD) varies widely from 28% to 94% in published reports.

TCTAP A-023 Clinical Impact of Platelet Reactivity and Gene Polymorphisms Tests in Patients with Interventional Procedures for Coronary Artery Disease

TCTAP A-023 Clinical Impact of Platelet Reactivity and Gene Polymorphisms Tests in Patients with Interventional Procedures for Coronary Artery Disease

Abstract P162: Coronary Intervention Procedures in CAD Patients with Diabetes: Racial Disparities Are Associated with Post-Procedure Mortality

Background: The two major intervention treatment procedures for coronary artery disease (CAD) are coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with. Besides being a major risk factor for CAD, diabetes mellitus (DM) also impacts unfavorably CAD patients’ prognosis. We hypothesized that racial and socio-economic disparities are associated with post-procedure mortality in CAD patients with DM. Methods: A retrospective cohort study of post-procedure mortality after CABG and PCI in 188,851 CAD patients with DM (mean age 65.5∓11.3 years, 35.3% women) was conducted. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios (OR) were obtained from multivariable logistic regression, adjusted for a number of demographic, socio-economic and clinical confounders, including the severity of comorbid conditions (other than DM) measured by Elixhauser Comorbidity Index, Walraven modification. All results were analyzed with SAS version 9.2. Results: Post-CABG in-hospital mortality was higher than post-PCI (adjusted OR 1.89, 95% CI: 1.72-2.08, p&lt;0.01). Post-procedure mortality was associated with higher severity of co-existing conditions (10.6% increase for each point increase in Elixhauser-Walraven score, p&lt;0.01) and emergency room (ER) admission (adjusted OR 1.10, 95% CI: 1.08-1.11, p&lt;0.01). African Americans were more likely to undergo ER admission (43.7%) than other racial groups. ER admission was also significantly higher in lower socio-economic status groups, while severity of co-existing conditions was higher (p&lt;0.01). Conclusion: Racial and socio-economic disparities are associated with in-hospital mortality after coronary intervention procedures. Further investigation of mortality disparities in CAD patients with DM is warranted.

Moral Hazard and Less Invasive Medical Treatment for Coronary Artery Disease: The Case of Cigarette Smoking

Comparisons of the effectiveness of two common procedures for Coronary Artery Disease: Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG). Evidence indicates that CABG – the more invasive procedure – leads to superior long term outcomes for otherwise similar patients, though there is little consensus as to why. In this article, we propose a novel explanation: patient offsetting behavior. We hypothesize that patients who undergo the more invasive procedure, CABG, are more likely to improve their behavior – eating, exercise, smoking, and drinking – in a way that increases longevity. To test our hypothesis, we use Medicare records linked to the National Health Interview Survey to study one such behavior: smoking. We find that CABG patients are 12 percentage points more likely to quit smoking in the one-year period immediately surrounding their procedure than PCI patients, a result that is robust to alternative specifications.

Nanoparticle Drug- and Gene-eluting Stents for the Prevention and Treatment of Coronary Restenosis

Percutaneous coronary intervention (PCI) has become the most common revascularization procedure for coronary artery disease. The use of stents has reduced the rate of restenosis by preventing elastic recoil and negative remodeling. However, in-stent restenosis remains one of the major drawbacks of this procedure. Drug-eluting stents (DESs) have proven to be effective in reducing the risk of late restenosis, but the use of currently marketed DESs presents safety concerns, including the non-specificity of therapeutics, incomplete endothelialization leading to late thrombosis, the need for long-term anti-platelet agents, and local hypersensitivity to polymer delivery matrices. In addition, the current DESs lack the capacity for adjustment of the drug dose and release kinetics appropriate to the disease status of the treated vessel. The development of efficacious therapeutic strategies to prevent and inhibit restenosis after PCI is critical for the treatment of coronary artery disease. The administration of drugs using biodegradable polymer nanoparticles as carriers has generated immense interest due to their excellent biocompatibility and ability to facilitate prolonged drug release. Despite the potential benefits of nanoparticles as smart drug delivery and diagnostic systems, much research is still required to evaluate potential toxicity issues related to the chemical properties of nanoparticle materials, as well as to their size and shape. This review describes the molecular mechanism of coronary restenosis, the use of DESs, and progress in nanoparticle drug- or gene-eluting stents for the prevention and treatment of coronary restenosis.

Access-site complications of percutaneous diagnostic and therapeutic procedures in coronary artery disease: pseudoaneurysms and arteriovenous fistulas

Access-site complications of percutaneous diagnostic and therapeutic procedures in coronary artery disease: pseudoaneurysms and arteriovenous fistulas

Cancer Risk from Medical Radiation Procedures for Coronary Artery Disease: A Nationwide Population-based Cohort Study

To assess the risk of cancer incidence after medical radiation exposure for coronary artery disease (CAD), a retrospective cohort study was conducted based on Taiwan's National Health Insurance Research Database (NHIRD). Patients with CAD were identified according to the International Classification of Diseases code, 9th Revision, Clinical Modification (ICD-9-CM), and their records of medical radiation procedures were collected from 1997 to 2010. A total of 18,697 subjects with radiation exposure from cardiac imaging or therapeutic procedures for CAD were enrolled, and 19,109 subjects receiving cardiac diagnostic procedures without radiation were adopted as the control group. The distributions of age and gender were similar between the two populations. Cancer risks were evaluated by age-adjusted incidence rate ratio (aIRR) and association with cumulative exposure were further evaluated with relative risks by Poisson regression analysis. A total of 954 and 885 subjects with various types of cancers in both cohorts after following up for over 10 years were found, with incidences of 409.8 and 388.0 per 100,000 person-years, respectively. The risk of breast cancer (aIRR=1.85, 95% confidence interval: 1.14-3.00) was significantly elevated in the exposed female subjects, but no significant cancer risk was found in the exposed males. In addition, cancer risks of the breast and lung were increased with the exposure level. The study suggests that radiation exposure from cardiac imaging or therapeutic procedures for CAD may be associated with the increased risk of breast and lung cancers in CAD patients.

Abstract 185: Comparative Efficacy of Revascularization Procedures for severe CAD in patients with Chronic Kidney Disease.

Introduction: Patients with Chronic Kidney Disease (CKD) are at increased risk for cardiovascular mortality. However, there are few comparative efficacy studies of coronary revascularization procedures in this high-risk population. Hypothesis: There is an association between treatment strategy, estimated glomerular filtration rate (eGFR), and survival among patients with CKD and coronary artery disease (CAD). Methods: We examined patients in the Duke Databank for Cardiovascular Diseases (N=8604) who had significant CAD by cardiac catheterization from 2003-2009. Patients were excluded if they had prior revascularization or if pre-procedure serum creatinine was missing. Patients were stratified by estimated pre-cath estimated glomerular filtration rate (eGFR) into 5 groups: normal (eGFR ≥ 60 ml/min/1.73m 2 ), mild CKD (eGFR 45-59 ml/min/1.73m 2 ), moderate CKD (eGFR 30-44 ml/min/1.73m 2 ), severe CKD (eGFR &lt;30 ml/min/1.73m 2 ) and ESRD (dialysis). Multi-variable Cox Proportional Hazards models were used to determine the association between CKD severity and mortality according to four possible treatment strategies: coronary artery bypass-graft surgery (CABG), PCI with drug eluting stent (DES), PCI with bare metal stent (BMS), or medical management (MED). In addition, we tested for interactions between treatment strategy and eGFR groups. Results: The sample was mostly male (64.9%, 5591/8604), median age was 62 y (IQR 54-71), and 28.8% (2476/8604) had diabetes. Median follow up was 4.0 y (IQR 2.0-6.1). After adjusting for 17 covariates, baseline eGFR was significantly associated with mortality. For all treatment strategies, there was an inverse association between mortality and each 10ml/min drop in baseline kidney function: MED HR = 1.185 (1.146-1.225), BMS HR = 1.246 (1.190-1.303), DES HR = 1.294 (1.244-1.347), and CABG HR = 1.262 (1.204-1.323). Multivariable models comparing treatment strategies demonstrated differential effects by kidney function (Table; interaction for treatment effect across eGFR groups, p=0.0053). In contrast to BMS, DES and CABG were associated with similar mortality reductions among groups with lower eGFR. Conclusions: There are strong associations between eGFR and increased mortality among patients with documented CAD, however, these vary significantly by revascularization strategy. These data suggest that a randomized trial of revascularization strategies in patients with CKD may be warranted to guide clinical practice.

Miejscowe powikłania inwazyjnej diagnostyki i leczenia choroby wieńcowej: tętniaki rzekome i przetoki tętniczo-żylne

Background: Pseudoaneurysms (PAs) and arteriovenous fistulas (AVFs) are among the most serious access-site vascular complications of percutaneous diagnostic and therapeutic procedures in coronary artery disease. Aim: To assess the clinical course and methods of treatment of these access-site complications. Material and methods: Medical records of 26 949 patients who underwent coronary angiography and/or angioplasty in the period 2000-2009 in two tertiary referral level catheterization laboratories were reviewed. We identified 91 patients with confirmed accesssite complications: 90 iatrogenic PAs and 3 AVFs (2 of which were accompanied by PA). Results: Prolonged compression with an elastic bandage was the most frequently (55 patients) used first-line treatment of PAs. Others included compression with ultrasound probe (15 patients), ultrasound-guided thrombin injection (11 patients), and surgery (3 patients). Forty-seven patients with PAs required second-line treatment, which in most cases was thrombin injection (23 patients). Thrombin injection and compression with ultrasound probe were the most frequently used third-line treatment techniques. The overall effectiveness (complete closure of PA) of the treatment techniques was: surgery – 100%, thrombin injection – 86.8%, compression with ultrasound probe – 70.8%, prolonged compression with elastic bandage – 42.4%, observation – 0%. Conclusions: Significant access-site complications of percutaneous coronary interventions, especially AVFs, are infrequent. Spontaneous closure of the PA during hospitalization was not observed. Both thrombin injection and compression with an ultrasound probe allow for fast and effective treatment of iatrogenic PA. However, surgery remains the most effective treatment technique. Prolonged compression with an elastic bandage offers low efficacy.

Long-term coronary artery graft patency as evaluated by 64-slice coronary computed tomographic angiography

Coronary artery bypass graft (CABG) surgery has been a mainstream surgical procedure for coronary artery disease for the past three decades. 64-Slice coronary computed tomographic angiography (CCTA) has been established as an accurate alternative to invasive coronary artery angiography for postoperative evaluation of bypass grafts. The goal for this study was to utilize CCTA to evaluate long-term graft patency for various graft types as well as their targets. We analyzed all consecutive patients with a history of coronary artery bypass graft undergoing CCTA over a 3-year period. A total of 827 grafts in 269 patients were included in the study. Mean survival of the grafts was 21 years (95% confidence interval 20.6, 22.3). The mean survival of grafts to the left anterior descending coronary artery, the left circumflex coronary artery, and the right coronary artery were 22.9, 20.6, and 20.1 years, respectively (P=0.05). Evaluation of graft types demonstrated internal thoracic artery grafts, saphenous venous grafts, and radial artery grafts (RA) had a mean survival of 20.5 years, 21.6 years, and 12.6 years, respectively (P=0.05). Factors significantly affecting the time to closure (P≤0.01) were age [odds ratio (OR) 1.03], male sex (OR 2.39), smoking (OR 2.07), left anterior descending coronary artery graft territory (OR 0.55 compared with right coronary artery), and RA (OR 3.65 compared with thoracic artery grafts, 3.79 compared with saphenous venous grafts). In conclusion, this study confirms the practicality of using CCTA in a community setting to study bypass graft patency. The choice of graft is significant for long-term patency. This study raises doubt on the long-term fate of RA and further studies should be conducted to better evaluate their outcomes.

Current diagnostic concepts to detect coronary artery disease in women

The goal of non-invasive diagnostic testing is to detect coronary artery disease (CAD) timely and with optimal fidelity. In women, the accuracy of most functional diagnostic investigations is diminished compared with men. To minimize the sex-related bias in detection of CAD, there is a need for a non-invasive test strategy capable of risk-stratifying women, and of identifying subsets of patients in need of further invasive testing. The present review discusses the validity of classical diagnostic procedures for CAD in women, and addresses the relevance of newer techniques in the context of a female-specific diagnostic approach.

Outcomes of Second Revascularization Procedures after Stent Implantation

Drug-eluting stents (DES) reduce subsequent revascularization procedures. Although randomized trials have compared DES to brachytherapy and balloon angioplasty (PTCA) for in-stent restenosis, few long-term comparisons have been made to bare metal stents (BMS) or bypass surgery (CABG), particularly following second procedures. We sought to assess the association between revascularization modality and long-term clinical outcomes of patients receiving a second procedure for coronary artery disease. Between January 2000 and July 2005, 4,666 consecutive patients underwent initial coronary stent implantation (DES or BMS). From this population we identified 569 patients undergoing a second target vessel revascularization (DES, BMS, PTCA or CABG). Outcomes were assessed at 6, 12, and 24 months after the second procedure, with follow-up through September 2006. Adjusted cumulative incidence rates were calculated using inverse probability weighted estimators. We found that at 24 months, there were no significant differences in death or myocardial infarction for PTCA, BMS, DES, and CABG (17.7%, 14.9%, 7.5%, and 10.2%, p = 0.26[3dfl]). DES patients had lower rates of death or myocardial infarction or third target vessel procedures than patients receiving PTCA (14.6% vs. 30.0%, p = 0.01) and BMS (14.6% vs. 42.2%, p < 0.01), but rates similar to CABG patients (14.6% vs. 14.6%, p = 0.99). For patients undergoing a second revascularization procedure, PTCA, BMS, DES, and CABG are associated with a similar risk of death or nonfatal myocardial infarction. DES and CABG are associated with lower rates of third revascularization procedures compared to PTCA and BMS. Further studies are needed to determine the optimum application for CABG vs. DES as a second or third revascularization procedure.

Controversies in Off-pump Coronary Artery Surgery

Motivated by a desire to reduce the morbidity of a well-established and effective procedure for coronary artery disease, up to 25% of coronary artery bypass operations are being performed without the use of a heart-lung pump. Concerns remain about the quality of the coronary anastomoses and the completeness of revascularization. Randomized trials have not revealed the significant reduction in morbidity or mortality that the early enthusiasts had hoped for. Yet a number of non-randomized studies have shown clinical benefit from the avoidance of an extracorporeal circulation, but these have been criticized for potential bias in patient selection and management.A majority of surgeons have not yet adopted this technique and are waiting for the accumulation of more evidence.

Non-invasive assessment of coronary flow reserve - valuable functional information in cardiac workflow

Coronary flow reserve can be determined echocardiographically in the LAD in about 90 % and in the RCA in more than 80 % of patients respectively by the use of modern high-resolution ultrasound equipment. For this purpose either high frequency fundamental imaging or echo-contrast enhanced harmonic Doppler technology is used. The main advantage of the method lies in its noninvasiveness and the lack of radiation exposure. In combination with coronary morphologic findings obtained from heart catheterization, CFR is helpful in the planning of further invasive procedures for coronary artery disease and in the estimation of the prognosis of such procedures. The functional status after PTCA of LAD/RCA or mammary bypass surgery can be evaluated during follow-up monitoring. Alteration in the coronary microcirculation can also be discovered in a non-invasive way, improvement of microcirculatory disorders by adequate therapy can be assessed by serial measurements of CFR.

Synchronized coronary revascularization and multiple cardiac cysthydatid operation

Cardiac cysthydatid is rare pathology and is seen in 0.5 to 2% of echinococcal infections. It is found in the left ventricle most frequently and then in the right ventricle. We present a case with a ruptured cysthydatid at the right atrium's interatrial septum and multiple cysthydatids localized at the outer surface of the left ventricle's apex, which necessitated a synchronized coronary revascularization with our diagnosis and surgical procedure modalities. Our patient was a 61-year-old man with complaints of fever, dyspnea, tachycardia and chest pain, which began 2 months before admittance. An echocardiography in our clinic revealed a 4.7 × 1.7 centimeter, pediculled, going in and out to tricuspidal inflow, cystic mass adherent to the interatiral septum in the right atrium, which prompted immediate hospitalization. He was in New York Heart Association Class II. His electrocardiography (EKG) showed ischemia at inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His EKG showed ischemia at the inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His preoperative biochemical parameters were normal, and cysthydatid serology tests were negative. With these results,l we planned a synchronized surgical procedure for coronary artery disease with multiple cardiac cysthydatids. During operation, after the right atriotomy, a fragile cystic mass with a ruptured image and dimensions of 5 × 2 × 2 centimeters, originating from the interatrial septum and in a conglomerate form, was resected and extirpated. The left atrium was not involved. Then, 3 masses with dimensions of 2 × 2 centimeters, which were not diagnosed with the echocardiogram, at the epicardial surface of the left ventricle apex were excised. The defected part of the left ventricle was repaired with teflon felt supports for rupture prophylaxis. Then, a left internal mammary artery graft, which was prepared at the beginning of the operation, was anastomosed to LAD. The patient didn't have any additional problem during the postoperative period, and he was discharged at 1 week after surgery. To avoid recurrence, the patient was prescribed albendazole as a prophylaxis for the duration of 2 months. Histopathology confirmed the diagnosis of cysthydatid. Patients with cardiac cysthydatid can be asymptomatic or can cause minimal nonspecific symptoms for years. The condition can be lethal if not diagnosed and treated. The primary treatment for cysthydatid is surgery. Echocardiography is an important diagnostic method for cysthydatid. Serological tests can produce negative results if the immune responses of the patient is not sufficient, so it must be remembered in the endemic places for echinococcus.

Current options in the management of coronary artery disease

World Health Organization projections suggest that, for the foreseeable future, coronary artery disease (CAD) will remain the largest element of global disease burden, reflecting the aging of the population. Recent American College of Cardiology/American Heart Association guidelines estimate that 16.6 million Americans currently have stable angina. Chronic stable angina is associated with significant morbidity and mortality, thus highlighting the need for accurate and early detection and treatment. Clinical examination is the single most important step in evaluating risk. Age, sex, pain type, coexisting diabetes mellitus, hypertension, or known vascular disease are powerful predictors of prognosis and, except for special patient groups, are more reliable than ambulatory electrocardiographic recording, exercise testing, or electron-beam computed tomography. Cost-effective methods for screening the general population for “silent” risk factors predisposing them to atherosclerotic disease in later life are nevertheless required. Aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents are currently the backbone of pharmacologic therapy, supplemented by lifestyle changes aimed at promoting exercise, weight reduction, and increased fruit and vegetable intake. However, side effects of chronic drug treatment, especially for those taking multidrug regimens, may affect quality of life and are the principal reason for poor compliance. Coronary bypass surgery and angioplasty are frequently used interventional procedures for CAD, although they can be invasive and costly, and they often need to be repeated. Current options for the management of CAD have their limitations, thus confirming the appropriateness of continuing the search for improved therapies to reverse the disease process and reduce the global burden.

Nicht invasive Bestimmung der koronaren Flussreserve mittels Echokardiographie

Coronary flow reserve (CFR) can be determined echocardiographically in the LAD in about 90% and in the RCA in more than 70% of patients, respectively, by the use of modern high-resolution ultrasound equipment. For this purpose either high frequency fundamental imaging or echo-contrast enhanced harmonic Doppler technology is used. The main advantage of the method lies in its noninvasiveness and the lack of radiation exposure. In combination with coronary morphologic findings obtained from heart catheterization, CFR is helpful in the planning of further invasive procedures for coronary artery disease and in the estimation of the prognosis of such procedures. The functional status after PTCA of LAD/RCA or mammary bypass surgery can be evaluated during follow-up monitoring. Alteration in the coronary microcirculation can also be discovered in a non-invasive manner; improvement of microcirculatory disorders by adequate therapy can be assessed by serial measurements of CFR

Estudio comparativo de la angioplastia coronaria en pacientes con diabetes.: Resultados clínicos y angiográficos inmediatos y evolución clínica en el primer año

The success of revascularization procedures for coronary artery disease could be lower in diabetic patients.To report the results of coronary angioplasty in diabetic and non diabetic patients.All angioplasty procedures performed between 1996 and 1999 were recorded. Demographic data, procedure details, hospital outcome and evolution at one year of follow up were analyzed.During the study period, 358 patients were treated; of these, 79 were diabetics. Despite the greater severity of coronary lesions among diabetic patients the clinical success of the procedure was 92.4% in diabetics and 91.8% in non diabetics. Hospital mortality was 1.3% in diabetics and 0.7% in non diabetics. Major complications occurred in 3.8% of diabetics and 3.2% in non diabetics. One year survival was 95.9% for diabetics and 98% in non diabetics. There were five late cardiac deaths among non diabetics and 3 among diabetics during the year of follow up. The frequency of new revascularization procedures was 4.3% in diabetics and 8.3% in non diabetics. Event-free survival was 95.6% in diabetics and 89.2% in non diabetics.Results of angioplasty were similar in diabetic and non diabetic patients in terms of hospital outcome and late follow-up.

Health gains from invasive and interventional procedures in coronary artery disease: review of evidence and current UK trends

Summary Enormous advances in the interventional treatment of coronary artery disease have occurred since radiological imaging of the coronary arteries became a reality in the late 1950s. Although cardiac surgeons and interventionalists may occasionally perform life-saving procedures, it is important to realize that coronary artery disease is a progressive condition and the majority of procedures are palliative. The benefits, both symptomatic, and in longevity, can be grouped under the term “healthgain’. Medical therapy also improves longevity and reduces symptoms, however. The greatest healthgain for the patient results when interventional procedures and proven medical therapies are melded to maximize the benefit of each (NHS Centre for Reviews and Dissemination 1997).