Effect of exercise protocol and lead selection on the accuracy of heart rate-adjusted indices of ST-segment depression for detection of three-vessel coronary artery disease

Objectives: To determine the frequency of multivessel coronary artery disease(CAD) in patients suffering from inferior wall acute myocardial infarction (AMI) having STsegment depression in anterior chest leads. Study Design: Cross Sectional Survey. Setting:Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: December2013 to June 2014. Materials and Methods: After fulfilling the inclusion criteria, 120 patientswith acute inferior wall MI were studied. Patients were divided in two groups. Group I includedpatients with ST segments depression in leads V1-V3 and Group II with ST segment depressionin leads V4-V6. Age of patients ranged from 25 to 70 years. Results: The mean age was52.5±10.5 years. As regards sex distribution, 100 patients were male, 54 in Group I and 46in Group II. There were 20 female patients, 11 in Group I and 9 in Group II. Thirty six (30%)patients were diabetic, 22(33.8%) in Group I and 14(25.5%) in Group II. Forty five (37.5%)patients were hypertensive. Fifty two (43.3%) patients were smokers. Forty three (35.8%)patients had family history of ischemic heart disease, 25(38.5%) in Group I and 18(32.7%) inGroup II. Thirty five (29.2%) had hyperlipidemia, 20 (30.8%) in Group I and 15(29.2%) in GroupII. All patients underwent coronary angiogram. Thirty eight (31.7%) patients had single vesseldisease, 29(44.6%) patients in Group I and 9(16.4%) in Group II. Forty three (35.8%) patientshad double vessel coronary artery disease, 23 patients (35.4%) in Group I and 20(36.4%) inGroup II. Thirty nine (32.5%) had three vessel coronary artery disease, 13 (20%) in Group I and26 (47.3%) in Group II. Eighty three (69.2%) patients had multivessel coronary artery disease37(56.8%) in Group I and 46 (83.6%) in Group II (p value <0.002). Conclusion: The presence ofprecordial ST depression during acute inferior wall myocardial correlates well with multivesselCAD. Precordial ST-segment depression in acute inferior wall MI is related to anterior injury dueto LAD stenosis and these patients tend to have more severe CAD.

Download Full-text

Three-Vessel Coronary Artery Disease, Aortic Stenosis, and Constrictive Pericarditis 27 Years after Chest Radiation Therapy: A Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20061031 ◽

2006 ◽

Vol 9 (4) ◽

pp. E728-E730 ◽

Cited By ~ 4

Author(s):

Raed Aqel ◽

Steven Lloyd ◽

Himanshu Gupta ◽

Gilbert Zoghbi

Keyword(s):

Coronary Artery Disease ◽

Radiation Therapy ◽

Case Report ◽

Coronary Artery ◽

Aortic Stenosis ◽

Constrictive Pericarditis ◽

Vessel Coronary Artery Disease ◽

Artery Disease ◽

Vessel Coronary Artery

Download Full-text

Cost-effectiveness analysis of percutaneous coronary intervention for single-vessel coronary artery disease: an economic evaluation of the ORBITA trial

BMJ Open ◽

10.1136/bmjopen-2020-044054 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044054

Author(s):

Victoria McCreanor ◽

Alexandra Nowbar ◽

Christopher Rajkumar ◽

Adrian G Barnett ◽

Darrel Francis ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cost Effectiveness ◽

Coronary Artery ◽

Coronary Intervention ◽

Single Vessel ◽

Vessel Coronary Artery Disease ◽

Effectiveness Analysis ◽

Percutaneous Coronary ◽

Artery Disease ◽

Vessel Coronary Artery

ObjectiveTo evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.DesignA cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months.SettingFive UK NHS hospitals.Participants200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy.InterventionsAt recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure.Outcome measuresIncremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo.ResultsThe estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses.ConclusionsThe ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by the National Institute of Health and Care Excellence when undertaking health technology assessment for the NHS context.Trial registration: The ORBITA study is registered with ClinicalTrials.gov, number NCT02062593.

Download Full-text