scholarly journals VARIATION IN CARE PRACTICES FOR ACUTE MYOCARDIAL INFARCTION WITH MULTIVESSEL CORONARY ARTERY DISEASE PRESENTING WITH CARDIOGENIC SHOCK IN THE UNITED STATES, 2009-2018: A REPORT FROM THE NCDR RESEARCH TO PRACTICE (R2P) INITIATIVE

2020 ◽  
Vol 75 (11) ◽  
pp. 1126
Author(s):  
Rohan Khera ◽  
Eric Secemsky ◽  
Yongfei Wang ◽  
Nihar R. Desai ◽  
Thomas M. Maddox ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
The United States ◽  
Research To Practice ◽  
Multivessel Coronary Artery Disease ◽  
Variation In Care ◽  
Care Practices ◽  
Artery Disease

scholarly journals Prevalence and Clinical Correlates of Coronary Artery Disease among New Dialysis Patients in the United States: A Cross-Sectional Study

2001 ◽  
Vol 12 (7) ◽  
pp. 1516-1523 ◽  
Author(s):  
AUSTIN G. STACK ◽  
WENDY E. BLOEMBERGEN
Keyword(s):  
United States ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
The United States ◽  
Comorbid Conditions ◽  
Clinical Correlates ◽  
History Of ◽  
Artery Disease

Abstract. Despite the high prevalence of coronary artery disease (CAD) among patients with end-stage renal disease (ESRD), few studies have identified clinical correlates using national data. The purpose of this study was to determine the prevalence and clinical associations of CAD in a national random sample of new ESRD in the United States in 1996/1997 (n = 4025). Data on demographic characteristics and comorbidities were obtained from the Dialysis Morbidity and Mortality Study, Wave 2. The principal outcome was CAD, defined as the presence of a previous history of CAD, myocardial infarction, or angina, coronary artery bypass surgery, coronary angioplasty, or abnormal coronary angiographic findings. Multivariate logistic regression analysis was used to assess the relationship of conventional factors and proposed uremic factors to the presence of CAD. CAD was present in 38% of patients. Of the total cohort, 17% had a history of myocardial infarction and 23% had angina. Several conventional risk factors, including advancing age, male gender, diabetes mellitus, and smoking, were significantly associated with CAD. Of the proposed uremic factors, lower serum albumin levels but higher residual renal function and higher hematocrit values were significantly associated with the presence of CAD. Vascular comorbid conditions, structural cardiac abnormalities, white race, and geographic location were also strongly correlated with the presence of CAD. This national study suggests that several conventional CAD risk factors may also be risk factors for CAD among the ESRD population. This study identifies nonconventional factors such as serum albumin levels, vascular comorbid conditions, and structural cardiac abnormalities as important disease correlates. Future logitudinal studies are required to explore the relative importance of the relationships observed here.

scholarly journals Trends in coronary artery disease screening before kidney transplantation

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005282021
Author(s):  
Xingxing S. Cheng ◽  
Sai Liu ◽  
Jialin Han ◽  
Margaret R. Stedman ◽  
Glenn M. Chertow ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Kidney Transplant ◽  
Temporal Trends ◽  
The United States ◽  
Comorbidity Burden ◽  
Risk Patients ◽  
Artery Disease ◽  
Fatal Myocardial Infarction

Background: Coronary artery disease (CAD) screening in asymptomatic kidney transplant candidates is widespread but not well supported by contemporary cardiology literature. We describe here temporal trends in CAD screening before kidney transplant in the United States. Methods: Using the United States Renal Data System, we examined Medicare-insured adults who received a first kidney transplant from 2000 through 2015. We stratified analysis based on whether the patient's comorbidity burden met guideline definitions of high-risk for CAD. We examined temporal trends in non-urgent CAD tests within the year prior to transplant and the composite of death and non-fatal myocardial infarction in the 30 days after transplant. Results: Of 94,832 kidney transplant recipients, 37,139 (39%) underwent at least one non-urgent CAD test in the 1 year prior to transplant. From 2000 to 2015, The transplant program waitlist volume had increased as transplant volume stayed constant, while patients in the later eras had slightly higher comorbidity burden (older, longer dialysis vintage, and a higher prevalence of diabetes mellitus and CAD). The likelihood of CAD test in the year prior to transplant increased from 2000 through 2003 and remained relatively stable thereafter. When stratified by CAD risk status, test rates decreased modestly in high-risk patients but remained constant in low-risk patients after 2008. Death or non-fatal myocardial infarction within 30 days after transplant decreased from 3.4% in 2000 to 1.5% in 2015. Nuclear perfusion scan was the most frequent modality of testing throughout examined time periods. Conclusions: CAD testing rates before kidney transplantation have remained constant from 2000 through 2015 despite widespread changes in cardiology guidelines and practice.

scholarly journals Impact of complete revascularization for acute myocardial infarction with multivessel coronary artery disease in diabetes mellitus patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kang ◽  
K.W Park ◽  
T.M Rhee ◽  
H.S Lee ◽  
Y.J Ki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease

Abstract Background Clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with Diabetes Mellitus (DM) patient. Objectives We sought to compare prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM. Methods A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on angiographic image. The primary endpoints of this study was patient oriented composite outcome (POCO) defined as a composite of all cause death, any myocardial infarction, and any revascularization within 3 years. Results Overall, 3-year POCO were significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (HR 0.52, 95% CI 0.38–0.71) only in the non-DM group. Conclusion In AMI patients with multivessel disease, CR may be ineffective in improving clinical outcomes in patients with DM. Funding Acknowledgement Type of funding source: None

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