EFFECT OF PHYSICIAN SPECIALTY ON TREATMENT RECOMMENDATION TO PATIENTS WITH CORONARY ARTERY DISEASE

2000 ◽  
Vol 16 (1) ◽  
pp. 190-198 ◽  
Author(s):  
Joseph McDonnell ◽  
Annejet P. Meijler ◽  
James P. Kahan ◽  
Henk Rigter ◽  
Steven J. Bernstein
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Decision Making ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Significant Coronary Artery Disease ◽  
Clinical Decision ◽  
Treatment Recommendation ◽  
Physician Specialty ◽  
Artery Disease

Objective: To assess the influence of physician specialty and the way in which patient data are presented in the treatment recommended for patients with coronary artery disease.Methods: In a prospective study, 3,628 patients with significant coronary artery disease who had been referred to 1 of 10 heart centers in the Netherlands as possible candidates for either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) were recruited. Within each center, the recommended treatment is determined by a team consisting of cardiologists only, cardiovascular surgeons only, or cardiologists and cardiovascular surgeons (i.e., composite teams). The main outcome measures are the proportions of patients for whom PTCA, CABG, or noninvasive (medical) therapy was recommended.Results: Composite teams made 71% of recommendations, surgeon-only teams, 12%, and cardiologist-only teams, 17%. Cardiologist-only teams primarily recommended patients to PTCA, surgeon-only teams to CABG, while combined teams made more evenly distributed recommendations (p < .001). Although the patients discussed by the three types of teams were clinically different, the recommendation patterns remained significant after adjusting for these differences (p < .001). For patients with recent myocardial infarction, direct presentation of the case to the team by the referring cardiologist reduced the likelihood that CABG would be recommended.Conclusions: The treatment recommended to patients with coronary artery disease is affected by the composition of the team providing the recommendation. These findings have important implications for clinical decision making for patients with cardiovascular disease.

scholarly journals 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Circulation ◽  
2021 ◽  
Author(s):  
Jennifer S. Lawton ◽  
Jacqueline E. Tamis-Holland ◽  
Sripal Bangalore ◽  
Eric R. Bates ◽  
Theresa M. Beckie ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Therapeutic Option ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Significant Coronary Artery Disease ◽  
Heart Association ◽  
Coronary Artery Revascularization ◽  
Artery Disease

Aim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients’ interests.

Coronary Artery Disease as a Relevant Risk Factor in Screening of Abdominal Aortic Ectasia and Aneurysm

2018 ◽  
Author(s):  
Ahmed Koshty ◽  
Magdalena Bork ◽  
Andreas Böning ◽  
Dursun Gündüz ◽  
Sebastian Pleger
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Screening Program ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Sonographic Examination ◽  
Screening Programs ◽  
Abdominal Aortic ◽  
Artery Disease ◽  
Aortic Ectasia

Background The aim of this study was to investigate the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic ectasia (AAE) in coronary artery disease (CAD) patients in a multicenter setting to obtain significant data to establish an AAA screening program in our departments. Methods Between January and September 2016, 500 patients with suspected or diagnosed CAD planned for coronary angiography or coronary artery bypass graft (CABG) underwent a sonographic examination of the infrarenal abdominal aorta to diagnose AAA or AAE. We calculated the prevalence of AAA and AAE in patients diagnosed of CAD and investigated factors potentially associated with the occurrence of AAA. Results The overall prevalence in all grades of CAD for AAE was 35.1% and for AAA 5.4%. In patients with three-vessel CAD, the prevalence of AAE was 34% and of AAA 6.8%. Significant correlation was found between the three-vessel CAD and AAA (p = 0.039). The logistic regression analysis showed significant correlation between AAA and age > 65 years (p = 0.05). The multivariate analysis of risk factors and CAD revealed significant correlations between one-vessel CAD and arterial hypertension (AH) (p = 0.004) and age > 65 years (p = 0.001) as well as between three-vessel CAD and AH (p = 0.01), peripheral artery disease (p = 0.01), and age > 65 years (p = 0.03). Conclusion Our results confirm, that in comparison to other data, the prevalence of AAA in patients with CAD is high. Thus, it is recommended to include patients with CAD, especially elderly patients with three-vessel CAD, in future AAA screening programs.

Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions

2020 ◽  
Vol 16 (5) ◽  
pp. 481-496 ◽  
Author(s):  
Ali Pooria ◽  
Afsoun Pourya ◽  
Alireza Gheini
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Adverse Events ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Wide Range ◽  
Artery Disease

Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.

SYNTAX score and coronary artery bypass graft surgery in Bangladesh

2019 ◽  
Vol 27 (7) ◽  
pp. 542-547
Author(s):  
Redoy Ranjan ◽  
Asit Baran Adhikary
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Artery Bypass Graft ◽  
Artery Disease

Background The SYNTAX score is a helpful tool for determining the optimal myocardial revascularization strategy in complex coronary artery disease. The aim of this study was to assess whether the SYNTAX score predicts postoperative mortality in patients undergoing coronary artery bypass grafting. Methods The study included 1100 consecutive patients referred for coronary artery bypass graft surgery over a 4-year period. Angiographic data were interpreted by both experienced intervention cardiologists and cardiac surgeons. The patients were divided into three groups based on SYNTAX score tertiles: low ≤22 ( n =  560), intermediate 23–32 ( n =  360), and high ≥33 ( n =  180). Results Compared to patients with a low SYNTAX score, those with intermediate and high scores were significantly older ( p <  0.001), had a lower left ventricular ejection fraction ( p <  0.001), higher pulmonary artery pressure ( p <  0.001), and higher incidences of acute coronary syndrome and left main coronary artery disease. A significantly higher EuroSCORE ( p =  0.003) was also observed in patients with a higher SYNTAX score. Patients with intermediate and high SYNTAX scores had higher 5-year mortality rates (18.6% and 19.5%, respectively) than patients with low SYNTAX scores (9.5%, p <  0.05). In multivariate analysis, SYNTAX score was not an independent predictor of late mortality. Conclusion Although SYNTAX score is not independently predictive of late mortality in patients with complex coronary artery disease undergoing myocardial revascularization surgery, patients with lower SYNTAX scores had a lower mortality rate after coronary artery bypass graft surgery.

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