Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease

2017 ◽  
Vol 26 (9) ◽  
pp. 976-983 ◽  
Author(s):  
Shannon Galway ◽  
Falisha Adatia ◽  
Maja Grubisic ◽  
May Lee ◽  
Patrick Daniele ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Sex Differences ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Medication Use ◽  
Nonobstructive Coronary Artery Disease ◽  
Artery Disease ◽  
Cardiac Medication

Abstract 15359: Cost-effectiveness of Different Strategies for the Diagnosis of Stable Coronary Artery Disease: Results from the Evinci Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Giuseppe Turchetti ◽  
Valentina Lorenzoni ◽  
Stefania Bellelli ◽  
Francesca Pierotti ◽  
Daniele Rovai ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Imaging Modalities ◽  
Fractional Flow ◽  
Stress Imaging ◽  
Non Invasive ◽  
Artery Disease

Introduction: In patients with suspected coronary artery disease (CAD) the comparative value of non invasive diagnostic imaging modalities or strategies is not yet defined. Hypothesis: We hypothesized that a comparative cost-effectiveness (CE) analysis of different non-invasive imaging strategies in a European population of patients with stable angina could identify the best approach for the diagnosis of significant CAD. Methods: In 475 pts (291 males, 60±9 yrs) with stable angina enrolled in the EVINCI multicenter study, CT coronary angiography (CTCA) and stress imaging were performed before invasive coronary angiography (ICA). Significant CAD was defined as >50% stenosis in the left main or >70% stenosis in a major coronary vessel or 30-70% stenosis with fractional flow reserve ≤0.8. Non-invasive imaging strategies included CTCA or stress imaging (ECHO, CMR, SPECT or PET) alone or in combination. Combinations were positive if both CTCA and the stress test were positive. CE analysis was performed using per patient data. Effectiveness was defined as percentage of correct diagnosis. Costs were calculated by country-specific reimbursements for each test considered plus ICA costs when non invasive tests were positive. Incremental cost-effectiveness ratios (ICERs) were obtained by regression analysis and using a propensity-score adjustment. Results: Significant CAD was diagnosed at ICA in 140 pts (29%). CTCA had the highest diagnostic performance among single imaging modalities and CTCA-PET among combinations (Table). At CE analysis, ECHO approach was the least costly but also the least effective, while CTCA alone or in combination with PET had increasingly higher effectiveness for a willingness to pay (WTP) exceeding 2,000 Euro and 5,000 Euro, respectively (Table). Conclusion: Stress ECHO is a cost-effective approach to diagnose stable CAD when the WTP is low. CTCA alone or combined with stress PET allows a more effective diagnostic workflow for higher WTP.

scholarly journals The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katerina V. Kiburg ◽  
Andrew I. MacIsaac ◽  
Georgia E. McCluskey ◽  
Vijaya Sundararajan ◽  
Richard J. MacIsaac
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Medication Use ◽  
Patients With Diabetes ◽  
Artery Disease ◽  
Ras Inhibitors

Abstract Background Although it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented. Methods Merged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM. Results From 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53). Conclusions Although patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

Sign in / Sign up

Export Citation Format

Share Document