Trends of coronary revascularization procedures in Gaza

2019 ◽  
pp. 1-4
Keyword(s):  
Coronary Angiography ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
St Elevation ◽  
Revascularization Procedures ◽  
Diagnostic Coronary Angiography

Background: we investigated the results of diagnostic coronary angiography and trends in rates of myocardial revascularization procedure included Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) procedures in Gaza between 2015 and 2018. Methods: A descriptive retrospective study based on the analysis of all diagnostic Coronary Angiographies (CAG) based on the Ministry of Health hospitals in Gaza City Report and the Center of Bureau of Statistics, to evaluate the annual rate of PCI and CABG volume have been done since January 2015until January 2019. Results: A total of 4887 diagnostic coronary angiography procedures were performed. The mean age of patients was 58.0±10.2 years. A 3245 of cases were male (66.4%). A total of 5225 revascularization procedures (PCI: 4286,CABG: 939) were performed during the study period. From 2014 to 2018 the PCI volume increased by 94 % (80/100 000 to 155/100 000)(P < 0.0001), CABG volume decreased by 47 % (30/100 000 to 17 /100 000) (P <0.0001), PCI/CABG ratio increased from 2.7 to 9.1(P<0.0001).The indications for diagnostic coronary angiography were stable angina (57% of cases), non-ST-elevation acute coronary syndrome (NSE-ACS) in 24.0%, ST-elevation myocardial infarction (STEMI) in 19.0%, the diagnostic coronary angiography results showed significant lesions in 64.5% of patients. About 19.2% of total cases have three vessel disease, 21% have two vessel disease and 24.4% of them have one vessel disease. The segments most involved were Left Anterior Descending Artery (LAD) which was involved in 47.2% of cases. Discussion: We observed dramatic increases in the total coronary revascularization procedures with a marked decrease in CABG and increase in PCI procedures in Gaza.

scholarly journals Coronary Revascularization and Long-Term Survivorship in Chronic Coronary Syndrome

2021 ◽  
Vol 10 (4) ◽  
pp. 610
Author(s):  
Ana Gabaldon-Perez ◽  
Victor Marcos-Garces ◽  
Jose Gavara ◽  
Cesar Rios-Navarro ◽  
Gema Miñana ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Symptomatic Improvement ◽  
Left Ventricular ◽  
Western World ◽  
Coronary Syndrome ◽  
The 1960S ◽  
Revascularization Procedures ◽  
Invasive Management

Ischemic heart disease (IHD) persists as the leading cause of death in the Western world. In recent decades, great headway has been made in reducing mortality due to IHD, based around secondary prevention. The advent of coronary revascularization techniques, first coronary artery bypass grafting (CABG) surgery in the 1960s and then percutaneous coronary intervention (PCI) in the 1970s, has represented one of the major breakthroughs in medicine during the last century. The benefit provided by these techniques, especially PCI, has been crucial in lowering mortality rates in acute coronary syndrome (ACS). However, in the setting where IHD is most prevalent, namely chronic coronary syndrome (CCS), the increase in life expectancy provided by coronary revascularization is controversial. Over more than 40 years, several clinical trials have been carried out comparing optimal medical treatment (OMT) alone with a strategy of routine coronary revascularization on top of OMT. Beyond a certain degree of symptomatic improvement and lower incidence of minor events, routine invasive management has not demonstrated a convincing effect in terms of reducing mortality in CCS. Based on the accumulated evidence more than half a century after the first revascularization procedures were used, invasive management should be considered in those patients with uncontrolled symptoms despite OMT or high-risk features related to left ventricular function, coronary anatomy, or functional assessment, taking into account the patient expectations and preferences.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

Treatment of non-ST elevation acute coronary syndromes

2018 ◽  
Author(s):  
Marco Valgimigli ◽  
Marco Angelillis
Keyword(s):  
Coronary Revascularization ◽  
Artery Bypass ◽  
Treatment Options ◽  
Risk Scores ◽  
Single Individual ◽  
Serious Adverse Events ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
St Elevation

Treatment of patients presenting with a non-ST elevation acute coronary syndrome (NSTE-ACS) aims at immediate relief of ischaemia and the prevention of serious adverse events, including death, myocardial (re)infarction, and life-threatening arrhythmias. In NSTE-ACS, patient management is guided by risk stratification (troponin, electrocardiogram, risk scores, etc.). Treatment options include anti-ischaemic and antithrombotic drugs and coronary revascularization including percutaneous coronary interventions, or coronary artery bypass grafting. While long-term secondary prevention with aspirin monotherapy is currently the gold standard approach for all NSTE-ACS patients who tolerate the drug, additional medications on top of aspirin such as oral P2Y12 inhibitors or oral anticoagulation have been investigated across clinical trials and their long-term use should be guided by the ischaemic versus bleeding risk status of each single individual patient.

scholarly journals Adherence to Medical Treatment in Patients who Have Experienced Acute Coronary Syndrome and Percutaneous Coronary Intervention

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 36-38
Author(s):  
N. M. Kuzmina ◽  
N. I. Maximov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
Adherence To Therapy

Purpose: to study adherence to therapy after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We analyzed retrospectively 127 case histories of patients who underwent PCI for ACS in 2015 (in Udmurtia at that time PCIs were mostly carried out later than 6 hours after onset of symptoms). Inclusion criteria: age 25–75 years; confirmed ACS; stenting of coronary arteries for the first time. Exclusion criteria: pregnancy; prisoners; incompetent persons; history of PCI or coronary artery bypass grafting. In two years after the PCI 95 patients were questioned concerning use of statins (including their doses) and dual antiplatelet therapy (DAPT). Results. In 2 years after index PCI 83% of patients took statins regularly. DAPT for 1 year or more after PCI received 85% of patients. Conclusion. Adherence to therapy with statins and antiplatelet therapy was found to be high. PCI in patients with ACS was mainly delayed (more than 6 hours from the onset of symptoms). It is necessary to further improve the routing of patients to PCI performing centers from Udmurtia regions for the timely myocardial revascularization.

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Heart ◽  
2019 ◽  
pp. heartjnl-2019-315655 ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Corina Grey ◽  
Yannan Jiang ◽  
Rodney T Jackson ◽  
Andrew J Kerr
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Procedure ◽  
St Elevation ◽  
Event Rates ◽  
Invasive Management

ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

scholarly journals Is there a place for a multidisciplinary “Heart Team” approach to the selection of myocardial revascularization method in patients with acute coronary syndromes?

2021 ◽  
Vol 26 (2) ◽  
pp. 4210
Author(s):  
O. L. Barbarash ◽  
V. I. Ganyukov ◽  
R. S. Tarasov ◽  
L. S. Barbarash
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Team Approach ◽  
Heart Team ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Selection Of

Current review article, based on foreign and Russian studies, guidelines of the European and North American cardiological and surgical communities, summarizes the expert positions on the place of multidisciplinary “Heart Team” approach in the selection of management strategy for patients with various types of coronary artery disease. The positions of modern clinical guidelines regarding percutaneous coronary intervention and coronary artery bypass grafting in acute coronary syndrome are given. Prospective positions for optimizing the decisionmaking process by a multidisciplinary team when considering difficult patients are presented.

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