scholarly journals Are Hospitalizations for Percutaneous Coronary Procedures Missed Opportunities for Teaching Rules of Secondary Prevention?

2016 ◽  
Vol 68 (1) ◽  
Author(s):  
Ricarda Marinigh ◽  
Paolo M. Fioretti ◽  
Rosa Pecoraro ◽  
Claudio Fresco ◽  
Silvio Brusaferro
Keyword(s):  
Risk Factors ◽  
Coronary Angiography ◽  
Secondary Prevention ◽  
Randomized Clinical Trials ◽  
Hospital Admissions ◽  
Beta Blockers ◽  
Individual Risk ◽  
High Tech ◽  
Invasive Procedures ◽  
Percutaneous Coronary

Background and aims: Percutaneous coronary intervention (PCI) is the most frequently used revascularization approach, often repeatedly applied. The quest for the ultimate revascularization procedure however may capture cardiologist’s attention and lead them to minimize the issue of secondary prevention in their patients. Aims of this study were to assess: 1. The individual risk factor profile, 2. The relation between the risk factors correction and the number of hospital admissions for elective procedures, 3. The appropriateness of medical treatment in patients admitted for elective coronary invasive procedures (diagnostic and interventional). 4. The patients knowledge of threshold values for cardiovascular risk factors. Patients and Methods: 100 patients (71% males, mean age 68 years) consecutively admitted for elective coronary angiography or PCI. They underwent a classical risk factors assessment and were divided in three groups according to the number of admissions for coronary angiography and in two groups according to the number of PCIs. Results: Fifty-seven % of patients had been previously admitted for invasive examination at least three times and 58% had already been treated with at least one PCI. Seventyone % were treated with beta-blockers but only 25% of them received a dosage found effective in RCTs (randomized clinical trials). Sixty % were treated with ACE-inhibitors and 83% received the dosage found effective in RCTs. Fifty-two % were treated with statins and 95% received a dosage found effective in RCTs. Nine % were still active smokers. Fourtynine % had a LDL cholesterol level above 100 mg/dL. The percentage of patients not on target was unrelated to the number of hospital admissions for invasive procedures. Conclusions: Modern cardiology is quickly embracing high tech procedures and trials results but often fails to spend enough time teaching how to control risk factors according to the recommendations of the evidence-based guidelines, even independently of the number of hospitalizations for invasive cardiovascular procedures.

scholarly journals Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention

2020 ◽  
Vol 9 (10) ◽  
pp. 3242
Author(s):  
Sinjini Biswas ◽  
Diem Dinh ◽  
Mark Lucas ◽  
Stephen J. Duffy ◽  
Angela L. Brennan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Healthcare System ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Coronary Intervention ◽  
Disease Diagnosis ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Significant Burden

Unplanned readmissions to hospital after percutaneous coronary intervention (PCI) pose a significant burden to the healthcare system and are potentially preventable. In this study, we sought to determine the incidence of, and risk factors for, unplanned hospital readmissions within 30 days following PCI. We prospectively collected data on 28,488 patients undergoing PCI between 2013 and 2019, who were enrolled in the state-wide multi-centre Victorian Cardiac Outcomes Registry. Patients’ data were then linked to data from the Victorian Department of Health administrative database that records statewide hospital admissions. Disease diagnosis codes were used to identify cause of readmission. Patients who had an unplanned readmission were further divided into those who had a cardiac vs. non-cardiac cause for readmission. Overall, 3059 patients (10.7%) had an unplanned hospital readmission within 30 days of PCI, of which 1848 patients (60.4%) were readmitted for primarily cardiac diagnoses. Independent predictors of both 30-day unplanned cardiac and non-cardiac readmissions post-PCI were female sex, having ≥1 admission in the 12 months prior to PCI, acute coronary syndrome presentation, having any in-hospital complication and being discharged on an oral anticoagulant (all p < 0.05). A stepwise increase in readmission risk was observed with increasing number of admissions from 1 to ≥4 admissions in the 12 months prior to PCI. In conclusion, a substantial proportion of patients undergoing PCI have unexpected readmissions to hospital in the 30 days following PCI. Targeted strategies for patients with risk factors for readmission may be useful to reduce this significant burden to the healthcare system.

scholarly journals Acute myocardial infarction at an early age – importance of acute chest pain fast track in patient management

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Carvalho ◽  
J M Bastos ◽  
V Viegas ◽  
A Pacheco ◽  
L Ferraz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Clinical Characteristics ◽  
Statistical Difference ◽  
Fast Track ◽  
Acute Chest Pain ◽  
Smoking History ◽  
Younger Patients ◽  
Percutaneous Coronary

Abstract Background Acute coronary syndrome (ACS) has a higher incidence in middle-aged and elderly patients but 2% to 6% of ACS cases occur in people younger than 45 years of age (Y). Younger patients have different clinical characteristics when compared to older patients. Acute chest pain fast track led to a reduction in the time required for the diagnosis of acute coronary syndromes, particularly those with ST segment elevation (STEMI). Aim This study aims to assess the differences in risk factors and clinical characteristics between young and older ACS patients. Besides that, we try to determine if the benefits of acute chest pain fast track have extended to this younger population. Material and methods Retrospective observational study carried out through the analysis of the clinical process. Clinical data were collected from ACS patients under 45Y from 2010 to 2019 and from ACS patients over 45Y from 2010 to 2012. Statistical analysis was made using R software and RStudio. Results This study included 93 patients with ACS under 45Y and 172 patients with ACS over 45Y. A total of 265 patients were included. The male gender was predominant in both groups but with a higher prevalence in the younger ones (88% vs 73%, p&lt;0,005). The prevalence of hypertension was higher in older ACS patients but the younger ones had more overweight (39.8% vs 17.4%, p&lt;0,001), smoking history (84.9% vs 38.4%, p&lt;0,001) and family history of sudden death (25.8% vs 5.8%, p&lt;0,01). Diabetes had no statistical difference. Dyslipidemia as previous known risk factor had no statistical difference but LDL was higher in patients with less than 45Y (147.2 vs 120.7 mg/dL, p&lt;0,001). STEMI were tendentially more prevalent in patients under 45Y (55.9% vs 44.8%, p 0.09). The anterior wall was the most frequently involved in both groups (52% vs 63%, p 0.28), followed by the inferior wall (42% vs 36%). Accordantly, anterior descending artery was the artery most frequently involved in both groups (44.1% vs 48.3%), followed by right coronary artery (24.7 vs 26.7%). STEMI patients under 45Y were submitted to an emergent coronary angiography in 89% of cases and STEMI patients over than 45Y were submitted in 70.1% of cases. Particularly for patients under 45Y, all STEMI patients were submitted to an emergent coronary angiography after 2014, which emphasis the importance of acute chest pain fast track in the emergency room. Finally, ACS patients under 45Y were less submitted to percutaneous coronary angiography compared to patients over 45Y (15.1% vs 4.7%, p&lt;0,001). Conclusions Cardiovascular risk factors differ accordingly the age of ACS patients. Younger patients had more overweight and smoking history. They probably have alternative pathophysiologic mechanisms that explain differences in percutaneous coronary angiography. Acute chest pain fast track had an important role reducing morbimortality related to ACS by reducing the time until STEMI diagnose. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Iatrogenic Radial Arteriovenous Fistula Secondary to Transradial Coronary Angiography: A Case Report

2020 ◽  
Vol 5 (01) ◽  
pp. 53-56
Author(s):  
Satish Kumar Rao V. ◽  
Srinivas Bhyravavajhala ◽  
Ramakrishna Narayanan ◽  
Sreekanth Yerram
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Coronary Angiography ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Rare Case ◽  
Access Site ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Cardiovascular Interventions

AbstractTransradial access is the commonly followed route for performing percutaneous coronary diagnostic and angioplasty interventions. Transradial access has drastically decreased the vascular access site complications when compared with the transfemoral access. Arteriovenous fistula developing at the transradial access site is one of the rare complications. The risk factors and the mechanism of development are not entirely known. We present a rare case of a 63-year-old female developing radiocephalic fistula a few days after transradial coronary angiography and discuss management.The transradial route is preferred for cardiovascular interventions. Complications arising out of this are rare even though this route is widely used. Arteriovenous fistula is one of the rare complications, and the mechanisms causing it are not always clearly evident. This report will elaborate on the possible causes and steps to prevent this complication and help in managing once it occurs.

scholarly journals Reintroduction of elective cardiac interventions in the era of COVID-19: the Barts experience

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001446
Author(s):  
Stephen Hamshere ◽  
Katrina Comer ◽  
Fizzah Choudhry ◽  
Krishna Rathod ◽  
Gordon Mills ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Aortic Valve ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Multidisciplinary Teams ◽  
Transcatheter Aortic Valve ◽  
Percutaneous Coronary ◽  
Procedural Complications

BackgroundThe response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway.MethodsThis was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April–June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used.Results143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms.ConclusionWe demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.

scholarly journals Coronary Artery Disease (CAD) - risk factors and causes: In Libyan patients.

2021 ◽  
Author(s):  
Osama Bheleel ◽  
Alaa Abdulhamid ◽  
Ibtisam Alhadi Naas ◽  
Hanaa Grash ◽  
Hajer M almuaket ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
University Hospital ◽  
Contributing Factors ◽  
Percutaneous Coronary ◽  
Artery Disease

Aims Coronary artery disease (CAD) is the leading cause of death worldwide in both men and women. Accordingly, we retrospectively reviewed the effects of various risk factors on coronary angiographic outcomes. Methods and Results Data were collected from the catheter lab through Tripoli university hospital records, whereas the team reviewed clinical data and coronary artery diagrams for one year from 01/04/2019 to 31/03/2020. In our study, the total number of cases was 666; 401 male and 265 female, ranging in age between 27 and 91 years. Considering the data, a significantly increased incidence of coronary artery disease (CAD) among the male who smokes, and who were less than 60 years of age. Furthermore, in the present study, the total number of normal patients was predominantly female. The most common risk factors for women were diabetes mellitus (DM), hypertension (HTN) (12%,13% respectively). While the men share the significant effects of smoking on coronary angiography (C. Angio) findings (40.52%), and most of them underwent a percutaneous coronary intervention (PCI). Conclusions In our study, there was evidence that CAD is a prevalent disease among the middle-aged populations with male gender preference. The risk factors including diabetes, hypertension, and smoking are the most contributing factors for the developing CAD in Libya. Keywords: coronary artery disease; percutaneous coronary intervention; risk factors; coronary angiography; Libya

scholarly journals Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England

2021 ◽  
Author(s):  
Thomas Beaney ◽  
Ana Luisa Neves ◽  
Ahmed Alboksmaty ◽  
Kelsey Flott ◽  
Aidan Fowler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Hospital Admissions ◽  
Age Groups ◽  
Case Fatality ◽  
Individual Risk ◽  
Nationally Representative ◽  
Individual Risk Factors ◽  
Underlying Risk ◽  
Over Time

Background The Covid-19 case fatality ratio varies between countries and over time but it is unclear whether variation is explained by the underlying risk in those infected. This study aims to describe the trends and risk factors for admission and mortality rates over time in England. Methods In this retrospective cohort study, we included all adults (≥18 years) in England with a positive Covid-19 test result between 1st October 2020 and 30th April 2021. Data were linked to primary and secondary care electronic health records and death registrations. Our outcomes were i) one or more emergency hospital admissions and ii) death from any cause, within 28 days of a positive test. Multivariable multilevel logistic regression was used to model each outcome with patient risk factors and time. Results 2,311,282 people were included in the study, of whom 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days. There was significant variation in the case hospitalisation and mortality risk over time, peaking in December 2020-February 2021, which remained after adjustment for individual risk factors. Older age groups, males, those resident in more deprived areas, and those with obesity had higher odds of admission and mortality. Of risk factors examined, severe mental illness and learning disability had the highest odds of admission and mortality. Conclusions In one of the largest studies of nationally representative Covid-19 risk factors, case hospitalisation and mortality risk varied significantly over time in England during the second pandemic wave, independent of the underlying risk in those infected.

Investigating Six-Month Health Outcomes of Patients with Angina Discharged from a Chest Pain Service

2002 ◽  
Vol 1 (4) ◽  
pp. 253-264 ◽  
Author(s):  
Karen Smith ◽  
Dawn Ross ◽  
Elizabeth Connolly
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Chest Pain ◽  
Secondary Prevention ◽  
Health Outcomes ◽  
Hospital Admissions ◽  
British Heart Journal ◽  
Prevention Measures ◽  
Post Discharge

Hospital admissions for patients with suspected cardiac chest pain are increasing. The development of a chest pain service allows rapid diagnosis, investigation and treatment. Since the in-patient stay is often short, there is limited time for education and risk factor management. Little is known about the patients' recovery post discharge. This study was completed to investigate the 6-month health outcomes of 57 patients discharged from the chest pain service by measuring cardiovascular symptoms and risk profiles, mood and quality of life, adherence to secondary prevention, morbidity and mortality. The results of this study showed that 58% of the sample still suffered angina, 72% reported breathlessness, and 79% reported lethargy. Assessment of mood showed that 76% suffered from anxiety and 78% depression. Quality of life was impaired. A reduction of cholesterol level was the only significant change in risk factors. Secondary prevention measures showed that there was still room for improvement. Twenty-five percent of the sample was readmitted to hospital due to their cardiac condition. Patients had an average of eight contacts with their general practitioner, four of which were cardiac related. The ongoing symptoms, anxiety and depression and uncorrected risk factors can impact on their recovery. Currently, however, no programme of rehabilitation is available for angina patients, despite the potential for up to 30% of patients suffering a subsequent cardiac event (Ghandi et al., British Heart Journal 73 (1995) 193–198). This study suggests the need to develop, implement and evaluate a CR programme in this client group.

scholarly journals Risk factors and incidence of contrast-induced acute kidney injury associated with diagnostic or interventional coronary angiography

2020 ◽  
Vol 9 (1) ◽  
pp. 21-24
Author(s):  
Abhishek Maskey ◽  
Ram Chandra Kafle ◽  
Sudip Lamsal
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Statistical Tests ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Cross Sectional ◽  
Iodinated Contrast ◽  
Percutaneous Coronary ◽  
Hospital Acquired

Background and Aims: Coronary angiography/ interventions depend on iodinated contrast media (CM) and consequently pose risk of contrast-induced acute kidney injury (CI-AKI). This is an important complication that accounts for a significant number of cases of hospital-acquired kidney injury, with adverse effects on prognosis and health care. This study aimed to assess incidence and evaluate risk factor CI-AKI associated with diagnostic or interventional coronary angiography. Methods: A prospective cross sectional observational hospital based study was conducted. All patients undergoing percutaneous coronary angiography in Manipal Teaching Hospital from May 1, 2019 to April 31, 2020 were included in this study. Appropriate statistical tests were used to analyse results and P <0.05 was considered statistically significant. Results: We evaluated a total of 155 patients. Among them, 90 (58%) were male and 65 (42%) female. The mean age of patients was 62.74 ± 13.9 years. Overall incidence of contrast induced acute kidney injury was 15.48%. CI-AKI was observed to be more common in patient with advance age and diabetes. Apart from advance age and diabetes, none of the other conventional risk factors such as hypertension, anaemia, volume of contrast, baseline chronic kidney disease found to have a significant association with incidence of CI-AKI. None of the patients in our study required renal replacement therapy, and there was no mortality. Conclusion: The overall incidence of CI-AKI after coronary intervention in this study is high. Patients with advance age and diabetes were at high risk of CI-AKI.

scholarly journals Analysis of the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary intervention

2018 ◽  
Vol 243 (12) ◽  
pp. 970-975 ◽  
Author(s):  
Hui-Chao Pan ◽  
Xian-Hao Wu ◽  
Qian-Li Wan ◽  
Bao-Hong Liu and ◽  
Xu-Sheng Wu
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Stenosis ◽  
Coronary Intervention ◽  
Artery Stenosis ◽  
Contrast Induced Nephropathy ◽  
Aged Patients ◽  
Percutaneous Coronary

Contrast-induced nephropathy has been the common cause of hospital-acquired acute kidney injury in the elderly patients. This study aimed to analyze the risk factors for contrast-induced nephropathy in over-aged patients undergoing coronary angiography or percutaneous coronary intervention. A total of 470 over-aged patients (≥80 years old) were judged as the contrast-induced nephropathy group ( n = 46) and non-contrast-induced nephropathy group ( n = 424) according to the postoperative 48-h serum creatinine levels. The patients’ clinical information such as hypertension grade, number and degree of coronary artery stenosis, and death rate was compared. The risk factors for contrast-induced nephropathy were also analyzed. The hypertension grade in the contrast-induced nephropathy group was significantly higher than that in the non-contrast-induced nephropathy group ( P = 0.004). The degree of coronary artery stenosis was significantly more in the contrast-induced nephropathy group compared with the non-contrast-induced nephropathy group ( P = 0.003). The death rate of the contrast-induced nephropathy group (15.8%) was significantly higher than that of the non-contrast-induced nephropathy group (0.6%; P = 0.000). The percentage of patients with abnormal urine microalbumin was significantly bigger in the contrast-induced nephropathy group (62.5%) when comparing to the non-contrast-induced nephropathy group (23.6%; P = 0.00). Besides, there was also significant difference in the emergency/selective operation between the contrast-induced nephropathy group and non-contrast-induced nephropathy group ( P = 0.001). Further, hypertension grade ( P = 0.019), emergency/selective operation ( P = 0.025), degree of coronary artery stenosis ( P = 0.038), eGFR ( P = 0.034), and urine microalbumin ( P = 0.005) were the risk factors for contrast-induced nephropathy. Hypertension grade, emergency/selective operation, degree of coronary artery stenosis, eGFR, and urine microalbumin were the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary angiography and percutaneous coronary intervention, providing guidance for the clinical prevention of contrast-induced nephropathy. Impact statement In this work, we evaluated the risk factors for contrast-induced nephropathy (CIN) in over-aged patients receiving coronary angiography (CAG) and percutaneous coronary intervention (PCI). We found that hypertension grade, emergency/selective operation, degree of coronary artery stenosis, eGFR, and urine microalbumin were the risk factors for CIN in over-aged patients receiving CAG and PCI. This study provides guidance for the clinical prevention of CIN in over-aged patients undergoing coronary intervention, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.

scholarly journals Vascular Complications from Coronary Angiography/Percutaneous Coronary Intervention: Comparing Day Case Patients and Inpatients in a Tertiary Hospital in Thailand: A Retrospective Cohort Stud

2020 ◽  
Author(s):  
Chantana Charoensin ◽  
Ratchanee Srichai ◽  
Thammasin Ingviya
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Retrospective Cohort ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Closure Device ◽  
Day Case ◽  
Vascular Closure Devices ◽  
Percutaneous Coronary

Objective: To compare the incidence along with risk factors of vascular complications between patients having undergone Coronary angiography/Percutaneous Coronary Interventions (CAG/PCIs); as day cases and those as inpatients. Material and Methods: Our study is a retrospective cohort study. We performed a retrospective chart review of the patients, visiting a heart center of the hospital from October, 2014 to September, 2018. We included patients of a minimum 18 years of age, who had undergone CAG/PCIs. Excluded patients were those who had been referred from other hospitals. The main outcomes were vascular complications defined as: (1) bleeding with significant blood loss during the procedure. (2) Hematoma within 1 month after the procedure. Wilcoxon’s rank sum and chi-squared test were used to assess the risk factors. Results: Of all 784 patients having undergone CAG/PCI, 387 were day cases and 397 were inpatients. Only 12 cases developed vascular complications. The incidence of vascular complications was not significantly different between either day case; whose incidence was 1.3% (95% confidence interval (CI), 0.72-1.87), and inpatients; whose incidence was 1.8% (95% CI, 1.10-2.42). We found that the risk factors of vascular complications were percutaneous coronary intervention, and using a vascular closure device to remove the introducer sheath. Conclusion: Performing CAG/PCI as day cases did not increase the risks of complications post-procedure, as compare to the inpatients. However, due to the small numbers of patients with complications future studies with more patients are needed to ensure the safety of day case CAG/PCI. Patients undergoing PCI, or patients with vascular closure devices used should be closely observed before discharge.

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