Stability after initial decline in coronary revascularization rates in the united states.
Female; Humans; Male; Aged; Middle Aged; United States; Aged 80 and over; Coronary Artery Bypass/statistics & numerical data; Percutaneous Coronary Intervention/statistics & numerical data; Procedures and Techniques Utilization/statistics & numerical data
BACKGROUND: It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States. METHODS: We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed. RESULTS: Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P < .001) but remained stable thereafter (P = .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P = .02) but remained stable thereafter (P = .60). Similar trends were seen in men and women. Both PCI and CABG rates were lower in women than men over the study period (PCI, 482 to 324/100,000 in men vs 232 to 153/100,000 in women; CABG, 172 to 118/100,000 in men vs 64 to 38/100,000 in women). Annual PCI rates were higher than CABG rates in patients of all age groups including in younger patients (age < 50) and octogenarians. The proportion of coronary revascularization procedures performed per insurance type remained relatively similar across the study period. CONCLUSIONS: Annual rates of coronary revascularization have changed significantly over time, potentially because of advances in revascularization techniques, availability of new evidence, and updated guidelines. Rates of PCI declined more steeply than CABG before plateauing but remained higher than rates of CABG across the study period.
Raza S; Deo VS; Kalra A; Zia A; Altarabsheh SE; Deo VS; Mustafa RR; Younes A; Rao SV; Markowitz AH; Park SJ; Costa MA; Simon DI; Bhatt DL; Sabik JF 3rd
The Annals of thoracic surgery
2019
2019-11
Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.athoracsur.2019.03.080" target="_blank" rel="noreferrer noopener">10.1016/j.athoracsur.2019.03.080</a>
PMID: 31039350
Coronary embolism: A systematic review.
BACKGROUND: Coronary embolism is a rare and potentially fatal phenomenon that occurs primarily in patients with valvular heart disease and atrial fibrillation. There is a lack of consensus regarding the diagnosis, treatment, and management of coronary embolism, leaving management at the discretion of the treating physician. Through this review, we aim to establish a better understanding of coronary embolism, and to identify treatment options - invasive and non-invasive - that may be used to manage coronary embolism. METHODS AND RESULTS: Our systematic review included 147 documented cases of coronary embolism from case reports and case series. The average age of our population was 54.2 ± 17.6 years. The most common causes of coronary embolism included infective endocarditis (22.4%), atrial fibrillation (17.0%), and prosthetic heart valve thrombosis (16.3%). Initial presentation was indistinguishable from an acute coronary syndrome (ACS) due to coronary atherosclerosis, and the diagnosis required a high level of suspicion and evaluation with angiography. Treatment strategies included, but were not limited to, thrombectomy, thrombolysis, balloon angioplasty and stent placement. Myocardial dysfunction on echocardiography was observed in over 80% of patients following coronary embolism. "Good outcomes" were reported in 68.7% of case reports and case series, with a mortality rate of 12.9%. CONCLUSION: Coronary embolism is an under-recognized etiology of myocardial infarction with the potential for significant morbidity and mortality. To improve outcomes, physicians should strive for early diagnosis and intervention based on the underlying etiology. Thrombectomy may be considered with the goal of rapid restoration of coronary flow.
Lacey MJ; Raza S; Rehman H; Puri R; Bhatt DL; Kalra A
Cardiovascular revascularization medicine : including molecular interventions
2020
2020-03
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.carrev.2019.05.012" target="_blank" rel="noreferrer noopener">10.1016/j.carrev.2019.05.012</a>
PMID: 31178350
Aortic valve replacement in bioprosthetic failure:Insights from the society of thoracic surgeons national database.
BACKGROUND: To determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for degenerated bioprosthesis. METHODS: The study was conducted using data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. All patients who had isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Trend analyses were conducted to track changes during this time period. RESULTS: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and 900 in 2014; relative change = +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and 840 in 2016; relative change = -3.4%, P= 0.005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P= 0.001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = 0.001). There was no difference in post-operative stroke (1.80% vs. 1.80%, P= 0.87), renal failure requiring dialysis (2.7% vs. 2.8%, P= 0.69), or operative mortality (3.5% vs. 4.0%, P= 0.36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. CONCLUSIONS: The number of patients undergoing SAVR for degenerated bioprosthesis is decreasing in U.S, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for degenerated bioprosthesis after its FDA approval in 2015.
Kalra A; Raza S; Hussain M; Shorbaji K; Delozier S; Deo VS; Khera S; Kleiman NS; Reardon MJ; Kolte D; Gupta T; Mustafa RR; Bhatt DL; Sabik JF 3rd
The Annals of thoracic surgery
2019
2019-09-23
Copyright © 2019. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1016/j.athoracsur.2019.08.023" target="_blank" rel="noreferrer noopener">10.1016/j.athoracsur.2019.08.023</a>
PMID: 31557477