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Heart and Vascular Health
Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque

Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque | Heart and Vascular Health | Scoop.it

More intensive statin therapy reduces cardiovascular morbidity and mortality. However, the mechanism of the dose-dependent effect on plaque stabilization by statin therapy is not fully elucidated.

Micron resolution of optical coherence tomography allows detailed assessment of fibrous cap thickness, which contributes to plaque instability.

Increase in fibrous cap thickness in coronary atherosclerotic plaque benefits from higher dose atorvastatin compared with a lower regimen in patients with unstable angina pectoris.

Larger and longer term studies are needed to determine the direct relationship between an increase in fibrous cap thickness and coronary event risk reduction.

Seth Bilazarian, MD's insight:

This study used imaging called Optical Coherence Tomography (OCT) to assess plaques in the coronary arteries.  Use of statin medications like Atorvastatin (Lipitor) reduces the amount of cholesterol in the blood but this study adds direct evidence that in addition to reducing the plaque size it also thickened the overlying cover of the plaque called the fibrous cap.  When this cap becomes disrupted (erodes or ruptures) clot forms and a heart attack can ensue.  This mechanism of benefit through plaque stabilization is a critical contributor to the benefits of statin therapy in patients with coronary plaques.

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Choosing wisely for interventionalists: top 5

Choosing wisely for interventionalists:  top 5 | Heart and Vascular Health | Scoop.it

FFR, BMS, complete angiography, complete revascularization, radial approach: best patient care, save healthcare dollars.

 

Calling all interventionalists: What five practices would you highlight to promote best patient care and save healthcare dollars? Here are 5 ideas from my community practice perspectives:

1. Use FFR liberally for intermediate lesions but not for severe ones
2. Use bare-metal stents if there's any doubt about the patient's insurance status
3. Do complete angiography before intervention
4. Don't send patients home without complete revascularization
5. Take up the radial approach

 

What's on your list?

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Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA

Systems of Care for Heart Attack => ST-Segment–Elevation MI from AHA | Heart and Vascular Health | Scoop.it

Key take away for patients:

This paper was a survey of over 300 hospitals that take care of the sickest type of heart attack called the STEMI.  Best practices to improve care by reducing the time to open up the artery (called door to balloon time (D2B)) were identified. 

 

These practices are:

1.  accepting patients at a PCI hospital regardless of bed availability

2.  single phone call activation of cath lab

3.  emergency department physician activation
of lab without cardiology consultation

4.  national data registry participation

5.  Prehospital activation of the catheterization laboratory by paramedics & transferring physicians.

 

The most commonly reported barriers to system
implementation were hospital and cardiology group
competition and EMS transport and finances.

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