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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Angioplasty Performed Without Pre-Procedural Aspirin

Angioplasty Performed Without Pre-Procedural Aspirin | Heart and Vascular Health | Scoop.it

Aspirin is an essential medicine before and after angioplasty or percutaneous coronary intervention (PCI). Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI. 

The study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h before undergoing PCI. Aspirin nonreceivers were more likely to have had previous gastrointestinal bleeding or to present with cardiogenic shock or after cardiac arrest. Absence of aspirin before PCI was associated with a higher rate of death (3.9% vs. 2.8%; p < 0.001) and stroke (0.5% vs. 0.1%;  with no difference in need for transfusions. This association was consistent across multiple pre-specified subgroups.

Conclusions  Lack of aspirin before PCI was associated with significantly increased in-hospital mortality and stroke. Our study results support the need for quality efforts focused on optimizing aspirin use before PCI.

Seth Bilazarian, MD's insight:

The inexpensive, readily available medicine, aspirin before PCI reduces death and stroke significantly.  The 1.1% absolute risk reduction means that for every 91 people who are taking aspirin before angioplasty or PCI, one life will be saved.  This quality metric has become part of the pre-procedure assessment for patients it's so important

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Nonemergency PCI (angioplasty) at Hospitals with or without On-Site Cardiac Surgery

Nonemergency PCI (angioplasty) at Hospitals with or without On-Site Cardiac Surgery | Heart and Vascular Health | Scoop.it

A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point.

Seth Bilazarian, MD's insight:

Good news for community hospitals doing quality work and for patients relying on local care for heart disease and treatment with angioplasty (PCI). In Massachusetts, safety and efficacy of balloon angioplasty & stenting in community hospitals (without On-site cardiac surgery) to treat patients with coronary artery disease was not different than large academic hospitals (with surgery on site).  Study conducted by physicians at hospitals with on-site cardiac surgery.

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Why Severe Heart Attacks Are Becoming Less Deadly = Stents

Why Severe Heart Attacks Are Becoming Less Deadly = Stents | Heart and Vascular Health | Scoop.it

Severe heart attacks may not be as deadly as they used to be, according to new research.  A new French study demonstrated that patients hospitalized for severe heart attacks – technically known as ST-elevation myocardial infarctions – the chances of dying within 30 days dropped from 13.7% in 1995 to 4.4% in 2010, an improvement of 68%.
Researchers looked at data from nationwide registries in France 1995- 2010 of 6,700 patients who had heart attacks and were admitted to intensive care units. They found that the improvement in survival was likely related to a number of factors, including demographic changes, more timely presentation to hospitals, improvements in medications and treatments, and higher rates of STENTING open up blocked arteries.

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America’s Coronary Stent Hot Spots

America’s Coronary Stent Hot Spots | Heart and Vascular Health | Scoop.it

While coronary stents have proved effective in restoring blood flow in heart-attack patients, research shows they are no better than medicine, exercise and dietary restrictions in preventing heart attacks in elective patients whose heart disease is deemed stable. When doctors opt for stents, they prop open coronary arteries in a procedure called Percutaneous Coronary Intervention, or PCI. More than 90 percent of PCIs include stenting. To show where the use of stents is high, Bloomberg News ranked regional health-care markets by three measures: the number of PCI procedures for every 1,000 Medicare enrollees; how often they are performed for every 1,000 angiography scans of coronary arteries; and the number per 1,000 cases of diagnosed ischemia — or reduced cardiac blood flow. More procedures in each case may indicate locales where doctors are more inclined to use stents.

Seth Bilazarian, MD's insight:

The variability in utilization of stenting procedures is very impressive and hard to explain on differences in demographics.  The red spots are 3 times greater than the blue and the gold color is twice the rate of the blue areas.  The blue areas are NOT under-served.  The northwest and northeast have very high concentrations of cardiologists. There are local cultural influences driven by physicians and patients and hospitals which account for these differences.

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Can You Do Too Much to Prevent a Stroke?

Can You Do Too Much to Prevent a Stroke? | Heart and Vascular Health | Scoop.it
Too many people who are free of symptoms associated with stroke are undergoing surgery to clear carotid arteries, or are having stents inserted, than is justified by available evidence, experts say.

Stroke is the fourth leading cause of death among Americans, and a much larger contributor to chronic disability and health care costs than this ranking suggests. There’s no question that preventing strokes is important. But a big question is how best to do so and in whom.

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