To develop guidelines for ranking the urgency with which patients with angiographically proven coronary disease need revascularisation procedures, factors that a panel of cardiac specialists agreed were likely to affect urgency were incorporated into 438 fictitious case-histories. Each panelist then rated the cases on a 7-point scale based on maximum acceptable waiting time for surgery; 1 on the scale represented emergency surgery and 7 delays of up to 6 months. For only 1% of cases was there agreement on a single rating by at least 12/16 panelists. Results of this ranking exercise were used by the panel to draw up triage guidelines. The three main urgency determinants were severity and stability of symptoms of angina, coronary anatomy from angiographic studies, and results of non-invasive tests for risk of ischaemia. Together these three factors generally gave an urgency rating for any given case to within less than 0.25 scale points of the value predicted with all factors. A numerical scoring system was derived to permit rapid estimation of the panel's recommended ratings.
Comment In: Lancet. 1990 Aug 4;336(8710):310-11973994
BACKGROUND: Larger studies evaluating the angiographic results of second-generation stents are scarce. The objectives of this study were to assess current standards of angiographic and clinical outcomes after implantation of the second-generation stainless steel stent, NIR (Medinol Ltd, Tel Aviv, Israel), and to compare the outcomes with those of the first-generation Palmaz-Schatz (PS) stent (Johnson & Johnson, Warren, NJ). METHODS: Patients having coronary artery lesions that could be covered by a stent of 15 mm in length were randomly assigned to receive the NIR or the PS. Procedural success, 6-month angiographic findings, and 1-year clinical outcomes were determined. RESULTS: In 424 patients included in the study, the overall procedural success rate was high (NIR 98%, PS 99%, P =.90). Follow-up angiography was conducted in 91% of the patients. The overall rate of angiographic restenosis was low in both groups (NIR 9.9%, PS 12.6%, P =.35). We found a low restenosis rate in vessels with a minimal lumen diameter >3.1 mm after the procedure, particularly in the NIR group (
The technique of Percutaneous Coronary Intervention (PCI) has improved considerably over the last decades. Important developments have been the introduction of stents and better anticoagulation treatment. PCI is used most commonly in the treatment of unstable angina pectoris or non ST-elevation myocardial infarction. In Sweden today, more than half of the patients with ST-elevation myocardial infarction are treated primarily with PCI. Despite the high degree of opening of the infarct-related artery, the reduction in mortality is modest compared with treatment with thrombolysis indicating that there is room for considerable improvement. There is a need for randomised studies of adjunctive therapies but it can be speculated that thrombectomy devices and specific reperfusion injury therapy might reduce mortality in PCI treatment of ST-elevation myocardial infarction.
STUDY OBJECTIVES: Snoring is associated with a significant increased risk for acute myocardial infarction and stroke. However, our knowledge of mechanisms is still incomplete. The aim of the study was to investigate the influence of snoring in combination with feelings of tiredness on the 3-year progression of atherosclerosis in women with cardiovascular disease. DESIGN: Repeated quantitative coronary angiograms were carried out with an average time interval of 3.25 years. SETTING: Department of Thoracic Radiology at Karolinska Hospital, Stockholm, Sweden. PARTICIPANTS: The study sample comprised 103 women cardiac patients with repeated, valid, and comparable measurement of quantitative coronary angiograms. MEASUREMENTS AND RESULTS: Absolute luminal diameter (in mm) was measured in 10 predefined coronary segments. Mean segment diameter was calculated as the mean of all diameters measured along a given segment. The change over time was calculated by subtracting the first from the second measurement. Snoring and feelings of tiredness were measured by a short version of the Karolinska Sleep Questionnaire. We found that snoring women, after adjusting for age, waist-hip ratio, smoking, event at hospitalization, education, hypertension and alcohol intake, had a statistically significantly larger progression of atherosclerosis than did nonsnoring women (0.18 mm vs 0.07 mm change; P = .0006). CONCLUSION: Snoring contributes to the atherosclerotic process and should be taken into consideration when treating patients with cardiac disease.