There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES).
In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial, comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months.
The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2 years were further assessed with specific focus on patient-related composite (all death, all MI, or any revascularization) and stent-related composite outcomes (cardiac death, target vessel MI, or symptom-driven target lesion revascularization). A total of 1,390 patients were assigned to receive the EES, and 1,384 patients were assigned to receive the SES.
At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15.6% in the SES group, (HR: 0.95, 95% CI: 0.78 to 1.15), and the stent-related outcome: 5.2% in the EES group versus 5.3% in the SES group (HR: 0.97, 95% CI: 0.70 to 1.35) did not differ between groups. Rate of definite stent thrombosis was lower in the EES group (0.2% vs. 0.9%, (HR: 0.23, 95% CI: 0.07 to 0.80).
At 2-year follow-up, the EES was found to be noninferior to the SES with regard to both patient-related and stent-related clinical outcomes.
Analyze clinical, temporal and procedural characteristics from 7,528 consecutive percutaneous coronary intervention (PCI) patients in one of the largest published contemporary European PCI-database during a 6-year period.
Retrospective study design.
1998-2004. Temporal and referral changes in a Danish PCI-registry were analyzed. Demographic and angiographic variables were compared with data from randomized clinical trials, US-registries and current guidelines.
22,214 patients were examined with coronary angiography and 7,528 patients were treated with PCI. The annual number of PCI's increased by 15%. Over time, the fraction of patients with risk factors increased, median age increased from 61 to 64 years and the coronary pathology was significantly worsened. ST-elevation myocardial infarction patients primarily admitted to hospitals without facilities for primary angioplasty, were less likely to receive primary PCI. Baseline-data were in general in par with randomized clinical trial study populations and large-scale US data-registries. Interestingly, 14% of all PCI-procedures were performed on patients with a clinical presentation, for which coronary artery bypass grafting would be recommended by guidelines.
PCI is performed in an increasingly sicker population, but generally in accordance with randomized trials and similar to US tradition. However, 14% were treated with PCI even though coronary artery bypass grafting was recommended by guidelines.
Results of 35-years clinical investigation on acute coronary syndrome performed in the 3rd Central military clinical hospital named after A.A. Vishnevsky are presented. Research topics are the following: pathways of blood coagulation alterations,lipid metabolism, improving drug management of ischemic heart disease exacerbations, new medical technologies in diagnostics and treatment of acute coronary syndrome. Decision procedure in patient with acute coronary syndrome was developed in the Hospital. Criteria for percutaneous coronary interventions and coronary artery bypass surgery were elaborated. Original scale for death and cardiac complications risk assessment in patients with acute myocardial infarction undergoing coronary artery stenting was developed. According to the scale, differential scheme of antiplatelet therapy was introduced, and its implementation resulted in decrease of complications rate. Advantage of early invasive strategy vs. conservative approach was proven.
To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort.
Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization.
A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in-hospital survival were identified utilizing logistic regression.
ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization (P = 0.013, OR = 0.26 (95% CI: 0.09-0.76), hyperlactatemia (P = 0.046, OR = 1.14 (95% CI: 1.002-1.3) per mmol increase), baseline renal insufficiency (P = 0.043, OR = 3.45, (95% CI: 1.04-11.4), and the presence of anoxic brain injury (P = 0.008, OR = 8.22 (95% CI: 1.73-39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population (N = 101), independent predictors of survival to discharge included complete revascularization (P = 0.03, OR = 2.5 (95% CI: 1.1-6.2)) and peak lactate (P = 0.02).
The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.
Comment In: Catheter Cardiovasc Interv. 2011 Oct 1;78(4):549-5021953751
Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization.
Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada.
Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization.
Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers.
Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.
Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.
We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC ( or = 105 km). Revascularization rates are adjusted for age and sex.
The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close ( or = 32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64-105 km).
The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (
Cites: Can J Cardiol. 1999 Nov;15(11):1277-8210579743
The current survival trends in patients with acute myocardial infarction (AMI) are not known. A population-based study using administrative data to examine the short and long term survival of patients after AMI in Alberta between 1994 and 1999 was conducted.
AMI patients were identified from hospital discharge data. Temporal changes in the adjusted (age, sex, AMI anatomical location and comorbidities) fatality rate were analyzed in 19,928 AMI patients.
The age- and sex-adjusted incidence of hospitalization for AMI in Alberta significantly declined from 169.6 per 100,000 population in 1994 to 160.8 per 100,000 in 1999 (P=0.03). The risk-adjusted in-hospital case fatality rate from all causes was 11.4% (95% CI 10.6% to 12.3%) in 1994 versus 9.2% (8.4% to 10.1%) in 1999; the 30-day case fatality rate was 12.6% (11.7% to 13.6%) in 1994 versus 10.1% (9.1% to 11.0%) in 1999; and the one-year case fatality rate was 19.0% (17.8% to 20.1%) in 1994 versus 14.9% (13.8% to 16.0%) in 1999. The percentage of hospitalized AMI patients who underwent coronary angiography within one year after admission rose from 48.2% in 1994 to 52.4% in 1999; percutaneous transluminal coronary angioplasty increased from 25.5% to 35.0% and coronary artery bypass surgery increased from 9.7% to 12.6%. Prescriptions for pharmacological drugs at discharge increased from 1994 to 1999 among patients aged 65 and older: from 29.5% in 1994 to 41.0% in 1999 for beta-blockers, from 5.2% to 18.7% for lipid lowering agents and from 14.0% to 20.5% for angiotensin-converting enzyme inhibitors.
There was a modest improvement in patient survival after AMI between 1994 and 1999. The improvements may be associated with increasing use of revascularization and pharmacological therapy provided in the management of AMI.