What is the Optimal Rate of Invasive Coronary Angiography After Acute Coronary Syndrome? (ANZACS-QI 22).
- 作者列表："Chan D","Ghazali S","Selak V","Lee M","Scott T","Kerr A
BACKGROUND:Invasive coronary angiography plays a pivotal role in the management of acute coronary syndromes (ACS). Wide variability in its use has been previously documented. Our aim was to investigate whether coronary angiography is being used appropriately prior to discharge after ACS, taking into account relative contraindications of the procedure. METHODS:Patients presenting with ACS in 2015 to two large, demographically distinct New Zealand (NZ) District Health Boards (DHBs)-Counties Manukau (CMDHB) and Waitemata (WDHB)-were identified from the NZ Ministry of Health National Dataset using ICD-10-AM codes. Patients' clinical data were obtained from the electronic and paper clinical records. Pre-defined relative contraindications to coronary angiography were identified. RESULTS:Of the 3,809 patient admissions coded with ACS, 600 patient admissions (300 from each DHB) were reviewed. Sixty-one (61) (10%) did not meet diagnostic criteria for ACS on review of clinical data and were excluded. Of the patients reviewed, 55% received coronary angiography, with a higher rate in WDHB than CMDHB (61% and 49%, respectively) and 37.5% had relative contraindications documented. The overall rate of angiography was appropriately high in those without a relative contraindication (90.3%) and low in those with one (7.4%). There were fewer patients with relative contraindications in WDHB than CMDHB (36.7% and 48.5%) but the rate of angiography in those with (6.9% and 7.8%) and without (92.5% and 87.5%) contraindications in the two DHBs was similar. CONCLUSIONS:The decision to offer coronary angiography after ACS appears to be appropriately influenced by the presence or absence of relative contraindications. Approximately 60% of patients had no documented relative contraindication suggesting that this may be an appropriate angiography rate in New Zealand practice. However, differences between the two DHBs of around 10% appear to be clinically appropriate due to variation in contraindication rates.
背景: 侵入性冠状动脉造影在急性冠状动脉综合征 (ACS) 的治疗中起着关键作用。以前已经记录了其使用的广泛可变性。我们的目的是调查在ACS后出院前是否适当使用冠状动脉造影，同时考虑到手术的相对禁忌症。 方法: 使用ICD-10-AM个代码，从新西兰卫生部国家数据集中识别2015年向两个大型、人口统计学上不同的新西兰 (NZ) 地区卫生局 (DHBs)-Manukau (CMDHB) 和Waitemata (WDHB)-呈现ACS的患者。患者的临床数据从电子和纸质临床记录中获得。确定了冠状动脉造影的预定相对禁忌症。 结果: 在编码为ACS的3,809例患者入院中，回顾了600例患者入院 (每个DHB 300例)。61例 (61) (10%) 在回顾临床资料时不符合ACS的诊断标准，被排除。在审查的患者中，55% 接受了冠状动脉造影，WDHB的发生率高于CMDHB (分别为61% 和49%)，37.5% 有相对禁忌症记录。无相对禁忌症者的血管造影总发生率较高 (90.3%)，有相对禁忌症者低 (7.4%)。在WDHB中有相对禁忌症的患者少于CMDHB (36.7% 和48.5%)，但在两种dhb中有 (6.9% 和7.8%) 和没有 (92.5% 和87.5%) 禁忌症的患者中，血管造影率相似。 结论: ACS后提供冠状动脉造影的决定似乎受到相对禁忌症的存在与否的适当影响。大约60% 的患者没有记录的相对禁忌症，这表明这可能是新西兰实践中合适的血管造影率。然而，由于禁忌症发生率的变化，约10% 的两个dhb之间的差异似乎是临床上合适的。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.