Introduction: Fractional flow reserve is an established method for assessing coronary artery stenosis severity. However, long-term outcome data in a real-world population is lacking. Aims: We aim to determine whether FFR use is superior to angiography alone in relation to cardiac death and all-cause death in a real-world population. Methods: Patients undergoing angiography between June-2017 and June-2018 recorded by the Centre-for-Health-Record-Linkage (CHeReL) were included. The CHeReL database captures health data from ≥97% of all healthcare facilities in the state of New South Wales, with a population of 7.5 million people. The cohort was stratified into angiography-FFR group when concomitant FFR was performed, and the angiography-only group which included all patients undergoing angiography without concomitant FFR. The primary and secondary outcomes were cardiac death and all-cause death respectively. Results: The study cohort comprised 34,597 patients, in which 32,863 (95%) patients underwent angiography alone and 1,734 (5%) patients had angiography combined with FFR. At 1-year follow-up, the angiography-FFR group had a lower occurrence of the endpoints of cardiac death (0.8% vs 2.3%, P<0.001) and all-cause death (1.7% vs 4.7%, P<0.001) compared to the angiography-only group. Multivariable Cox regression analysis showed FFR use to be associated with lower rates of both cardiac death (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.32-0.93, P=0.025) and all-cause death (HR 0.55, 95% CI 0.38-0.79, P=0.001) independent of age, sex, facility, country of birth, referral source, marital status, Charlson comorbidity index, valvular heart disease, pre-existing atrial fibrillation (AF), presenting illnesses including AF, congestive heart failure or acute coronary syndrome, planned percutaneous coronary intervention or coronary artery bypass graft surgery, and concomitant or subsequent cardiac valve surgery. Conclusions: FFR use was associated with a reduction in both cardiac death and all-cause death in this real-world study.
INTRODUCTION: Haemorrhagic stroke (HS) is an important cardiovascular cause of mortality worldwide. In Australia, long term temporal trends in HS hospitalisation rates and predictors of mortality are unknown. Methods: All New South Wales residents with first-ever HS from 2002-2017 were identified from the Centre-for-Health-Record-Linkage statewide databases. Mortality tracked to 31 Dec 2018 via the death registry were adjusted for age, sex, admission year, referral source, surgical evacuation of HS status, and comorbidities in multivariable regression analyses. Results: There were 35433 patients (51% male) admitted for HS. Age-adjusted mean (±SD) admission rates were higher for males than females (63.6±6.2 vs 49.9±4.4 admissions-per-100,000-persons-per-annum respectively, p<0.001). Annual admission rates declined for both sexes from 2002-2017 (male: 74.4 to 52.5 vs female: 55.2 to 43.6 admissions-per-100,000-persons, both p<0.001 for linear trend). Admission rates were highest in patients ≥60yo but significantly declined from 2002-2017 in both sexes, while admission rates for <60yo patients remained static. Crude in-hospital and 1-year mortality post-HS were 22.5% and 38.2% respectively. Adjusted in-hospital and 1-year mortality post-HS were lower in 2017 compared to 2002 (adjusted odds ratio [aOR]=0.56, 95% confidence interval [CI]=0.49-0.65; adjusted hazard ratio [aHR]=0.73, 95%CI=0.66-0.80, respectively) (all p<0.001). Annual rates of surgical evacuation were static during study period (10.4% per year). Surgical evacuation was associated with better in-hospital and 1-year mortality (aOR=0.47, 95%CI=0.42-0.53; aHR=0.49, 95%CI=0.45-0.53, both p<0.001 respectively). Increasing age and higher Charlson comorbidity index independently predicted greater in-hospital and 1-year mortality. Male sex was associated with lower in-hospital mortality (aOR=0.88, 95%CI=0.83-0.93, p<0.001) but not at 1-year. Conclusion: Age-adjusted admission rates for HS fell between 2002-2017 for both sexes, driven mostly by ≥60 age groups, with adjusted in-hospital and 1-year mortality improving by 43% and 27% respectively. Strategies to improve survival including greater access to surgical evacuation should be further explored.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.