Introduction: Adherence to secondary prevention medication has a potential significant benefit on outcome and mortality. We examined whether adherence to betablockers differ by sex and the effect of adherence to beta-blockers on outcome using data from the Genesis Cardiovascular Outcome Registry (GCOR). Methods: Data was prospectively collected on 8255 patients (1866 women and 6386 men). Patients were assessed for 1-year adherence and effect on outcome measured by death, MACE, MI, TVR, and unplanned readmission. Results: Drug adherence at 1-year was significantly lower in men compared to women (47.9% vs 51.3%, p=0.01). Patients adherent to beta-blockers at 1-year had a significant reduction in the risk of death (HR 0.30; 95% CI 0.14-0.61, p=0.001), with the benefit similar for both women (HR 0.17; 95% CI 0.04-0.79, p=0.02) and men (HR 0.37; 95% CI 0.16-0.86, p=0.02). A significant increase in risk for myocardial infarction at 1-year was noted for the whole cohort (HR 2.72; 95% CI 1.44-5.15, p=0.002), with the highest risk of myocardial infarction noted in men (HR 3.30; 95% CI 1.55-7.02, p=002). An increased risk for unplanned readmission was noted (HR 1.20; 95% CI 1.03-1.39, p=0.02), with similar rates seen for women and men. Conclusion: Adherence to betablockers at 1-year was associated with a significant reduction in death. The increase risk of MI in men and higher rate of unplanned readmission needs further investigation.
Background: Coronary angiography, important for the diagnosis and treatment of CAD, is mainly conducted via the transradial or transfemoral approach. The aim is to determine whether, in patients with varying BMI, either approach would impact the radiation dose, contrast volume or fluoroscopy time required. This could help inform decisions about which approach would be preferable for patients of certain BMI. Methods: 849 participants underwent angiography via transradial or transfemoral approach. Patients with severe PAD, cardiogenic shock and old CABG were excluded. Primary outcome variables were fluoroscopy time, radiation dose, and contrast volume. Results: A significant positive correlation between radiation dose and BMI was found for both radial and femoral approaches. Radiation exposure via transradial approach was slightly more strongly correlated (B=0.421[!ln txfm'ed],p,0.001) with BMI than femoral (B=0.335[!ln txfm'ed],p,0.001). The association between radiation dose and BMI as a continuous variable was found to be significant in the transradial (p=0.005) and transfemoral (p=0.002) approaches. The association between the other variables and BMI was significant in the transfemoral (p,0.001) but not in the transradial (fluoroscopy time: p=0.955; contrast volume: p=0.480) approach. Conclusion: Our study shows that there is a positive correlation between radiation dose and BMI in both transradial and transfemoral approaches, with the correlation being stronger in the transradial approach. For patients with higher BMI, the transfemoral approach may be preferable to minimise the increase in the radiation dose.
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