IntroductionPatients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists.Material and methodsFive hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after hospitalization. The surveys were carried out in 1997–1998, 1999–2000, 2006–2007 and 2011–2013.ResultsThe proportion of smokers increased from 16.0% in 1997–1998 to 16.4% in 2011–2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% (p < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% (p = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% (p < 0.01), 47.7% and 52.8% (p = 0.53), 44.2% and 42.2% (p = 0.75) for high blood pressure, and 42.5% and 71.2% (p < 0.001), 51.4% and 79.6% (p < 0.001), 52.4% and 72.4% (p < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group.ConclusionsThe control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs.
Zawał serca z uniesieniem odcinka ST spowodowany późną zakrzepicą w stencie metalowym, leczony dowieńcowym podaniem abciksimabu oraz aspiracyjną trombektomią Z Zb bi ig gn ni ie ew w S Si iu ud da ak k 1 1 , , J Ja ac ce ek k G Go od dl le ew ws sk ki i 2 2 , , L Le es sz ze ek k B Ba ad da ac cz z A b s t r a c tA case of a 56-year-old male with a diagnosis of ST-segment elevation myocardial infarction caused by in-stent thrombosis in a previously impanted bare metal stent after discontinuation of aspirin is presented. On admission there were ST segment elevations in leads II, III, aVF with Q wave in III and aVF in the electrocardiogram. Three years before the admission patient had suffered from inferior wall myocardial infarction and was treated successfully with primary percutaneous coronary intervention (PPCI) of the right coronary artery with bare metal stent (BMS) implantation. Twelve months after the index PPCI patient stopped receiving all medications including ASA. He felt he was in good health condition and did not need to take medications any longer. For the next 2 years he had never visited doctor for follow-up visit. In current angiography occlusion of the right coronary artery with thrombus was identified. Patient was treated with aspiration thrombectomy which revealed large thrombus burden and with intralesion administration of bolus of abciximab via thrombectomy catheter. Afterwards PCI with drug eluting stent implantation was performed. Patient was discharged home after 5 days. At discharge his antiplatelet therapy consisted of acetylsalicylic acid (75 mg once daily) for life, and clopidogrel (75 mg once daily, for at least 12 months).K Ke ey y w wo or rd ds s: : abciximab, myocardial infarction, thrombectomy, stent thrombosis S t r e s z c z e n i ePrzedstawiono przypadek 56-letniego pacjenta z zawałem serca z uniesieniem odcinka ST spowodowanego późną zakrzepicą w stencie metalowym po odstawieniu leczenia przeciwpłykowego kwasem acetylosalicylowym. Przy przyjęciu do pracowni hemodynamiki w zapisie elektrokardiograficznym obserwowano uniesienia odcinka ST o charakterze falii Pardeego w odprowadzeniach II, III, aVF oraz patologiczne załamki Q w III i aVF. Trzy lata wcześniej pacjent miał wykonaną przezskórną interwencję wieńcową w zakresie prawej tętnicy wieńcowej połączoną z implantacją stentu metalowego z powodu świeżego zawału serca. Zabieg wykonano optymalnie, przebiegł bez powikłań. Dwanaście miesięcy po przezskórnej interwencji wieńcowej chory przestał zażywać leki, w tym kwas acetylosalicylowy, ponieważ czuł się dobrze. Przez następne 2 lata nie zażywał żadnych leków i nie był u kontroli u lekarza. W obecnym badaniu koronarograficznym stwierdzono zamknięcie prawej tętnicy wieńcowej z obecnością dużej skrzepliny. Zastosowano trombektomię aspiracyjną systemem 6 F. W koszyczku uwidoczniono dużą ilość odessanego materiału zakrzepowego i zatorowego. Następnie podano dowieńcowo bolus abciksimabu i uzyskano znaczącą redukcję skrzepliny. Ostatecznie wykonano przezskórną interwencję wieńcową z im...
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