Background and Aims There is a possibility of the high variability of the appropriateness of PCI performed in Indonesia. It is assumed that appropriate PCI tends to have clinical outcomes than other categories. This study aimed to evaluate the appropriateness of the percutaneous coronary intervention (PCI) procedure in Indonesia. Method and Results We assigned appropriateness ratings to 214 acute coronary syndromes (ACS) and 191 stable ischemic heart disease (SIHD) records that underwent PCI in four hospitals from 2017 - 2018. The included hospitals consist of one public and three private hospitals, two cardiovascular centers, and two general hospitals with the most performed PCI procedures on 2016 - 2018 and accessible to the researchers. The PCI appropriateness was adjudicated using 2016/2017 ACC/AHA guidelines of the Appropriate Use of Care (AUC) for coronary revascularization in ACS and SIHD. The results were categorized into “appropriate”, “maybe appropriate”, and “rarely appropriate”. The result from this study demonstrated that in ACS patients, 76.0% and 24.0% of PCI were appropriate” and “maybe appropriate”. While, in SHID patients, 68.7%, 28.7%, and 2.6% of PCI were “appropriate”, “maybe appropriate”, and “rarely appropriate”. In ACS patients, “appropriate” PCI is more commonly found in ST-elevation myocardial infarction (STEMI) cases (62.6%). In SIHD patients, 54.0% and 46.0% of left-main diseases patients underwent “maybe appropriate” and “rarely appropriate” PCI. Conclusion The majority of PCI performed in ACS and SIHD patients from the studied hospitals are “appropriate”.
Background: In patients with acute coronary syndrome (ACS), the role of admission blood pressure (BP) on outcomes remains inconclusive.Objective: This study aimed to investigate the association between admission BP and various outcomes in patients hospitalized for ACS. Method:In this cross-sectional study, 279 patients who admitted with ACS to Kediri District Hospital and Bogor General Hospital between January and June 2020 were included. Data were analyzed using SPSS software v25.Result: There was association between hypertension status on admission and diagnosis; there were more hypertensive patients with non-ST segment elevation (NSTE) ACS compared to ST segment elevation (STE) ACS diagnosis (p=0.002); and signifi cant difference on admission systolic BP between STE-ACS and NSTE-ACS patients (p<0.00001). Patients who died during hospitalization had signifi cantly lower admission systolic BP compared to survived patients (p=0.001). Patients with reduced ejection fraction (EF) on follow-up echocardiography had signifi cantly lower admission systolic BP compared to patients with normal EF (p=0.014). Patients with diastolic dysfunction on follow-up echocardiography had signifi cantly higher admission systolic BP compared to patients without diastolic dysfunction (p=0.009). No signifi cant difference on length of stay between hypertensive and non-hypertensive patients (p=0.416). Conclusion:Lower admission systolic BP was associated with increased inhospital mortality and reduced EF, while higher systolic BP was associated with diastolic dysfunction.
Background:The results of clinical trials of phosphodiesterase (PDE) 5 inhibitors for the treatment of HFpEF patients are inconsistent. Thus, we undertook a meta-analysis to evaluate the clinical value of sildenafil for HF with preserved EF (HFpEF) patients.Methods: Relevant studies were searched and identified in the PubMed, Cochrane Library and EMBASE databases. We searched randomized controlled trials (RCTs) that compared PDE5i with placebo in HFpEF and extracted relevant clinical data.Results: Six RCTs enrolling 471 HFpEF patients were included in the meta-analysis. Compared with placebo, sildenafil was not significantly associated in death (OR = 1.12, 95%CI: 0.06 to 19.40), adverse events (OR = 2.55, 95%CI:0.67 to 9.62) . Also, sildenafil therapy had no impact on the patient's six-minute walk test, PASP, E/e', peak VO2, NT-proBNP but improved at PVR(SMD = -1.04, 95% CI = -1.96 to -0.13) significantly compared to placebo in HFpEF patients. Whereas, if only the RCT study with HFpEF combined with pulmonary hypertension is included, sildenafil therapy was associated with a marked improvement in E/e' (SMD = -0.745, 95% CI = -1.24 to -0.25) in HFpEF patients combined with pulmonary hypertension.Conclusions: Compared with placebo, sildenafil therapy was associated with the improvement of diastolic function in HFpEF patients combined with pulmonary hypertension, while sildenafil treatment of HFpEF patients does not increase death or rehospitalization.
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