There are heterogenous patterns of AF after cardiac surgery. A substantial minority of AF is short-lived and isolated with no impact on LOS; however, recurrent or prolonged AF significantly affects LOS.
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the United States and industrialized countries. In the undeveloped world a similar epidemic is brewing. A new pathophysiologic paradigm has emerged, which assigns the mediators of inflammation a much larger role in the disease process. This paradigm has helped explain the unpredictable nature of many adverse consequences of CAD. The long latent phase of the disease and often sudden initial presentation make efforts at early detection extremely important. Considerable work has been devoted to identify as well as influence predisposing risk factors for developing arteriosclerosis. Novel markers of inflammation, like C-reactive protein, have been identified and compared to traditional risk factors. In addition, new imaging modalities introduce the possibility of screening for sub-clinical disease. Electron-beam and spiral CT scanners, as well as other techniques, are emerging as powerful tools to detect early disease presence and allow intervention to take place before major clinical events occur. Advances in our understanding of the pathophysiology and our ability to image the stages of silent disease will go hand in hand to revolutionize our approach to prevention and treatment of this deadly disease.
Background —This study seeks to analyze changes in the practice of PTCA in California between 1989 and 1995 by use of the Office of Statewide Health Planning and Development (OSHPD) data set. Methods and Results —All hospital discharges in 1995 with a procedure code for PTCA or stent were identified. The 1995 PTCA data were compared with previously published data from 1989 obtained from the same database. The number of PTCAs performed increased by 49% between 1989 and 1995, from 24 883 to 37 118. The percentage of female patients increased from 29.8% to 32.7% ( P =0.0001). The percentage of diabetics increased from 14.4% to 21.6% ( P =0.0001) between 1989 and 1995. Procedures on patients with a principal diagnosis of acute myocardial infarction increased from 19.3% of all PTCAs in 1989 to 27.5% of PTCAs in 1995 ( P =0.0001). In-hospital mortality increased from 1.4% in 1989 to 1.9% in 1995 ( P =0.0001). There were 3087 admissions with stent placement in 1995. In-hospital mortality after stent placement was 0.9% ( P =0.0001 versus PTCA). Patients undergoing PTCA in hospitals performing >400 PTCAs in 1995 had a 4% incidence of death or emergency bypass surgery compared with a 6% incidence when PTCAs were performed in hospitals performing ≤400 PTCA in 1995 ( P <0.0001). Patients undergoing stent implantation in hospitals performing >75 stent procedures in 1995 had a 1.3% incidence of death or emergency bypass compared with an incidence of 4% when the procedure was performed in a hospital performing ≤75 stent placements in 1995 ( P <0.0001). Conclusions —The 1995 OSHPD data continue to suggest an inverse relationship between hospital PTCA and stent volume and adverse patient outcomes.
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