There is increasing evidence that a low vitamin D status may be an important and hitherto neglected factor of cardiovascular disease. This review is an overview of the current body of literature, and presents evidence of the mechanisms through which vitamin D deficiency affects the cardiovascular system in general and the heart in particular. Available data indicate that the majority of congestive heart failure patients have 25-hydroxyvitamin D deficiency. Furthermore, the low serum 25-hydroxyvitamin D level has a higher impact on hypertension, coronary artery disease an on the occurrence of relevant cardiac events. A serum 25-hydroxyvitamin D level below 75 nmol/l (30 ng/l) is generally regarded as vitamin D insufficiency in both adults and children, while a level below 50 nmol/l (20 ng/l) is considered deficiency. Levels below 50 nmol/l (20 ng/l) are linked independently to cardiovascular morbidity and mortality.
Objective
Comparing outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT).
Background
PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCT have compared outcomes of the two modalities in patients with multivessel CAD.
Methods
We did a meta-analysis from six RCT in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively.
Results
Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR= 2.31; 95% CI: [1.80–2.96]; P=<0.0001), lower incidence of stroke (RR= 0.35; 95% CI: [0.19–0.62]; P=0.0003), and no difference in death (RR= 1.02; 95% CI: [0.77–1.36]; P= 0.88) or MI (RR= 1.16; 95% CI: [0.72–1.88]; P= 0.53). At 5 years, PCI was associated with a higher incidence of death (RR= 1.3; 95% CI: [1.10 – 1.54]; P= 0.0026) and MI (RR= 2.21; 95% CI: [1.75–2.79]; P=<0.00 01).While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients.
Conclusion
In patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI.
Objectives
To assess the impact of aggressive protocol to decrease door-to-balloon (DTB) time on the incidence of false-positive STEMI (FP-STEMI) and in-hospital mortality.
Patients
Consecutive patients with presumed STEMI with confirmed ST-segment elevation that underwent emergent catheterization.
Methods
In July 1, 2009 we instituted an aggressive protocol to further reduce DTB time. A quality improvement (QI) initiative was initiated in January 1, 2010 to maintain short DTB while improving outcomes. Outcomes were compared before and after aggressive DTB and similarly before and after the QI initiative. Outcomes were DTB time, the incidence of FP-STEMI and in-hospital mortality. A review of the emergency catheterization database over the last 10 years (January 2001-December 2010) was carried out for historical comparison.
Results
Between July 1, 2008 and December 1, 2012, 1031 consecutive patients with presumed STEMI were assessed. Of these 170 were considered FP-STEMI. The median DTB time decreased from 76 to 61 minutes with the aggressive DTB protocol (P=. 001), accompanied by an increase of FP-STEMI (7.7% vs. 16.5%, p=.02). While TP-STEMI in-hospital mortality witnessed non-significant reduction, this was associated with a significant increase of FP-STEMI in-hospital mortality. After the QI initiative, a shorter DTB time (59 minutes) was maintained while decreasing FP-STEMI in-hospital mortality.
Conclusion
Aggressive measures to reduce DTB time were associated with an increased incidence of FP-STEMI and FP-STEMI in-hospital mortality. Efforts to reduce DTB time should be monitored systematically to avoid unnecessary procedures that may delays other appropriate therapies in critically ill patients.
Peripheral arterial disease (PAD) is responsible for 20% of all US hospital admissions. Management of PAD has evolved over time to include many medical and transcatheter interventions in addition to the traditional surgical approach. Non-invasive interventions including supervised exercise programs and antiplatelets use are economically attractive therapies that should be considered in all patients at risk. While surgery offers so far a clinically and economically appropriate option, the improvement of percutaneous transluminal angioplasty (PTA) technique with the addition of drug-coated balloons offers a reasonably clinically and economically attractive alternative that will continue to evolve in the future.
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