Improved Technology May Obviate Need For Drug When Assessing Patients For A Coronary Stent

Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 08 Dec 2011 - 2:00 PST

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Improved diagnostic technology may obviate need for drug when assessing whether a patient needs a coronary stent.

A new method for measuring narrowing in the arteries of the heart may allow patients to be assessed for a stent without having to take a drug with unpleasant side effects.

In England, it is estimated that one in seven men and one in 12 women over the age of 65 experience chest pain called angina caused by narrowing of the arteries in the heart. Around 60,000 such patients a year are fitted with a coronary stent a wire mesh tube that acts as a scaffold to keep open arteries that risk becoming blocked, leading to a heart attack. However, stents sometimes lead to problems later on as they can promote the growth of scar tissue, leading to re-narrowing of the artery. It is therefore important to determine when a stent is needed and when it might not be worth the risk.

The most accurate method currently used to measure narrowing in arteries requires the patient to take a drug such as adenosine that dilates the blood vessels. Now, a refined, investigational drug-free technique may be just as reliable, according to the results of a feasibility study published today in the Journal of the American College of Cardiology.

Doctors traditionally assess narrowing of the coronary arteries using an X-ray image called a coronary angiogram, but it may not always be clear from the angiogram whether a stent is absolutely necessary.

A technique called fractional flow reserve (FFR), which involves inserting a wire into the artery to measure changes in blood pressure, is sometimes used in addition to an angiogram to give a more clinically accurate measurement to help clinicians make the decision to insert a stent. However, FFR requires the patient to be given a drug such as adenosine to dilate blood vessels, which can cause unpleasant side effects including facial flushing and shortness of breath. Although there is good evidence that FFR is useful, it is done in only 5-10 per cent of cardiac stenting procedures because it is costly, time-consuming and some patients cannot receive adenosine, such as patients with certain heart conduction diseases.

Now, researchers at Imperial College London, in collaboration with US-based medical technology company Volcano Corporation (NASDAQ: VOLC), have developed a way to measure narrowings in the arteries instantaneously, using the same instruments as FFR but without the need for a drug. The new investigational method, termed the instant wave-Free Ratio™ (iFR™ ,could benefit patients by making it easier for doctors to determine whether a stent is the best option.

"FFR is a valuable tool that helps doctors make treatment decisions, but certain barriers mean it isn't used as often as it might be," said lead researcher Dr Justin Davies, from the National Heart and Lung Institute at Imperial College London. "One of those barriers is the need to inject adenosine, which simulates how the heart behaves when the patient is exercising. Having to use adenosine increases the time, cost and complexity of the procedure, not to mention causing some discomfort for the patient. Our new approach could enable doctors to perform an accurate measurement without the use of drugs. We think this will have a big impact on clinical practice."

Like FFR, iFR works by inserting a wire into the coronary artery to measure blood pressure on either side of the narrowing. Dr Davies and his colleagues demonstrated that it was possible to obtain a measurement during a particular time in the heart's cycle, which did not depend on using drugs to dilate the blood vessels.

In the study, the researchers used the new iFR method to measure 157 artery narrowings in 131 patients. They found that iFR produced very similar results to FFR, and that the measurements using iFR were highly reproducible.

This study was funded by the Imperial Comprehensive Biomedical Research Centre, established by a grant from the National Institute for Health Research; and the Coronary Flow Trust with support from Volcano Corporation. iFR is an investigational method being developed, and upon regulatory approval will be commercialized, by Volcano. Additional research is planned to validate this new methodology.

Article adapted by Medical News Today from original press release. Source: Imperial College London
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9 Dec. 2011. APA

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9.4% Of Percutaneous Coronary Intervention Patients Back In Hospital Within A Month

Editor's Choice
Academic Journal
Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 30 Nov 2011 - 8:00 PST

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According to a study published Online First by the Archives of Internal Medicine, one of the JAMA/Archives journals, an examination of the outcomes of over 15,000 individuals who underwent a percutaneous coronary intervention (PCI; balloon angioplasty or stent placement procedures to open narrow coronary arteries) revealed that almost 1 in 10 individuals were readmitted to hospital within 30 days. Furthermore, these patients also had an increased risk of death within one year. Several factors were connected with hospital readmission, including Medicare insurance, female sex, unstable angina and others.

The researchers explain:

"Thirty-day readmission rates have become a quality performance measure, and the Center for Medicare and Medicaid Services (CMS) publicly reports hospital-level, 30-day, risk-standardized readmission rates for patients hospitalized with congestive heart failure (CHF), acute myocardial infarction (AMI; heart attack), and for patients undergoing PCI. However, little is known regarding the factors associated with 30-day readmission after PCI."

Farhan J. Khawaja, M.D., of the Mayo Clinic and Mayo Foundation, Rochester, Minn., and colleagues carried out an investigation in order to detect factors connected with 30-day readmission rates as well as the reason for the readmission and the connection of 30-day readmission with one-year mortality rates for individuals after PCI. The team identified 15,498 PCI hospitalizations (elective or for acute coronary syndromes) between January 1998 and June 2008. A range of models were used in order to estimate the adjusted connection between clinical, demographic, and procedural variable as well as 30-day readmission and one-year mortality.

The team found that overall, 9.4% (1,459) patients who had undergone PCI procedures were readmitted to hospital within 30 days. Out of the 1,459 patients readmitted 1,003 (69%) were readmission due to cardiac-related reasons. Within 30 days there were 106 deaths (0.68%), including 73 deaths not linked to a readmission and 33 deaths that occurred during or after readmission.

The researchers state:

"After multivariate analysis, demographic factors associated with an increased risk of 30-day readmission for PCI included female sex, Medicare insurance, and less than a high school education. The clinical and procedural factors associated with an increased risk of readmission include CHF at presentation, cerebrovascular accident or transient ischemic attack, moderate to severe renal disease, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer, and a length of stay of more than three days."

After the researchers adjusted for various factors they discovered that individuals who were readmitted within 30 days had a higher death rate at one year compared to individuals who were not readmitted.

The researchers explain:

"Thirty-day risk-standardized readmission rates after PCI have become a publicly reported performance measure, and there is high interest from hospitals and clinicians to understand and improve modifiable factors associated with 30-day readmission rates.

Lack of early follow-up has been associated with increased risk of readmission among patients with heart failure and may also be playing a role in patients undergoing PCI. Early follow-up allows patients and clinicians to ensure understanding and compliance, and to gauge the effectiveness of therapies.

The educational component of follow-up cannot be underestimated because in one study, less than half of patients were able to list their diagnoses and the names, purpose, and adverse effects of their medications at the time of discharge. Education at the time of discharge and early follow-up also needs to be tailored to patient education level, which has previously been shown to be associated with the risk of readmission among Medicare beneficiaries."

Adrian F. Hernandez, M.D., M.H.S., and Christopher B. Granger, M.D., of Duke University Medical Center, Durham, N.C., wrote in an invited commentary accompanying the report:

"In the end, reducing hospital readmission rates by preventing progression of disease and occurrence of events should be a goal of care.

To reduce readmissions, we need better evidence on effective approaches that address our health systems shortcomings, ideally identifying and intervening in the most vulnerable patients. Early outpatient follow-up may be a strategy to reduce readmissions but other interventions will be necessary for this complex, multifaceted problem.

Understanding the common issues between PCI readmissions vs. other medical or surgical conditions will be necessary to have broad-based solutions. The challenge is determining what, if any, of these solutions will reduce readmission and improve overall quality of care during this period of patient vulnerability and fragmented care."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our heart disease section for the latest news on this subject. Arch Intern Med. November 28, 2011. doi:10.1001/archinternmed.2011.569.

Arch Intern Med. November 28, 2011. doi: 10/1001/archinternmed.2011.568.

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Grace Rattue. "9.4% Of Percutaneous Coronary Intervention Patients Back In Hospital Within A Month." Medical News Today. MediLexicon, Intl., 30 Nov. 2011. Web.
9 Dec. 2011. APA

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World's First Drug Eluting Bioresorbable Vascular Scaffold Treats Coronary Artery Disease

Main Category: Heart Disease
Also Included In: Medical Devices / Diagnostics;  Clinical Trials / Drug Trials
Article Date: 07 Dec 2011 - 0:00 PST

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The interventional cardiology team at the Montreal Heart Institute (MHI) used the world's first drug eluting bioresorbable vascular scaffold to successfully treat a woman suffering from coronary artery disease. This landmark procedure was performed by Dr. Jean-François Tanguay, interventional cardiologist and coordinator of the Coronary Unit, as part of the ABSORB EXTEND clinical trial. This successful intervention was a first in North America.

A breakthrough that could change the lives of patients

The patient, a woman in her sixties, had suffered from chest pain for a number of months. She was diagnosed with a severe lesion to the heart main artery. She responded favorably to the procedure, was discharged after 24 hours and now, one month after, has regained a normal way of life with no more chest pain.

The investigational ABSORB bioresorbable vascular scaffold, developed by global healthcare company Abbott, is an innovative therapy that restores blood flow by opening a clogged vessel and providing support to the vessel while it heals. Once the vessel can remain open without the extra support, the bioresorbable scaffold is designed to be slowly metabolized until the device dissolves after approximately two years, leaving patients with a treated vessel free of a permanent metallic implant. With no metal left behind, the vessel has the potential to return to a more natural state. After the device has been metabolized, the patient's vessel is free to move, flex, pulsate and dilate similar to an untreated vessel.

For Dr. Jean-François Tanguay, it was important to be part of this first intervention, since during his postdoctoral studies he worked on early models of bioresorbable vascular scaffolds. "Treatments for coronary artery disease have progressed tremendously from the days of balloon angioplasties and metal stents leading to improved clinical outcome in our patients," said Dr. Tanguay, who is also an associate professor of Medicine at the Université de Montréal. "By effectively opening up a blocked artery without leaving a permanent implant behind in the blood vessel, this bioresorbable vascular scaffold has the potential to revolutionize how we treat our patients."

A revolution in the way we treat patients with coronary artery disease

This treatment is available in Canada as part of Abbott's global ABSORB EXTEND clinical trial which is a significant milestone toward making this innovative technology available to heart disease patients in Canada. In Canada, the clinical trial is conducted at four centers, including the Montreal Heart Institute (Dr. Jean-François Tanguay), Institut Universitaire de Cardiologie et de Pneumologie de Québec (Dr. Éric Larose), University of Ottawa Heart Institute (Dr. Marino Labinaz) and St. Michael's Hospital in Toronto (Dr. Christopher E. Buller). The ABSORB EXTEND trial will enroll approximately 1,000 patients from up to 100 centers in Europe, Asia Pacific, Canada and Latin America.

The device is made of polylactide, a proven biocompatible material that is commonly used in medical implants such as dissolvable sutures. ABSORB has CE Mark and is authorized for sale in Europe. It is under clinical investigation around the world with more than 500 patients treated with the device.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Montreal Heart Institute. "World's First Drug Eluting Bioresorbable Vascular Scaffold Treats Coronary Artery Disease." Medical News Today. MediLexicon, Intl., 7 Dec. 2011. Web.
9 Dec. 2011. APA

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Transfer To Another Hospital For Percutaneous Coronary Intervention - Recommended Guidelines Rarely Met

Editor's Choice
Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease
Article Date: 30 Nov 2011 - 8:00 PST

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According to an investigation in the Nov. 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, the estimated time for patients in need of transfer to another hospital for percutaneous coronary intervention (PCI; procedures such as stent placement of balloon angioplasty used to open narrow coronary arteries) seldom meets the recommended guidelines of 30 minutes or less.

The researchers explain:

"Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction (STEMI) who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in to door-out (DIDO) time (i.e., the time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes."

Jeph Herrin, Ph.D., of Yale University School of Medicine, New Haven, Conn., and his team, set out to analyze DIDO times for individuals who arrived at an emergency department with STEMI and who required transfer to another hospital for PCI. The team analyzed data on all individuals' hospitals reported with five or more suitable transfer patients between January 1, and December 31, 2009.

According to results from the study, out of the 13,776 individuals from 1,034 hospital included in the examination, 9.7% (1,343) patients DIDO time was within the recommended 30 minutes, while for 4,267 patients (31%) DIDO time exceeded 90 minutes. After the team adjusted for hospital and patient characteristics they found: Women had a mean (average) estimated time 8.9 minutes longer than men African Americans estimated time was 9.1 minutes longer compared to white patients Individuals aged between 18-35 years had an estimated time considerably longer than all patients apart from those over the age of 75, with a time 18.3 minutes longer relative to those aged 46-55 yearsThe researchers conclude:

"Among patients presenting to emergency departments and requiring transfer to another facility for percutaneous coronary intervention, the DIDO time rarely met the recommended 30 minutes. DIDO time may be a key component of treatment delays in patients with STEMI who are transferred for PCI; improvement efforts should focus on understanding and reducing this delay."

Furthermore, in a study published Online First, Eric A. Secemsky, M.D., of the University of California, San Francisco, and his team set out to analyze if developing a 24-hour cardiac catheterization laboratory (CCL) was connected with enhanced transfer times among individuals with STEMI presenting at a public hospital previously reliant on transferring individuals for percutaneous coronary intervention.

The team enrolled patients with a clinical diagnosis of STEMI between April 2005 and October 2008, successful transfer for angiography and available data for all time intervals. They discovered that among transfer patients, median (midpoint) times were 184 minutes for door-to-catheterization (DTC) and 200 minutes for door-to-balloon (DTB), with no patients transferred in under 90 minutes. Among individuals treated after the 24-hour PCI facility was created median times for DTC reduced to 50 minutes, and median times for DTB decreased to 84 minutes, with 65% of individuals transferred in under 90 minutes.

The researchers conclude:

"Creation of a CCL successfully improved median DTB times to less than 90 minutes, and currently, nearly 90 percent of patients with STEMI are revascularized in less than 90 minutes."

In an article published Online First, Archives editor Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, states: "Primary PCI [pPCI] is resource intensive and therefore not widely available. Of the nearly 5,000 acute care hospitals in the United States, less than one-fourth have PCI capability and even less can provide 24-hours-a-day, 7-days-per-week (24/7) PCI.

Despite years of hard work and noble efforts by many individuals and professional organizations...to enable hospitals to either provide pPCI or reduce door-in to door-out (DIDO) time in transferring to a facility that does, results have been disappointing. After years of well-intentioned arduous efforts to decrease DIDO time, it is time to consider other strategies.

Dr. Redberg concludes:

"The reports by Herrin et al and Want et al show us that DIDO time remains much slower than benchmarks. For low- and intermediate-risk patients, there is no mortality advantage to pPCI over thrombolytic therapy...It is time to reconsider transferring patients with STEMI for pPCI. Timely reperfusion by thrombolytics, not late pPCI via transfer, will save lives."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our cardiovascular / cardiology section for the latest news on this subject. Arch Intern Med. 2011;171[21]:1879-1886; doi:10.1001/archinternmed.2011.564.

Arch Intern Med. November 28, 2011. doi:10.1001/archinternmed.2011.566.

Please use one of the following formats to cite this article in your essay, paper or report:

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Grace Rattue. "Transfer To Another Hospital For Percutaneous Coronary Intervention - Recommended Guidelines Rarely Met." Medical News Today. MediLexicon, Intl., 30 Nov. 2011. Web.
9 Dec. 2011. APA

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Improved Technology May Obviate Need For Drug When Assessing Patients For A Coronary Stent

Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 08 Dec 2011 - 2:00 PST

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Improved diagnostic technology may obviate need for drug when assessing whether a patient needs a coronary stent.

A new method for measuring narrowing in the arteries of the heart may allow patients to be assessed for a stent without having to take a drug with unpleasant side effects.

In England, it is estimated that one in seven men and one in 12 women over the age of 65 experience chest pain called angina caused by narrowing of the arteries in the heart. Around 60,000 such patients a year are fitted with a coronary stent a wire mesh tube that acts as a scaffold to keep open arteries that risk becoming blocked, leading to a heart attack. However, stents sometimes lead to problems later on as they can promote the growth of scar tissue, leading to re-narrowing of the artery. It is therefore important to determine when a stent is needed and when it might not be worth the risk.

The most accurate method currently used to measure narrowing in arteries requires the patient to take a drug such as adenosine that dilates the blood vessels. Now, a refined, investigational drug-free technique may be just as reliable, according to the results of a feasibility study published today in the Journal of the American College of Cardiology.

Doctors traditionally assess narrowing of the coronary arteries using an X-ray image called a coronary angiogram, but it may not always be clear from the angiogram whether a stent is absolutely necessary.

A technique called fractional flow reserve (FFR), which involves inserting a wire into the artery to measure changes in blood pressure, is sometimes used in addition to an angiogram to give a more clinically accurate measurement to help clinicians make the decision to insert a stent. However, FFR requires the patient to be given a drug such as adenosine to dilate blood vessels, which can cause unpleasant side effects including facial flushing and shortness of breath. Although there is good evidence that FFR is useful, it is done in only 5-10 per cent of cardiac stenting procedures because it is costly, time-consuming and some patients cannot receive adenosine, such as patients with certain heart conduction diseases.

Now, researchers at Imperial College London, in collaboration with US-based medical technology company Volcano Corporation (NASDAQ: VOLC), have developed a way to measure narrowings in the arteries instantaneously, using the same instruments as FFR but without the need for a drug. The new investigational method, termed the instant wave-Free Ratio™ (iFR™ ,could benefit patients by making it easier for doctors to determine whether a stent is the best option.

"FFR is a valuable tool that helps doctors make treatment decisions, but certain barriers mean it isn't used as often as it might be," said lead researcher Dr Justin Davies, from the National Heart and Lung Institute at Imperial College London. "One of those barriers is the need to inject adenosine, which simulates how the heart behaves when the patient is exercising. Having to use adenosine increases the time, cost and complexity of the procedure, not to mention causing some discomfort for the patient. Our new approach could enable doctors to perform an accurate measurement without the use of drugs. We think this will have a big impact on clinical practice."

Like FFR, iFR works by inserting a wire into the coronary artery to measure blood pressure on either side of the narrowing. Dr Davies and his colleagues demonstrated that it was possible to obtain a measurement during a particular time in the heart's cycle, which did not depend on using drugs to dilate the blood vessels.

In the study, the researchers used the new iFR method to measure 157 artery narrowings in 131 patients. They found that iFR produced very similar results to FFR, and that the measurements using iFR were highly reproducible.

This study was funded by the Imperial Comprehensive Biomedical Research Centre, established by a grant from the National Institute for Health Research; and the Coronary Flow Trust with support from Volcano Corporation. iFR is an investigational method being developed, and upon regulatory approval will be commercialized, by Volcano. Additional research is planned to validate this new methodology.

Article adapted by Medical News Today from original press release. Source: Imperial College London
Visit our heart disease section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Imperial College London. "Improved Technology May Obviate Need For Drug When Assessing Patients For A Coronary Stent." Medical News Today. MediLexicon, Intl., 8 Dec. 2011. Web.
8 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

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All opinions are moderated before being included (to stop spam)

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View the original article here

9.4% Of Percutaneous Coronary Intervention Patients Back In Hospital Within A Month

Editor's Choice
Academic Journal
Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology
Article Date: 30 Nov 2011 - 8:00 PST

email to a friend   printer friendly   opinions  

According to a study published Online First by the Archives of Internal Medicine, one of the JAMA/Archives journals, an examination of the outcomes of over 15,000 individuals who underwent a percutaneous coronary intervention (PCI; balloon angioplasty or stent placement procedures to open narrow coronary arteries) revealed that almost 1 in 10 individuals were readmitted to hospital within 30 days. Furthermore, these patients also had an increased risk of death within one year. Several factors were connected with hospital readmission, including Medicare insurance, female sex, unstable angina and others.

The researchers explain:

"Thirty-day readmission rates have become a quality performance measure, and the Center for Medicare and Medicaid Services (CMS) publicly reports hospital-level, 30-day, risk-standardized readmission rates for patients hospitalized with congestive heart failure (CHF), acute myocardial infarction (AMI; heart attack), and for patients undergoing PCI. However, little is known regarding the factors associated with 30-day readmission after PCI."

Farhan J. Khawaja, M.D., of the Mayo Clinic and Mayo Foundation, Rochester, Minn., and colleagues carried out an investigation in order to detect factors connected with 30-day readmission rates as well as the reason for the readmission and the connection of 30-day readmission with one-year mortality rates for individuals after PCI. The team identified 15,498 PCI hospitalizations (elective or for acute coronary syndromes) between January 1998 and June 2008. A range of models were used in order to estimate the adjusted connection between clinical, demographic, and procedural variable as well as 30-day readmission and one-year mortality.

The team found that overall, 9.4% (1,459) patients who had undergone PCI procedures were readmitted to hospital within 30 days. Out of the 1,459 patients readmitted 1,003 (69%) were readmission due to cardiac-related reasons. Within 30 days there were 106 deaths (0.68%), including 73 deaths not linked to a readmission and 33 deaths that occurred during or after readmission.

The researchers state:

"After multivariate analysis, demographic factors associated with an increased risk of 30-day readmission for PCI included female sex, Medicare insurance, and less than a high school education. The clinical and procedural factors associated with an increased risk of readmission include CHF at presentation, cerebrovascular accident or transient ischemic attack, moderate to severe renal disease, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer, and a length of stay of more than three days."

After the researchers adjusted for various factors they discovered that individuals who were readmitted within 30 days had a higher death rate at one year compared to individuals who were not readmitted.

The researchers explain:

"Thirty-day risk-standardized readmission rates after PCI have become a publicly reported performance measure, and there is high interest from hospitals and clinicians to understand and improve modifiable factors associated with 30-day readmission rates.

Lack of early follow-up has been associated with increased risk of readmission among patients with heart failure and may also be playing a role in patients undergoing PCI. Early follow-up allows patients and clinicians to ensure understanding and compliance, and to gauge the effectiveness of therapies.

The educational component of follow-up cannot be underestimated because in one study, less than half of patients were able to list their diagnoses and the names, purpose, and adverse effects of their medications at the time of discharge. Education at the time of discharge and early follow-up also needs to be tailored to patient education level, which has previously been shown to be associated with the risk of readmission among Medicare beneficiaries."

Adrian F. Hernandez, M.D., M.H.S., and Christopher B. Granger, M.D., of Duke University Medical Center, Durham, N.C., wrote in an invited commentary accompanying the report:

"In the end, reducing hospital readmission rates by preventing progression of disease and occurrence of events should be a goal of care.

To reduce readmissions, we need better evidence on effective approaches that address our health systems shortcomings, ideally identifying and intervening in the most vulnerable patients. Early outpatient follow-up may be a strategy to reduce readmissions but other interventions will be necessary for this complex, multifaceted problem.

Understanding the common issues between PCI readmissions vs. other medical or surgical conditions will be necessary to have broad-based solutions. The challenge is determining what, if any, of these solutions will reduce readmission and improve overall quality of care during this period of patient vulnerability and fragmented care."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our heart disease section for the latest news on this subject. Arch Intern Med. November 28, 2011. doi:10.1001/archinternmed.2011.569.

Arch Intern Med. November 28, 2011. doi: 10/1001/archinternmed.2011.568.

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Grace Rattue. "9.4% Of Percutaneous Coronary Intervention Patients Back In Hospital Within A Month." Medical News Today. MediLexicon, Intl., 30 Nov. 2011. Web.
8 Dec. 2011. APA

Please note: If no author information is provided, the source is cited instead.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam)

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

World's First Drug Eluting Bioresorbable Vascular Scaffold Treats Coronary Artery Disease

Main Category: Heart Disease
Also Included In: Medical Devices / Diagnostics;  Clinical Trials / Drug Trials
Article Date: 07 Dec 2011 - 0:00 PST

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The interventional cardiology team at the Montreal Heart Institute (MHI) used the world's first drug eluting bioresorbable vascular scaffold to successfully treat a woman suffering from coronary artery disease. This landmark procedure was performed by Dr. Jean-François Tanguay, interventional cardiologist and coordinator of the Coronary Unit, as part of the ABSORB EXTEND clinical trial. This successful intervention was a first in North America.

A breakthrough that could change the lives of patients

The patient, a woman in her sixties, had suffered from chest pain for a number of months. She was diagnosed with a severe lesion to the heart main artery. She responded favorably to the procedure, was discharged after 24 hours and now, one month after, has regained a normal way of life with no more chest pain.

The investigational ABSORB bioresorbable vascular scaffold, developed by global healthcare company Abbott, is an innovative therapy that restores blood flow by opening a clogged vessel and providing support to the vessel while it heals. Once the vessel can remain open without the extra support, the bioresorbable scaffold is designed to be slowly metabolized until the device dissolves after approximately two years, leaving patients with a treated vessel free of a permanent metallic implant. With no metal left behind, the vessel has the potential to return to a more natural state. After the device has been metabolized, the patient's vessel is free to move, flex, pulsate and dilate similar to an untreated vessel.

For Dr. Jean-François Tanguay, it was important to be part of this first intervention, since during his postdoctoral studies he worked on early models of bioresorbable vascular scaffolds. "Treatments for coronary artery disease have progressed tremendously from the days of balloon angioplasties and metal stents leading to improved clinical outcome in our patients," said Dr. Tanguay, who is also an associate professor of Medicine at the Université de Montréal. "By effectively opening up a blocked artery without leaving a permanent implant behind in the blood vessel, this bioresorbable vascular scaffold has the potential to revolutionize how we treat our patients."

A revolution in the way we treat patients with coronary artery disease

This treatment is available in Canada as part of Abbott's global ABSORB EXTEND clinical trial which is a significant milestone toward making this innovative technology available to heart disease patients in Canada. In Canada, the clinical trial is conducted at four centers, including the Montreal Heart Institute (Dr. Jean-François Tanguay), Institut Universitaire de Cardiologie et de Pneumologie de Québec (Dr. Éric Larose), University of Ottawa Heart Institute (Dr. Marino Labinaz) and St. Michael's Hospital in Toronto (Dr. Christopher E. Buller). The ABSORB EXTEND trial will enroll approximately 1,000 patients from up to 100 centers in Europe, Asia Pacific, Canada and Latin America.

The device is made of polylactide, a proven biocompatible material that is commonly used in medical implants such as dissolvable sutures. ABSORB has CE Mark and is authorized for sale in Europe. It is under clinical investigation around the world with more than 500 patients treated with the device.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Transfer To Another Hospital For Percutaneous Coronary Intervention - Recommended Guidelines Rarely Met

Editor's Choice
Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease
Article Date: 30 Nov 2011 - 8:00 PST

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According to an investigation in the Nov. 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, the estimated time for patients in need of transfer to another hospital for percutaneous coronary intervention (PCI; procedures such as stent placement of balloon angioplasty used to open narrow coronary arteries) seldom meets the recommended guidelines of 30 minutes or less.

The researchers explain:

"Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction (STEMI) who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in to door-out (DIDO) time (i.e., the time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes."

Jeph Herrin, Ph.D., of Yale University School of Medicine, New Haven, Conn., and his team, set out to analyze DIDO times for individuals who arrived at an emergency department with STEMI and who required transfer to another hospital for PCI. The team analyzed data on all individuals' hospitals reported with five or more suitable transfer patients between January 1, and December 31, 2009.

According to results from the study, out of the 13,776 individuals from 1,034 hospital included in the examination, 9.7% (1,343) patients DIDO time was within the recommended 30 minutes, while for 4,267 patients (31%) DIDO time exceeded 90 minutes. After the team adjusted for hospital and patient characteristics they found: Women had a mean (average) estimated time 8.9 minutes longer than men African Americans estimated time was 9.1 minutes longer compared to white patients Individuals aged between 18-35 years had an estimated time considerably longer than all patients apart from those over the age of 75, with a time 18.3 minutes longer relative to those aged 46-55 yearsThe researchers conclude:

"Among patients presenting to emergency departments and requiring transfer to another facility for percutaneous coronary intervention, the DIDO time rarely met the recommended 30 minutes. DIDO time may be a key component of treatment delays in patients with STEMI who are transferred for PCI; improvement efforts should focus on understanding and reducing this delay."

Furthermore, in a study published Online First, Eric A. Secemsky, M.D., of the University of California, San Francisco, and his team set out to analyze if developing a 24-hour cardiac catheterization laboratory (CCL) was connected with enhanced transfer times among individuals with STEMI presenting at a public hospital previously reliant on transferring individuals for percutaneous coronary intervention.

The team enrolled patients with a clinical diagnosis of STEMI between April 2005 and October 2008, successful transfer for angiography and available data for all time intervals. They discovered that among transfer patients, median (midpoint) times were 184 minutes for door-to-catheterization (DTC) and 200 minutes for door-to-balloon (DTB), with no patients transferred in under 90 minutes. Among individuals treated after the 24-hour PCI facility was created median times for DTC reduced to 50 minutes, and median times for DTB decreased to 84 minutes, with 65% of individuals transferred in under 90 minutes.

The researchers conclude:

"Creation of a CCL successfully improved median DTB times to less than 90 minutes, and currently, nearly 90 percent of patients with STEMI are revascularized in less than 90 minutes."

In an article published Online First, Archives editor Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, states: "Primary PCI [pPCI] is resource intensive and therefore not widely available. Of the nearly 5,000 acute care hospitals in the United States, less than one-fourth have PCI capability and even less can provide 24-hours-a-day, 7-days-per-week (24/7) PCI.

Despite years of hard work and noble efforts by many individuals and professional organizations...to enable hospitals to either provide pPCI or reduce door-in to door-out (DIDO) time in transferring to a facility that does, results have been disappointing. After years of well-intentioned arduous efforts to decrease DIDO time, it is time to consider other strategies.

Dr. Redberg concludes:

"The reports by Herrin et al and Want et al show us that DIDO time remains much slower than benchmarks. For low- and intermediate-risk patients, there is no mortality advantage to pPCI over thrombolytic therapy...It is time to reconsider transferring patients with STEMI for pPCI. Timely reperfusion by thrombolytics, not late pPCI via transfer, will save lives."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our cardiovascular / cardiology section for the latest news on this subject. Arch Intern Med. 2011;171[21]:1879-1886; doi:10.1001/archinternmed.2011.564.

Arch Intern Med. November 28, 2011. doi:10.1001/archinternmed.2011.566.

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Grace Rattue. "Transfer To Another Hospital For Percutaneous Coronary Intervention - Recommended Guidelines Rarely Met." Medical News Today. MediLexicon, Intl., 30 Nov. 2011. Web.
8 Dec. 2011. APA

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