1,721,021 research outputs found
In-hospital outcomes of ad hoc versus planned PCI for unprotected left-main disease:An analysis of 8574 cases from British Cardiovascular Intervention Society database 2006-2018
Full text linkBACKGROUND: Although data suggests ad hoc percutaneous coronary intervention (PCI) results in similar patient outcomes compared to planned PCI in nonselected patients, data for ad hoc unprotected left main stem PCI (uLMS-PCI) are lacking.AIM: To determine if in-hospital outcomes of uLMS-PCI vary by ad hoc versus planned basis.METHODS: Data were analyzed from all patients undergoing uLMS-PCI in the United Kingdom 2006-2018, and patients grouped into uLMS-PCI undertaken on an ad hoc or a planned basis. Patients who presented with ST-segment elevation, cardiogenic shock, or with an emergency PCI indication were excluded.RESULTS: In total, 8574 uLMS-PCI procedures were undertaken with 2837 (33.1%) of procedures performed on an ad hoc basis. There was a lower likelihood of intervention for stable angina (28.8% vs. 53.8%, p < 0.001) and a higher rate of potent P2Y12 inhibitor use (16.4% vs. 12.1%, p < 0.001) in the ad hoc PCI group compared to the planned PCI group. Patients undergoing uLMS-PCI on an ad hoc basis tended to undergo less complex procedures. Acute procedural complications including slow flow (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.01-2.86), coronary dissection (OR: 1.41, 95% CI: 1.12-1.77) and shock induction (OR: 2.80, 95% CI: 1.64-4.78) were more likely in the ad hoc PCI group. In-hospital death (OR: 1.65, 95% CI: 1.19-2.27) and in-hospital major adverse cardiac or cerebrovascular events (OR: 1.50, 95% CI: 1.13-1.98) occurred more frequently in the ad hoc group. In sensitivity analyses, these observations did not differ when several subgroups were separately examined.CONCLUSIONS: Ad hoc PCI for uLMS disease is associated with adverse outcomes compared to planned PCI. These data should inform uLMS-PCI procedural planning.</p
Operator volumes and in-hospital outcomes: an analysis of 7,740 rotational atherectomy procedures from the BCIS national database
No full textObjectives
The aims of this study were to use a national percutaneous coronary intervention (PCI) registry to study temporal changes in procedure volumes of PCI using rotational atherectomy (ROTA-PCI), the patient and procedural factors associated with differing quartiles of operator ROTA-PCI volume, and the relationship between operator ROTA-PCI volumes and in-hospital patient outcomes.
Background
Whether higher operator volume is associated with improved outcomes after ROTA-PCI is poorly defined.
Methods
Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all ROTA-PCI procedures performed in the United Kingdom between 2013 and 2016. Individual logistic regressions were performed to quantify the independent association between annual operator ROTA-PCI volume and in-hospital outcomes.
Results
In total, 7,740 ROTA-PCI procedures were performed, with a negatively skewed distribution and an annualized operator volume median of 2.5 procedures/year (range: 0.25 to 55.25). Higher volume operators undertook more complex procedures in patients with greater comorbid burdens than lower volume operators. A significant inverse association was observed between operator ROTA-PCI volume and in-hospital mortality (odds ratio [OR]: 0.986/case; 95% confidence interval (CI): 0.975 to 0.996; p = 0.007) and major adverse cardiac and cerebral events (OR: 0.983/case; 95% CI: 0.975 to 0.993; p < 0.001). Additionally, lower rates of emergency cardiac surgery (OR: 0.964/case; 95% CI: 0.939 to 0.991; p = 0.008), arterial complications (OR: 0.975/case; 95% CI: 0.975 to 0.982; p < 0.001) and in-hospital major bleeding (OR: 0.985/case; 95% CI: 0.977 to 0.993; p < 0.001) were associated with higher ROTA-PCI operator volume. Sensitivity analyses in several subgroups demonstrated a consistency of improved outcomes as annual ROTA-PCI volume increased. An annual volume of <4 ROTA-PCI procedures/year was observed to be associated with increased major adverse cardiac and cerebral events, with 239 of 432 operators (55%) not exceeding this threshold.
Conclusions
In-hospital adverse outcomes occurred less frequently as ROTA-PCI operator volume increased. These data suggest that operator volume is an important factor determining outcome after ROTA-PCI
Brachial arterial access for PCI: an analysis of the British Cardiovascular Intervention Society database
No full textTemporal trends in in-hospital outcomes following unprotected left-main percutaneous coronary intervention: an analysis of 14 522 cases from British cardiovascular intervention society database 2009 to 2017
Full text linkBackground:
Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain.
Methods:
Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment–elevation, cardiogenic shock, and with an emergency indication for PCI.
Results:
Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01–1.03]), female sex (odds ratio, 1.47 [1.19–1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02–2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45–0.70]), and year of PCI (odds ratio, 0.63 [0.46–0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events.
Conclusions:
Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time
Characterising the role of inflammatory procoagulant phospholipids in arterial thrombosis
Full text linkArterial thrombosis is an inflammatory response triggered by atherosclerotic plaque rupture causing acute coronary syndromes (ACS), strokes and death. Clotting reactions require interactions of coagulation proteins with aminophospholipids (aPL) and enzymatically oxidized phospholipids (eoxPL) on the surface of blood cells. This thesis investigates the role of aPL and eoxPL in arterial thrombosis.
Using liquid chromatography with tandem mass spectrometry (LC-MS/MS), I quantified eoxPL generated in thrombin-activated platelets from a healthy cohort and demonstrated a large degree of inter- and intra-individual variation. Aspirin supplementation in-vivo reduced the amount of COX-1 derived eoxPL, but increased diacyl 12 hydroxyeicosatetraenoic acid (12-HETE) containing eoxPL (12-HETE-PL) generation without affecting the levels of free 12-HETE. This suggests that aspirin interferes with re-esterification pathways of 12-HETE to acyl lysophospholipids.
Lipidomic analysis of arterial thrombi extracted from patients undergoing clot retrieval procedures demonstrated the presence of HETE-PL, with a predominance of platelet-derived 12-HETE-PL. Using a clinical cohort, I demonstrated elevated thrombin generation on the surface of isolated EV and leukocytes, but not platelets, from patients with ACS versus healthy controls (HC). Lipidomic analysis demonstrated no differences between groups in HETE-PL
amounts from resting platelets, leukocytes and EV. Nevertheless, as seen with the healthy cohort, thrombin-activated platelets from patients supplemented with aspirin had higher diacyl 12-HETE-PL generation. Finally, there were no differences in the fraction (%) externalized phosphatidylethanolamine (%PE) on the surface of platelets and leukocytes across the groups.
However, EV samples had lower %PE in ACS versus HC which, unlike platelets and leukocytes, correlated inversely with thrombin generation.
In summary, eoxPL were detected within arterial thrombi and their synthesis is increased with aspirin. Thrombin generation is higher on the surface of EV from ACS patients, which may be explained by differences in the aPL lipidome between groups. Further studies examining therapeutic agents targeting procoagulant lipids are needed
The devastating impact of artificial intelligence (AI) on the traditional ways of practising imaging and cardiology are 'imagers' an endangered species, and should trainees rethink their careers?
Full text linkCoronary artery disease and schizophrenia: the interplay of heart and mind
Full text linkThis editorial refers to ‘The effect of schizophrenia on major adverse cardiac events, length of hospital stay, and prevalence of somatic comorbidities following acute coronary syndrome’, by R. Attar et al., doi:10.1093/ehjqcco/qcy055
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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