The return of myocardial ischemia after coronary artery

Size: px
Start display at page:

Download "The return of myocardial ischemia after coronary artery"

Transcription

1 Occurrence and Risk Factors for Reintervention After Coronary Artery Bypass Grafting Joseph F. Sabik III, MD; Eugene H. Blackstone, MD; A. Marc Gillinov, MD; Nicholas G. Smedira, MD; Bruce W. Lytle, MD Background Reintervention after coronary artery bypass grafting (CABG) is common. We sought to determine its occurrence and identify patient characteristics and operative techniques that influence the need or bias for reintervention. Methods and Results From 1971 to 1998, patients underwent primary isolated CABG, and 1000 patients per year were actively followed-up every 5 years (n ). A multivariable time-related analysis was performed to model freedom from first coronary reintervention (either reoperation or percutaneous coronary intervention) and identify patient and operative characteristics associated with first reintervention. A total of 3997 patients underwent coronary reintervention, percutaneous in 1638 and reoperation in Freedom from reintervention was 99%, 96%, 88%, 73%, 60%, and 46% at 1, 5, 10, 15, 20, and 25 years, respectively. Risk of reintervention (hazard function) demonstrated a short, rapidly declining early phase followed by a longer, slow-rising late phase. Patient variables increasing the likelihood of coronary reintervention included younger age (P ), higher triglycerides (P 0.002), lower high-density lipoprotein (P 0.006), diabetes mellitus (P ), and more extensive coronary artery disease (P ). Increasing extent of arterial grafting performed at primary operation decreased the likelihood of coronary reintervention (P ). Conclusions Reintervention after primary CABG is common. Risk factors for arteriosclerosis and type of bypass conduit influence the need or bias for repeat coronary therapy. Aggressive post-cabg risk factor reduction and extensive arterial grafting at primary operation should decrease coronary reinterventions. (Circulation. 2006;114[suppl I]:I-454 I-460.) Key Words: angioplasty coronary disease revascularization risk factors surgery The return of myocardial ischemia after coronary artery bypass grafting (CABG) is common. 1 It has been estimated that by 15 years postoperatively, 62% of patients will have recurrent ischemia, 36% will experience a myocardial infarction, and 28% will undergo coronary reoperation or percutaneous coronary intervention (PCI). 2,3 The reason is progression of arteriosclerosis in native coronary arteries and failure of bypass grafts. To better understand the need for repeat coronary intervention after myocardial revascularization, we determined occurrence of coronary reintervention (both reoperation and PCI) to 25 years after primary CABG, and patient characteristics and operative techniques driving the need or bias for coronary reintervention. Patients and Methods Patients From 1971 to 1998, patients underwent primary isolated CABG at Cleveland Clinic. The first 1000 patients of each year were actively followed-up every 5 years (n ) and comprise the study population. Patient, operative, and follow-up variables were obtained from the Cardiovascular Information Registry; use of these data for clinical research has been approved by the Institutional Review Board. Mean follow-up was years, with patients followed-up 5 years, years, years, years, and years. Six hundred seventy-one patients (2.5%) were lost to follow-up. Total follow-up was patient-years. Study End Point End point of the study was first coronary reintervention, either PCI or isolated reoperative CABG, for recurrent myocardial ischemia. Patients who underwent reoperative CABG with concomitant cardiac procedures, such as valve replacement or repair, aortic replacement, or left ventricular aneurysmectomy, were excluded. Statistical Methods Analysis Time from primary CABG to first coronary reintervention was estimated both nonparametrically, using the Kaplan-Meier method, 4 and parametrically, using a multiphase hazard method. 5 The latter involved determining the number of hazard phases, appropriate form of equation for each phase, and parameters characterizing distribution of times to coronary reintervention (for additional details, see From the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. Presented at the American Heart Association Scientific Sessions, Dallas, Tex, November 13 16, Correspondence to Joseph F. Sabik III, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/Desk F24, Cleveland, OH American Heart Association, Inc. Circulation is available at DOI: /CIRCULATIONAHA I-454

2 Sabik et al Coronary Artery Bypass Grafting I-455 To identify which patient characteristics and operative techniques (Appendix) were associated with coronary reintervention, multivariable analyses were performed in the hazard-function domain. Bootstrap aggregation (bagging) using the median rule was used for variable selection, including selecting appropriate transformations of continuous and ordinal variables. 6,7 Interactions among selected variables were also sought by bagging. The P value criterion for retention of variables in the final model was Presentation Categorical variables are presented as frequencies and percentages. Continuous variables are summarized by mean and standard deviation. Asymmetric confidence limits are equivalent to 1 standard error (68%). Variables and Definitions Values of patient characteristics and operative techniques used in the multivariable analyses were obtained at primary CABG. Left ventricular function was graded as normal (ejection fraction [EF] 60%), mild dysfunction (EF 40% to 59%), moderate dysfunction (EF 25% to 39%), and severe dysfunction (EF 25%). A coronary artery system was considered importantly stenotic if it contained 50% diameter obstruction. Incomplete revascularization was defined as failure to graft any system containing 50% stenosis, or both left anterior descending coronary artery (LAD) and circumflex systems for 50% left main trunk stenosis. The authors had full access to the data and take full responsibility for their integrity. All authors have read and agree to the manuscript as written. Results Nonrisk-Adjusted Freedom from Reintervention A total of 3997 patients underwent coronary reintervention, percutaneous in 1638 and reoperation in Nonriskadjusted freedom from reintervention was 99%, 96%, 88%, 73%, 60%, and 46% at 1, 5, 10, 15, 20, and 25 years, respectively (Figure 1A). A 2-phase hazard model was identified, consisting of a short, rapidly declining early phase followed by a long, slow-rising late phase that began 1.5 years after primary CABG (Figure 1B). Two hundred five patients underwent coronary reintervention during the early phase and 3792 during the late phase. Risk Profiles of Reintervention Versus No-Reintervention Patients Preoperative characteristics of patients who underwent reintervention were different from those who did not (Table 1). Patients who underwent reintervention were younger, more likely to be male, more symptomatic, and had higher serum triglycerides and total cholesterol, better left ventricular function, more incomplete revascularization, and less internal thoracic artery (ITA) grafting. Multivariable analysis identified four general categories of factors associated with likelihood of undergoing reintervention: patient demography, noncardiac comorbidity, cardiac comorbidity, and operative technique at primary CABG (Table 2). Because the early hazard phase was small and late phase large, factors influencing the late phase had a greater impact on likelihood of reintervention. Patient Demography Older patients were less likely than younger ones to undergo repeat coronary intervention (P ; Figure 2). However, with greater surgical experience, likelihood of an older Figure 1. Freedom from reintervention after primary isolated CABG for all patients (n ). A, Parametric and actuarial estimates. Solid line represents parametric estimates enclosed within dashed 68% confidence limits ( 1 standard error). Symbols represent actuarial estimates at yearly intervals, and error bars represent 68% confidence limits. Numbers in parentheses are number of patients at risk. B, Hazard function (instantaneous risk). Dashed lines are 68% confidence limits. patient undergoing coronary reintervention increased (P 0.003). Diabetes mellitus was associated with having a coronary reoperation or PCI (Figure 3). Patients treated with insulin or oral medications had a similar and elevated risk of undergoing reintervention (P ). Patients with diet-controlled diabetes also had an increased risk of reintervention, but not as great as those treated pharmacologically (P 0.005). Risk associated with pharmacologically treated diabetes decreased with greater surgical experience (P 0.005). Increased serum lipid levels were also associated with repeat coronary intervention (Figure 4). Higher total cholesterol (P 0.007) and triglycerides (P ) increased the likelihood of reintervention, whereas higher high-density lipoprotein lowered risk (P ). History of smoking was associated with lower likelihood of coronary reintervention (P ). Coronary artery disease of the LAD (P 0.002), circumflex (P 0.003), or right coronary artery (P 0.008) increased the

3 I-456 Circulation July 4, 2006 TABLE 1. Baseline Patient Characteristics (n ) Reintervention No Yes (n ) (n 3997) Characteristic N (%) N (%) P Demography Age (years, mean SD) Male (82) 3445 (86) Diabetes mellitus (medically treated) 3553 (17) 291 (9) History of smoking (54) 1730 (50) Laboratory Values (mean SD) Total cholesterol LDL HDL Triglycerides Blood urea nitrogen NYHA class I 4005 (18) 487 (12) II 7778 (34) 1420 (36) III 2380 (10) 393 (10) IV 8791 (38) 1695 (43) Left ventricular dysfunction None (46) 2306 (58) Mild 6649 (30) 1102 (28) Moderate 3536 (16) 421 (11) Severe 1818 (8) 139 (3) Previous myocardial infarction (56) 1881 (47) Coronary artery disease ( 50% stenosis) LMT 3384 (15) 419 (11) LAD (92) 3562 (89) LCx (76) 2766 (69) RCA (82) 3045 (76) N of diseased systems ( 50% stenosis) (1) 15 (1) (10) 608 (15) (29) 1357 (34) (60) 2007 (51) Operative Procedure Intra-aortic balloon pump 340 (2) 24 (1) Incomplete revascularization 4735 (21) 879 (22) 0.05 Single ITA grafting (56) 1949 (49) Bilateral ITA grafting 2000 (9) 174 (4) ITA graft to LAD (59) 1898 (48) LCx 2169 (9) 189 (5) RCA 636 (3) 70 (2) HDL indicates high-density lipoprotein; ITA, internal thoracic artery; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; LDL, low-density lipoprotein; LMT, left main trunk; NYHA, New York Heart Association; RCA, right coronary artery; SD, standard deviation. TABLE 2. Risk Factors for Reintervention After Primary Isolated CABG: Direction of Influence on Early and Late Hazard Phase by Multivariable Analysis Is Indicated Hazard Phase Factor Early Late Demography Older age and later date of operation Male Higher NYHA class Diabetes mellitus and later date of operation History of smoking Laboratory Values Higher HDL Higher total cholesterol Higher triglycerides Better left ventricular function History of myocardial infarction Coronary Artery Stenosis Any LAD stenosis and later date of operation Any circumflex stenosis Any RCA stenosis Greater degree of RCA stenosis Previous operative procedure ITA graft to LAD ITA graft to LCx ITA graft to RCA Postoperative Support IABP postoperatively Experience Later date of operation IABP indicates intra-aortic balloon pump. likelihood of coronary reintervention. Risk associated with LAD disease also increased with greater surgical experience (P 0.02). Better left ventricular function (P ) increased the likelihood of reintervention, whereas history of a myocardial infarction decreased it (P ). The more symptomatic a patient at primary operation, the greater was the risk of reintervention (P ). Operative Procedure More extensive ITA grafting reduced the risk of reintervention (Figure 5). ITA grafts to the LAD (P ), circumflex (P 0.002), and right coronary artery (P 0.02) lowered the likelihood of repeat coronary intervention. Intra-aortic balloon pump insertion at primary operation increased the risk of early reintervention (P ). Patients who underwent operation later in the series were less likely to undergo reintervention (P ).

4 Sabik et al Coronary Artery Bypass Grafting I-457 Figure 2. Predicted freedom from coronary reintervention after primary isolated CABG stratified by age. Format is as in Figure 1. Discussion Background Coronary artery bypass grafting is effective in prolonging survival and relieving angina However, its effectiveness in eliminating myocardial ischemia is transient, with only 22% of patients free of ischemic events 15 years postoperatively. 2 Return of myocardial ischemia is caused by progression of arteriosclerosis in native coronary arteries and failure of the primary operation. Coronary reintervention, by either percutaneous methods or reoperation, is often performed to relieve patients recurrent symptoms. To better understand coronary reintervention after CABG, we determined its occurrence and identified patient characteristics and operative techniques that influence need or bias for reintervention. Principal Findings Coronary reintervention after CABG is common, with less than half of patients free of reintervention 25 years after surgery. Patient characteristics as well as operative techniques influenced need or bias for reintervention. Some patient characteristics increased the likelihood of reintervention (eg, arteriosclerosis risk factors), whereas others decreased it. Operative factors influencing the likelihood of reintervention were conduit choice and success of primary CABG. These findings are similar to those we recently reported for likelihood of undergoing coronary reoperation after primary CABG. 16 Risk Factors for Arteriosclerosis Diabetes mellitus, elevated triglycerides, and total cholesterol were associated with increased risk of coronary reintervention. These are known risk factors for arteriosclerosis that likely increase the need for reintervention by accelerating arteriosclerosis in coronary arteries and saphenous vein bypass grafts. In contrast, elevated high-density lipoprotein decreased risk of reintervention, probably by slowing development and progression of arteriosclerosis. Comorbidity Smoking, older age, and worse left ventricular function were all associated with decreased occurrence of reintervention. A possible explanation is that these factors increase the risk associated with reintervention and therefore may bias treatment in favor of medical therapy. Patients who were more symptomatic at primary operation were more likely to require reintervention. This may be Figure 3. Predicted freedom from coronary reintervention after primary isolated CABG stratified by diabetes mellitus and its treatment by either diet or medicine. Format is as in Figure 1.

5 I-458 Circulation July 4, 2006 Figure 4. Predicted freedom from coronary reintervention after primary isolated CABG stratified by elevated and normal serum lipid levels. Elevated lipids triglycerides of 300 and total cholesterol of 350. Normal lipids triglycerides of 100 and total cholesterol of 150. Format is as in Figure 1. because they had a lower symptom threshold to myocardial ischemia and thus were more likely to present with recurrent symptoms and undergo coronary reintervention to relieve them. ITA Grafts More extensive ITA grafting at primary operation reduced the need for coronary reintervention. Because of their resistance to arteriosclerosis, ITA grafts are more likely to remain patent than saphenous vein grafts. 17 Therefore, they should have a longer-lasting effect on prevention of myocardial ischemia than saphenous vein grafts. Sergeant et al similarly found that likelihood of coronary reoperation or PCI was reduced by more extensive ITA grafting at primary operation. 3 The incremental benefit of 1 and then 2 ITA grafts on both survival and freedom from reoperation has been previously reported Another reason ITA grafting may reduce coronary reintervention is that physicians and surgeons may be reluctant to intervene in patients with patent ITA grafts. Supporting this hypothesis is Sergeant et al s finding that ITA grafting did not decrease risk of return of angina after CABG. 2,3 It is therefore surprising that, despite a similar likelihood of experiencing recurrent angina, patients with previous ITA grafting are less likely to undergo coronary reintervention than patients with saphenous vein grafts alone. This bias against reintervening when ITA grafts are present may be appropriate. Patients with recurrent ischemia and patent ITA grafts are less likely to derive a survival benefit from reintervention than patients without patent ITA grafts. Success of Primary Operation Placing an intra-aortic balloon pump at primary CABG was associated with increased likelihood of early ( 18 months after primary CABG) reintervention. Need to insert an intraaortic balloon at primary operation suggests ineffective revascularization, possibly because of incomplete revascularization or early graft failure. An ineffective operation will not relieve myocardial ischemia, and therefore early coronary reintervention for symptom relief may be required. Surprisingly, incomplete revascularization was not found by multivariable analysis to increase the likelihood of coronary reintervention. This may be because of incomplete revascularization being highly correlated with another factor (such as intra-aortic balloon pump insertion) found by multivariable analysis to be associated with reintervention; if that is the case, incomplete revascularization would not appear to be a risk factor per se for reintervention. Figure 5. Predicted freedom from reintervention after primary isolated CABG stratified by single, double, or no ITA grafting at primary operation. Format is as in Figure 1.

6 Sabik et al Coronary Artery Bypass Grafting I-459 Limitations This study analyzes the clinical practice of coronary reintervention after primary CABG; it does not analyze the actual need for coronary reintervention. Because many factors go into the decision to proceed with coronary reintervention, including patient comorbidities, amount of ischemic myocardium, risk of reintervention, and benefits of the procedure, our findings on the occurrence and risk factors for coronary reintervention may be biased. Another limitation is that 3 decades of coronary surgery were included in this study, during which both surgical and medical therapy for coronary artery disease changed. However, a long observation period has advantages as well, including many years of follow-up data available for analysis and ability to evaluate the effect of surgical strategies that were common early in the series but not today, such as saphenous vein revascularization of the LAD. The association of preoperative risk factors and operative techniques on the likelihood of having a coronary reintervention were evaluated in this study. However, we did not determine how postoperative medical therapy and risk factor modification influenced the occurrence of coronary reintervention. This information was not available. Implications These findings suggest that reducing arteriosclerosis risk factors and ITA grafting at primary CABG will lower the need for repeat coronary intervention. Although we could not determine influence of postoperative risk factor modification on occurrence of coronary reintervention, it is logical to suggest that such modification would be beneficial. Support for this comes from the finding that aggressive lipid reduction after CABG decreased both saphenous vein graft arteriosclerosis and need for coronary reintervention. 21 Summary Coronary reintervention after primary CABG is common. Risk factors for arteriosclerosis progression and ITA grafting influence the need or bias for reintervention. Arteriosclerosis risk-factor reduction and extensive ITA grafting should decrease occurrence of coronary reintervention after primary surgical revascularization. Appendix Variables Considered in Analyses Demography Sex, age (years), height (cm), weight (kg), body surface area (m 2 ), body mass index (kg m 2 ) New York Heart Association functional class (I, II, III, IV) Left Ventricular Function Left ventricular function (normal; mild, moderate, and severe dysfunction), previous myocardial infarction, left ventricular segmental wall motion abnormalities (septal, anterior, inferior, lateral, apical, basilar, none) Family history of coronary artery disease, atrial fibrillation, complete heart block History of cigarette smoking, peripheral vascular disease, carotid stenosis, hypertension, diabetes mellitus (diet-controlled, oraltreated, and insulin-treated), renal insufficiency Preoperative Laboratory Values Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, creatinine, blood urea nitrogen, hematocrit Coronary Artery Anatomy and Stenosis Dominance (left, right, codominant), number of coronary artery systems with stenosis 50% (1, 2, 3), left main trunk stenosis (any, 50% stenosis, 70% stenosis), left anterior descending stenosis (any, 50% stenosis, 70% stenosis), circumflex stenosis (any, 50% stenosis, 70% stenosis), right coronary artery stenosis (any, 50% stenosis, 70% stenosis) Procedure Complete revascularization; incomplete revascularization of left anterior descending, circumflex, or right coronary artery system; any internal thoracic artery grafting; internal thoracic artery graft to left anterior descending, circumflex, or right coronary artery; any saphenous vein grafting; saphenous vein graft to left anterior descending, circumflex, or right coronary artery Experience Date of operation Postoperative Management Intra-aortic balloon pump None. Disclosures References 1. Sergeant P, Blackstone E, Meyns B. Is return of angina after coronary artery bypass grafting immutable, can it be delayed, and is it important? J Thorac Cardiovasc Surg. 1998;116: Sergeant P, Lesaffre E, Flameng W, Suy R, Blackstone E. The return of clinically evident ischemia after coronary artery bypass grafting. Eur J Cardiothorac Surg. 1991;5: Sergeant P, Blackstone E, Meyns B, Stockman B, Jashari R. First cardiological or cardiosurgical reintervention for ischemic heart disease after primary coronary artery bypass grafting. Eur J Cardiothorac Surg. 1998; 14: Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53: Blackstone EH, Naftel DC, Turner ME, Jr. The decomposition of timevarying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc. 1986;81: Breiman L. Bagging predictors. Machine Learning. 1996;24: Blackstone EH. Breaking down barriers: helpful breakthrough statistical methods you need to understand better. J Thorac Cardiovasc Surg. 2001;122: Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. N Engl J Med. 1984;311: Takaro T, Hultgren HN, Lipton MJ, Detre KM. The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions. Circulation. 1976;54: III107 III Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Second interim report by the European Coronary Surgery Study Group. Lancet. 1980;2: Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988;319: Passamani E, Davis KB, Gillespie MJ, Killip T. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N Engl J Med. 1985;312:

7 I-460 Circulation July 4, Coronary artery surgery study. (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation. 1983;68: Coronary artery surgery study. (CASS): a randomized trial of coronary artery bypass surgery. Quality of life in patients randomly assigned to treatment groups. Circulation. 1983;68: Alderman EL, Bourassa MG, Cohen LS, Davis KB, Kaiser GG, Killip T, Mock MB, Pettinger M, Robertson TL. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation. 1990;82: Sabik JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW. Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. J Thorac Cardiovasc Surg. 2006;131: Sabik JF, 3rd, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. Ann Thorac Surg. 2005;79: ; discussion Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg. 2004;78: ; discussion Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, Cosgrove DM. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg. 1999;117: Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC, Proudfit W. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314: The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. The Post Coronary Artery Bypass Graft Trial Investigators. N Engl J Med. 1997;336:

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

Prognostic impact of uric acid in patients with stable coronary artery disease

Prognostic impact of uric acid in patients with stable coronary artery disease Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,

More information

Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease

Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease Keynote Lecture Series Durability of mitral valve repair for mitral regurgitation due to degenerative mitral valve disease Tirone E. David Division of Cardiovascular Surgery, Peter Munk Cardiac Centre,

More information

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?

Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators

PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf

More information

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators

Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,

More information

The Cardiac Society of Australia and New Zealand

The Cardiac Society of Australia and New Zealand The Cardiac Society of Australia and New Zealand Guidelines on Support Facilities for Coronary Angiography and Percutaneous Coronary Intervention (PCI) including Guidelines on the Performance of Procedures

More information

California Health and Safety Code, Section 1256.01

California Health and Safety Code, Section 1256.01 California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program

More information

Diagnostic and Therapeutic Procedures

Diagnostic and Therapeutic Procedures Diagnostic and Therapeutic Procedures Diagnostic and therapeutic cardiovascular s are central to the evaluation and management of patients with cardiovascular disease. Consistent with the other sections,

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

Surgeons Role in Atrial Fibrillation

Surgeons Role in Atrial Fibrillation Atrial Fibrillation Surgeons Role in Atrial Fibrillation Steven J Feldhaus, MD, FACS 2015 Cardiac Symposium September 18, 2015 Stages of Atrial Fibrillation Paroxysmal (Intermittent) Persistent (Continuous)

More information

Perioperative Cardiac Evaluation

Perioperative Cardiac Evaluation Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project

More information

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter

Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter Endoskopische Venenentnahme der V. saphena in der koronaren Bypasschirurgie - Aktuelle Datenlage - Dr. med. Stefanie Reutter Endoskopische Venenentnahme (EVH) - Einführung 1979 Tevaearai und Kollegen haben

More information

The left internal mammary artery (LIMA) is the

The left internal mammary artery (LIMA) is the Case Report 925 Direct Stenting of a Transradial Left Internal Mammary Artery Graft Wei-Chin Hung, MD; Bih-Fang Guo, MD, PhD; Chiung-Jen Wu, MD; Chien-Jen Chen, MD; Chih-Yuan Fang, MD Taking the transfemoral

More information

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data

More information

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D.

Surgical Mitral Valve Repair The Gold Standard. A. Marc Gillinov, M.D. Surgical Mitral Valve Repair The Gold Standard A. Marc Gillinov, M.D. Disclosures Speaker/consultant Edwards Lifesciences Onyx Lifesciences Research support St. Jude Medical Medtronic A Common Case A Common

More information

Protocol. Cardiac Rehabilitation in the Outpatient Setting

Protocol. Cardiac Rehabilitation in the Outpatient Setting Protocol Cardiac Rehabilitation in the Outpatient Setting (80308) Medical Benefit Effective Date: 07/01/14 Next Review Date: 09/15 Preauthorization No Review Dates: 07/07, 07/08, 05/09, 05/10, 05/11, 05/12,

More information

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor

More information

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone

Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Total Cardiology, Calgary Acknowledgements and Disclosures Acknowledgements Jacques Genest

More information

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Appropriate Use: Big Brother is Watching Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Disclosures Consultant Boston Scientific, Medtronic, Middle Peak Medical, Millipede,

More information

Care of the Post-Cardiac Surgery Patient. Lundy J. Campbell, M.D. Associate Professor University of California

Care of the Post-Cardiac Surgery Patient. Lundy J. Campbell, M.D. Associate Professor University of California Care of the Post-Cardiac Surgery Patient Lundy J. Campbell, M.D. Associate Professor University of California Post-Operative Issues Post-op atrial fibrillation Acute kidney injury Acute respiratory failure

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better

Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Cardiac Rehabilitation: An Under-utilized Resource Making Patients Live Longer, Feel Better Marian Taylor, M.D. Medical University of South Carolina Director, Cardiac Rehabilitation I have no disclosures.

More information

Cardiac Rehabilitation: Strategies Approaching 2020

Cardiac Rehabilitation: Strategies Approaching 2020 ACC Banff 2015 Cardiac Rehabilitation: Strategies Approaching 2020 James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Libin Cardiovascular

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b

Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013 Reference: NHS Commissioning Board Clinical Commissioning Policy Statement: Percutaneous

More information

4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts

4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts Cardiac Rehabilitation: From the other side of the glass door No disclosures, no conflicts Charles X. Kim, MD, FACC, ABVM Objectives 1. Illustrate common CV benefits of CV rehab in real world practice.

More information

Duration of Dual Antiplatelet Therapy After Coronary Stenting

Duration of Dual Antiplatelet Therapy After Coronary Stenting Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are

More information

INTRODUCTION TO EECP THERAPY

INTRODUCTION TO EECP THERAPY INTRODUCTION TO EECP THERAPY is an FDA cleared, Medicare approved, non-invasive medical therapy for the treatment of stable and unstable angina, congestive heart failure, acute myocardial infarction, and

More information

12 Lead ECGs: Ischemia, Injury & Infarction Part 2

12 Lead ECGs: Ischemia, Injury & Infarction Part 2 12 Lead ECGs: Ischemia, Injury & Infarction Part 2 McHenry Western Lake County EMS Localization: Left Coronary Artery Right Coronary Artery Right Ventricle Septal Wall Anterior Descending Artery Left Main

More information

Provider Checklist-Outpatient Imaging. Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469)

Provider Checklist-Outpatient Imaging. Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469) Provider Checklist-Outpatient Imaging Checklist: Nuclear Stress Test, Thallium/Technetium/Sestamibi (CPT Code 78451-78454 78469) Medical Review Note: Per InterQual, if any of the following are present,

More information

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1

More information

Antonio Colombo MD on behalf of the SECURITY Investigators

Antonio Colombo MD on behalf of the SECURITY Investigators Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY

More information

Journal of the American College of Cardiology Vol. 38, No. 2, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.

Journal of the American College of Cardiology Vol. 38, No. 2, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20. Journal of the American College of Cardiology Vol. 38, No. 2, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01408-5 Prognostic

More information

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES Test Code Test Name CPT CHOL Cholesterol, Serum 82465 HDL HDL, (High Density Lipoprotein) 83718 TRIG Triglycerides, Serum 84478 FTRIG Triglycerides (Fluid) 84478 LIPID Lipid Panel 80061 LDL LDL (Low Density

More information

The clinical outcome after coronary bypass surgery: a 30-year follow-up study

The clinical outcome after coronary bypass surgery: a 30-year follow-up study European Heart Journal (2009) 30, 453 458 doi:10.1093/eurheartj/ehn530 CLINICAL RESEARCH Coronary heart disease The clinical outcome after coronary bypass surgery: a 30-year follow-up study Ron T. van

More information

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care

Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY

More information

Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease

Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease 10 CLINICAL STUDIES JACC Vol. 31, No. 1 INTERVENTIONAL CARDIOLOGY Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease WILLIAM S.

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

Automatic External Defibrillators

Automatic External Defibrillators Last Review Date: May 27, 2016 Number: MG.MM.DM.10dC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

Cardiac Rehab. Home. www.homecareforyou.com. Do you suffer from a cardiac condition that is limiting your independence in household mobility?

Cardiac Rehab. Home. www.homecareforyou.com. Do you suffer from a cardiac condition that is limiting your independence in household mobility? TM Nightingale Home Cardiac Rehab Do you suffer from a cardiac condition that is limiting your independence in household mobility? Such as, 1. A recent heart attack 2. A heart condition coronary artery

More information

Declaratory Ruling 2005-1 Replaces Declaratory Ruling 97-2

Declaratory Ruling 2005-1 Replaces Declaratory Ruling 97-2 Declaratory Ruling 2005-1 Replaces Declaratory Ruling 97-2 RE: The permitted role of unlicensed surgical assistants ( assistants ) in taking of the saphenous vein during coronary artery bypass graft (

More information

CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99)

CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99) CHAPTER 9 DISEASES OF THE CIRCULATORY SYSTEM (I00-I99) March 2014 2014 MVP Health Care, Inc. CHAPTER 9 CHAPTER SPECIFIC CATEGORY CODE BLOCKS I00-I02 Acute rheumatic fever I05-I09 Chronic rheumatic heart

More information

The Canadian Association of Cardiac

The Canadian Association of Cardiac Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a

More information

Primary Prevention of Cardiovascular Disease with a Mediterranean diet

Primary Prevention of Cardiovascular Disease with a Mediterranean diet Primary Prevention of Cardiovascular Disease with a Mediterranean diet Alejandro Vicente Carrillo, Brynja Ingadottir, Anne Fältström, Evelyn Lundin, Micaela Tjäderborn GROUP 2 Background The traditional

More information

NCD for Lipids Testing

NCD for Lipids Testing Applicable CPT Code(s): NCD for Lipids Testing 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein blood;

More information

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease

Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease What is Cardiac Rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification

More information

Heart Center Packages

Heart Center Packages Heart Center Packages For more information and appointments, Please contact The Heart Center of Excellence at the American Hospital Dubai Tel: +971-4-377-6571 Email: heartcenter@ahdubai.com www.ahdubai.com

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy File name: Cardiac Rehabilitation (Outpatient Phase II) File code: UM.REHAB.04 Origination: 08/1994 Last Review: 08/2011 Next Review:

More information

Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study

Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study European Journal of Clinical Investigation (2007) 37, 925 932 DOI: 10.1111/j.1365-2362.2007.01888.x Blackwell Publishing Ltd Review Assessing risk of myocardial infarction and stroke: new data from the

More information

06 Validation of risk prediction model

06 Validation of risk prediction model HA Territory-wide PCI Audit 2003-06 06 Validation of risk prediction model PCI Audit Working Group Central Committee (Cardiac Services) HA Convention 2007 Background Participants: All HA hospitals via

More information

Contemporary Management of Cardiovascular Disease

Contemporary Management of Cardiovascular Disease Contemporary Management of Cardiovascular Disease FRIDAY, OCTOBER 30, 2015 Baltimore Hilton Hotel Baltimore, Maryland Register Today! ccfcme.org/gocvddc Contemporary Management of Cardiovascular Disease

More information

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,

More information

Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis. Michael A. Blazing

Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis. Michael A. Blazing Perioperative Risk Stratification for Noncardiac Surgical Patients with Cardiac Diagnosis Michael A. Blazing Outline The coming crush A practical approach to clinical risk assessment Classic approach to

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

Cardiovascular Guidelines for DOT Physical Exams By Maureen Collins MSN, APRN, BC

Cardiovascular Guidelines for DOT Physical Exams By Maureen Collins MSN, APRN, BC Cardiovascular Guidelines for DOT Physical Exams By Maureen Collins MSN, APRN, BC The Federal Motor Carrier Safety Administration (FMCSA) administers the Federal Motor Carrier Safety Regulations (FMCSRs)

More information

Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up

Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up Hellenic J Cardiol 45: 379-383, 2004 Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up PETROS S. DARDAS, DIMITRIS

More information

After acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS

After acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS By Deborah Chyun, RN, PhD, Viola Vaccarino, MD, PhD, Jaime Murillo, MD, Lawrence H. Young, MD, and Harlan M. Krumholz,

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Minimally Invasive Mitral Valve Surgery

Minimally Invasive Mitral Valve Surgery Minimally Invasive Mitral Valve Surgery Stanford Health Care offers leading, superior options in cardiac surgery, including the latest techniques and research for Minimally Invasive Cardiac surgery. Advanced

More information

A randomized, controlled trial comparing the efficacy of carvedilol vs. metoprolol in the treatment of atrial fibrillation

A randomized, controlled trial comparing the efficacy of carvedilol vs. metoprolol in the treatment of atrial fibrillation A randomized, controlled trial comparing the efficacy of carvedilol vs. metoprolol in the treatment of atrial fibrillation Gabriel Sayer Lay Abstract: Atrial fibrillation is a common form of irregular,

More information

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR

More information

Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. Michael Acker, MD For the CTSN Investigators AHA November 2013

Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation. Michael Acker, MD For the CTSN Investigators AHA November 2013 Mitral Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation Michael Acker, MD For the CTSN Investigators AHA November 2013 Acknowledgements Supported by U01 HL088942 Cardiothoracic

More information

Majestic Trial 12 Month Results

Majestic Trial 12 Month Results Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.

More information

Antiplatelet and Antithrombotics From clinical trials to guidelines

Antiplatelet and Antithrombotics From clinical trials to guidelines Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories

More information

Results of streamlined regional ambulance transport and subsequent treatment of acute abdominal aortic aneurysm

Results of streamlined regional ambulance transport and subsequent treatment of acute abdominal aortic aneurysm CHAPTER 6 Results of streamlined regional ambulance transport and subsequent treatment of acute abdominal aortic aneurysm JW Haveman, A Karliczek, ELG Verhoeven, IFJ Tielliu, R de Vos, JH Zwaveling, JJAM

More information

CPT only copyright 2014 American Medical Association. All rights reserved. 12/23/2014 Page 87 of 593

CPT only copyright 2014 American Medical Association. All rights reserved. 12/23/2014 Page 87 of 593 Measure #40 (NQF 0048): Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older National Quality Strategy Domain: Effective Clinical Care 2015

More information

Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations. Danny Dvir, MD On behalf of VIVID registry investigators

Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations. Danny Dvir, MD On behalf of VIVID registry investigators Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantations Danny Dvir, MD On behalf of VIVID registry investigators Introduction Bioprosthetic valves are increasingly implanted in open-heart surgeries.

More information

Contemporary Management of Cardiovascular Disease

Contemporary Management of Cardiovascular Disease Contemporary Management of Cardiovascular Disease NOVEMBER 20 21, 2015 Hilton Anatole Hotel Register Today! ccfcme.org/gocvdtx Contemporary Management of Cardiovascular Disease Join us on November 20-21

More information

Cardiovascular disease is the leading cause of morbidity

Cardiovascular disease is the leading cause of morbidity electronic health records Implementation of an Electronic Health Record with an Embedded Quality Improvement Program to Improve the Longitudinal Care of Outpatients with Coronary Artery Disease Allan G.

More information

Appendix. Costing Case Samples for OOHCA

Appendix. Costing Case Samples for OOHCA Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF

More information

Prevention of Cardiovascular Disease in Children with Diabetes

Prevention of Cardiovascular Disease in Children with Diabetes Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus

More information

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit

Summary Evaluation of the Medicare Lifestyle Modification Program Demonstration and the Medicare Cardiac Rehabilitation Benefit The Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all. Nevertheless, portions of our files including charts,

More information

CIGI Direct Insurance Services, Inc. QUICK QUOTE CORONARY ANGIOPLASTY/CORONARY BYPASS

CIGI Direct Insurance Services, Inc. QUICK QUOTE CORONARY ANGIOPLASTY/CORONARY BYPASS QUICK QUOTE CORONARY ANGIOPLASTY/CORONARY BYPASS Amount of Insurance $ Type of Insurance 1. Has patient had: Date of last symptom, list date (or dates if more than one ) Angina pectoris (heart pain)? r

More information

CARDIAC CARE. Giving you every advantage

CARDIAC CARE. Giving you every advantage CARDIAC CARE Giving you every advantage Getting to the heart of the matter The Cardiovascular Program at Northwest Hospital & Medical Center is dedicated to the management of cardiovascular disease. The

More information

Central Office N/A N/A

Central Office N/A N/A LCD ID Number L32688 LCD Title Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Contractor s Determination Number L32688 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE

More information

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.

More information

Addendum to Clinical Review for NDA 22-512

Addendum to Clinical Review for NDA 22-512 Addendum to Clinical Review for DA 22-512 Drug: Sponsor: Indication: Division: Reviewers: dabigatran (Pradaxa) Boehringer Ingelheim Prevention of stroke and systemic embolism in atrial fibrillation Division

More information

National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1)

National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1) National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1) Tracking Information Publication Number 100-3 Manual Section Number 20.10.1 Manual Section

More information

Utilization Review Cardiac Rehabilitation Services: Underutilized

Utilization Review Cardiac Rehabilitation Services: Underutilized Utilization Review Cardiac Rehabilitation Services: Underutilized William J. Gill, MD Krannert Institute of Cardiology Indiana University School of Medicine Indianapolis, Indiana What is Cardiac Rehab?

More information

Remote Delivery of Cardiac Rehabilitation

Remote Delivery of Cardiac Rehabilitation Remote Delivery of Cardiac Rehabilitation Bonnie Wakefield, RN, PhD Kariann Drwal, MS Melody Scherubel, RN Thomas Klobucar, PhD Skyler Johnson, MS Peter Kaboli, MD, MS VA Rural Health Resource Center Central

More information

Pre-Operative Cardiac Evaluation Kalpana Jain, MD

Pre-Operative Cardiac Evaluation Kalpana Jain, MD Pre-Operative Cardiac Evaluation Kalpana Jain, MD Cardiac evaluation is an integral part of pre-op evaluation. Perioperative cardiac events are common causes of mortality. Major cardiac complications associated

More information

aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C

aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C Objectives: Understand the importance of preoperative lower extremity evaluation Ultrasound imaging to determine satisfactory venous conduit

More information

Atherosclerosis of the aorta. Artur Evangelista

Atherosclerosis of the aorta. Artur Evangelista Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis

More information

MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet

MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging Anne Günther Department of Radiology OUS Rikshospitalet CORONARY CT ANGIOGRAPHY (CTA) Accurate method in the assessment of possible

More information

ACSM Risk Factor Identification and Risk Stratification

ACSM Risk Factor Identification and Risk Stratification Thresholds for Use With ACSM Risk Stratification (p 24G) ACSM Risk Factor Identification and Risk Stratification By Dr. Sue Beckham, Ph.D., RCEP, PD Positive Family History Cigarette Smoking Myocardial

More information

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY Dr. Mahesh Vakamudi Professor and Head Department of Anesthesiology, Critical Care and Pain Medicine Sri Ramachandra University INTRODUCTION

More information

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

KIH Cardiac Rehabilitation Program

KIH Cardiac Rehabilitation Program KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to

More information

Understanding diabetes Do the recent trials help?

Understanding diabetes Do the recent trials help? Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and obesity History: A 13-year-old girl is seen for a routine clinic follow-up visit. She has been previously healthy, but her growth curve shows increasing body mass index (BMI) percentiles

More information