Tag Archives: coronary artery disease

Introduction Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide,1 accounting for nine million deaths globally in 2021.2 Numerous modifiable risk factors are associated with its development and progression, including dyslipidaemia, glycaemic control and smoking.3–9 Effective management of risk factors can reduce or even reverse the disease process.10–15 Screening for risk factors, however, is often sporadic and opportunistic in nature. Indeed, even after they are identified, gaps in treatment are common, with patients frequently falling short of updated guideline targets.16-20 It has been shown that when

Introduction Unfractionated heparin (UFH) is a naturally occurring anticoagulant released from mast cells.1 It works by reversibly binding to antithrombin III (AT III) and accelerating the rate at which AT III inactivates the coagulation enzymes thrombin (factor IIa) and factor Xa. Since its discovery in 1916,2 UFH has been the most widely used anticoagulant for procedural or therapeutic indications.3 Percutaneous coronary intervention (PCI) inevitably causes vessel wall injury, which leads to activation of platelets and a localised vascular inflammatory reaction, which is prothrombotic and associated with an increased risk of acute or subacu

Introduction Cardiovascular disease accounts for more than three million deaths in Europe annually, of which, coronary artery disease (CAD) is a leading cause.1 The burden of mortality and morbidity associated with CAD, and, in particular, acute coronary syndrome (ACS), is high. Effects on a patient’s lifestyle and self-image following ACS contribute to prevalence rates of 12–15% for depression and 10–38% for anxiety.2 Anxiety and depression are common in patients with cardiovascular disease,3 and are associated with disadvantaged clinical outcomes following ACS.4 The importance of psychological care for patients with life-threatening c

Introduction Cardiovascular diseases (CVDs) are responsible for the demise of 17.9 million people yearly, making it the main cause of death in the world.1 According to the American Heart Association’s (AHA) 2022 report on heart disease and stroke statistics, the average yearly indirect and direct expenses of CVD in the US were an estimated $378.0 billion in 2017–2018.2 Early detection of coronary artery disease (CAD) and proper treatment can reduce mortality, and the economic burden it brings along. Although progress has been made in the diagnosis of CAD, it has been limited by the low signal-to-noise ratio of conventional imaging modalit

Introduction According to projections, coronary artery disease (CAD), which is brought on by the atherosclerotic process in coronary arteries, will continue to be the world’s leading cause of death and morbidity.1,2 The development of coronary lesions may increase the risk of mortality for patients by causing serious adverse cardiovascular events including acute coronary syndrome (ACS). In the treatment of CAD, reperfusion via percutaneous coronary intervention (PCI) combined with the placement of drug-eluting stents (DES) and fibrinolytics has considerably improved patient clinical results.1,2 Even while it significantly lessens post-infar

Disease made worse? Dr Pitt O Lim When Grüntzig extended balloon angioplasty from the leg to the heart as a minimally invasive procedure for coronary atherosclerosis in 1977, there was a 10% rate of abrupt vessel closure (AVC), possibly causing a myocardial infarction (MI).1,2 At the time, cardiac surgeons stood by, rescuing these patients with emergency coronary artery bypass grafting (CABG). Bare-metal stent (BMS), a balloon-expandable metallic-mesh scaffold was introduced 10 years later to overcome this immediate complication. The drug-eluting stent (DES), marketed from 2003, overcomes BMS’s in-stent restenosis (ISR) due to healing tiss

Introduction Coronary artery disease (CAD) is a narrowing of the coronary arteries that supply oxygen and blood to the heart.1 The treadmill test is important to evaluate cardiovascular status and functional capacity in patients with or without CAD. This test is the cheapest and most effective diagnostic tool recommended by the American Heart Association (AHA) for diagnosing CAD for the first time, with a sensitivity of 45% and a specificity of 85%.2,3 After the weight-training test, risk stratification of CAD events can be carried out, either by using the Duke treadmill score (DTS) or the simplified treadmill score (STS). In patients who hav

How much does air pollution contribute to ASCVD development? A meta-analysis showed that a low and high air pollution concentration contributes to ASCVD among adults; however, the higher the concentration, the higher the risk of irreparable damage, which can exacerbate morbidity and mortality levels.7 This meta-analysis found that heart rate variability decreased for every 10 µg/m3 increase in PM2.5 within both short- and long-term exposure groups, whereas ASCVD risk increased. In observational studies, which took place in China, Canada, US and South Korea, the hazard ratio (HR) increased significantly in the exposure to different pollutants

Introduction Over the past two decades, extensive debates continued to be held to determine the minimum annual percutaneous coronary intervention (PCI) numbers an interventional healthcare institution must meet in order to maintain high-quality performance and ensure patient safety throughout the entirety of patients’ hospital stay. While PCI procedures have become routine, they remain quite complex and potentially risky. Operators’ expertise, cardiac catheter laboratory (Cathlab) team competence and equipment readiness, coronary care unit (CCU) preparedness, and cardiac surgery availability or accessibility, are all essential factors tha

Introduction Coronary artery disease (CAD) is a significant cause of morbidity and mortality in the UK, and anginal chest pain is the most common manifestation.1,2 Chest pain, however, is one of the most common presenting symptoms in both emergency, primary and secondary care, and can be secondary to a myriad of pathologies. Therefore, the diagnosis of CAD from symptoms alone can prove challenging. Despite developments in both invasive and non-invasive CAD imaging, these investigations are not without risks and cost to the health service. Reduction of unnecessary investigations, while identifying patients most at risk, has been a major motiv