Tag Archives: coronary artery disease

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

Introduction Undifferentiated chest pain places a significant burden on the UK National Health Service (NHS). Up to 50% of the general population experiences chest pain in their lifetime contributing to at least 1% of GP consultations and 5% of accident and emergency (A&E) attendances.1 Chest pain patients have a twofold higher mortality versus age-matched asymptomatic controls.1 One reason is undiagnosed obstructive coronary artery disease (CAD), which has effective treatments to prolong life and improve symptoms.1 The challenge is identifying the patients at greatest risk, providing a timely diagnosis and starting effective treatment. T

Introduction Depression is a significant cause of morbidity and mortality in patients with coronary artery disease (CAD), with depressive symptoms affecting up to 45% of patients with CAD.1 Cardiac patients with depressive symptoms experience a 2 to 2.5-fold mortality increase when compared with cardiac patients without depressive symptoms.2 Screening tools include the patient health questionnaire (PHQ), which exists in two- and nine-question formats, with PHQ2 being nearly 90% sensitive and 73% specific for depression,3 and PHQ9 being 88% sensitive and 88% specific for depression.4 We examined the records of patients with CAD in an ambulato

Self-monitoring of type 2 diabetes cuts costs Self-monitoring of type 2 diabetes used in combination with an electronic feedback system results in considerable savings on health care costs and also travel costs for patients, especially in sparsely populated areas, a new study shows. The study, carried out in Northern Karelia by the University of Eastern Finland, found that by replacing half of the required follow-up visits for type 2 diabetes with self-measurements and electronic feedback, total costs of glycated haemoglobin monitoring were reduced by nearly 60%. The annual per-patient cost was down from 280 euros to 120 euros. Fewer follow-u

Introduction Invasive coronary angiography (ICA) remains the cornerstone of diagnosis and treatment of patients with a high likelihood of coronary artery disease (CAD), or those with significant or unstable chest pain symptoms. However, there is always a concern that we overutilise ICA and this exposes patients to a small risk.1 Furthermore, ICA is an expensive procedure and overuse of diagnostic ICA can compete with percutaneous coronary intervention (PCI) and device implantations in hospitals with a single catheter lab. The National Institute of Health and Care Excellence (NICE) 2010 guidelines on stable chest pain, recommended that patien

A new gene therapy that targets the heart and requires only one treatment session, has been found safe for patients with coronary artery disease, according to a successful trial carried out in Finland (doi: 10.1093/eurheartj/ehx352). The treatment enhances circulation in ischaemic heart muscle and the effects were still visible one year after treatment. The randomised, blinded, placebo-controlled phase 1/2a trial was carried out in collaboration between the University of Eastern Finland, Kuopio University Hospital and Turku PET Centre. The biological bypass is based on gene transfer in which a natural human growth factor, AdVEGF-DΔNΔC, a ne