ABSTRACT
Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
ABSTRACT
Background: Hospitals play the most important role in health care system utilizing the majority of the health system resources. Appropriate and efficient management of hospitals could decreases the cost of diagnostic and therapeutic services while improve the quality of services. Efficient hospital management requires recognizing and prioritizing factors affecting hospital performance and choosing the correct interventions. In the current research managerial factors which affect Tehran Heart Center's [THC] performance were recognized and prioritized. Materials and Methods: A qualitative study using interview technique was performed in 2010 to identify managerial factors affecting T.H.C.'s performance. Top and middle line managers were included in this study. To prioritize the factors a questionnaire was designed and used. The results were analyzed by one sample t-test and Fuzzy DEMATEL techniques. Results: In this study 9 managerial factors affecting on T.H.C.'s performance were recognized which 7 of them were influencing based on the positive [Dfi-Rfi] and the others were influenced. The factors according to their intensity based on the quantity of [Dfi+Rfi]. So the influencing factors' ranking were as follow: delegation [3/16], management accountability [2/96], appropriateness of authority and responsibility [2/67], management motivation [2/61], process approach [2/26], systematic approach [2/25] and Top Management stability[1/68]. Conclusion: Paying more attention and focusing on the main influencing factors such as delegation, management accountability, authority and responsibility appropriateness, top management stability and management motivation, lead to higher performance in the hospitals.
ABSTRACT
Cardiovascular diseases [CVD] especially Ischemic Heart Diseases [IHD] are responsible for more than 40% of mortalities in the Islamic Republic of Iran: As is the case in the Western hemisphere. physica1lllactivity is the most prevalent CVDs risk factor. The aim of this research was to determine the association of the physical activity indices [work, sport and leisure, time indices], and body weight measures with the risk of developing IHD in Tehran, Islamic Republic of Iran, This case - control study was conducted during 2003 and 2004 in Tehran Heart Center and Tehran Shahid Rajaii hospital. A sample of 100 IHD patients [cases] and 100 healthy individuals served as control The controls we.re matched to the IHD patients by age [ +/- 5 years], sex, Information about Physical activity was recorded by means of the Beacke questionnaire. Some important risk factors including hypertension. hyperlipidemia. diabetes and Body Mass Index [BMI] were also recorded. All the data were statistically analyzed with the SPSS for Windows. All reported P values are based on two-sided and compared to a significance level of 5%. The patients had significantly lower indices for work sports and Leisure time Physical Activity [P <0,001]. Analysis of BMI showed that there was a significant association between obesity and the ask of developing IHD [P = 0.01]. There was a significant negative correlation between BMI and Leisure Time Physical Activity index: the higher the BMI, the lower the likelihood of participation in Leisure Time Physical Activity activities. After multivariate analysis. the Leisure Tune Physical Activity [LTPA] independently had a protective effect against developing IHD risk. also in the cases group. Obesity increased the risk of IHD nearly 4 times more 10 comparison with normal subjects. Physical activity has a beneficial effect on IHD risk developing and IHD related predisposing risk factors