RESUMO
Background: Renovascular hypertension and chronic kidney disease secondary to renal artery stenosis [RAS] can be treated by medical therapy, percutaneous transluminal angioplasty with or without stenting
Objective: To determine the effects of renal artery stenting on hypertension and renal function in patients with renal artery stenosis
Patients and Methods: This was an observational study in which 216 patients were identified retrospectively from 1[st] October, 2001 to 3T December 2006, who underwent 232 procedures. Clinical data pertaining to demographics, presence or absence of hypertension, creatinine, number of blood pressure medications and co morbidities was collected pre and post renal artery stenting, Follow up data was available for 144 procedures, with mean follow up period of 14 months
Results: In total, 232 procedures were performed on 216 patients, Of these, 95 [40.9%] had bilateral RAS [group 1], 117 [50.4%] had unilateral RAS [group 2], and 20 [8%] had RAS in a solitary functioning kidney [group 3]. Complete follow-up data was available on 144 patients. Indications for renal artery stenting were poorly controlled hypertension [56,9%], worsening renal function [8,6%], both [24.6%], and other [8,1%]. Procedural success was 100%, with no major in-lab complications. At a mean follow-up of 14.5 months, renal function remained stable with no significant difference in creatinine values but statistically significant drop in systolic blood pressure post stenting for the entire cohort and all the sub-groups
Conclusion: Renal artery stenting is a safe procedure with improvement of blood pressure control, stabilization or improvement in renal function in patients with unilateral, bilateral and RAS in solitary functioning kidneys
RESUMO
Background: Assessment of non-cardiac chest pain places a considerable burden on healthcare resources. A typical admission usually requires serial cardiac biomarkers, electrocardiograms [EKGs] and at times provocative [stress] testing to detect undiagnosed coronary artery disease. Provocative testing incurs costs and additional time investment
Objective: The purpose of this study was to identify such low risk chest pain admissions and examine the utilization of stress testing in this group to determine if they are really needed and outcome of these patients
Patients and Methods: This was a retrospective observational chart review of the patients admitted to Abington Memorial Hospital, from 1[st] January 2011 to 30[th] April 2011 .We included all patients who were admitted to the hospital with atypical chest pain with no prior history of coronary artery disease, a normal non diagnostic EKG and an initial negative troponin on presentation. We recorded the prevalence of risk factors for coronary artery disease, risk stratified the patients based on TIMI risk scoring and determined the utilization of stress tests. We studied the stress test results and the increase in length of hospital stay if a stress test was ordered. Patient's charts were also reviewed to record any adverse events and 30 day re-hospitalizations
Results: Out of 272 charts, 164 patients were included based on the above mentioned criteria. Mean age was 60 years, 33.5% were male. Risk factors included: hypertension [63%], diabetes mellitus [23%], smoking [20%], hyperlipidemia [49%], and family history [38%]. Two patients had positive troponin [peak level 0.43ng/ml] and subsequent negative stress tests. In the patients who were ruled out for ACS [acute coronary syndrome] no troponin elevation was seen in the third set of tests if the second set was normal. Patients were stratified to TIMI risk 0-4. A stress test was performed in 48% of the patients. 53% of patients with a TIMI=0 underwent stress testing, 37% with TIMI=1,50% with TIMI=2,52% with TIMI=3 and 60% with TIMI=4.There was no association between TIMI score and utilization of the stress test [p = 0.494]. 70% of stress tests were recommended by internists and 30% by cardiologists. None of the stress tests were positive for ischemia. 97.4% were negative, 2.6% [2/78] were read as positive and were followed by a cardiac catheterization which revealed normal coronary arteries [false positive stress test]. One patient with a recent negative outpatient stress test and recurrent chest pain underwent catheterization that showed normal coronaries. Performing inpatient stress tests increased the patient length of stay by 17 hours on average.There were no acute coronary syndromes, no deaths, and no 30 day re-hospitalizations due to cardiac complications in patients who did or did not had an inpatient stress test
Conclusion: Ordering stress tests in low risk chest pain patients is of low yield with a high false positive rate and increases the length of hospital stay. These patients can be safely managed with short term observation with rapid and early discharge from the hospital
RESUMO
Background: Assessment of non-cardiac chest pain places a considerable burden on healthcare resources. A typical admission usually requires serial cardiac biomarkers, electrocardiograms [EKGs] and at times provocative [stress] testing to detect undiagnosed coronary artery disease. Provocative testing incurs costs and additional time investment
Objective: The purpose of this study was to identify such low risk chest pain admissions and examine the utilization of stress testing in this group to determine if they are really needed and outcome of these patients
Patients and Methods: This was a retrospective observational chart review of the patients admitted to Abington Memorial Hospital, from 1[st] January 2011 to 30[th] April 2011.We included all patients who were admitted to the hospital with atypical chest pain with no prior history of coronary artery disease, a normal non diagnostic EKG and an initial negative troponin on presentation. We recorded the prevalence of risk factors for coronary artery disease, risk stratified the patients based on TIMI risk scoring and determined the utilization of stress tests. We studied the stress test results and the increase in length of hospital stay if a stress test was ordered. Patient's charts were also reviewed to record any adverse events and 30 day re-hospitalizations
Results: Out of 272 charts, 164 patients were included based on the above mentioned criteria. Mean age was 60 years, 33.5% were male. Risk factors included: hypertension [63%], diabetes mellitus [23%], smoking [20%], hyperlipidemia [49%], and family history [38%]. Two patients had positive troponin [peak level 0.43ng/ml] and subsequent negative stress tests. In the patients who were ruled out for ACS [acute coronary syndrome] no troponin elevation was seen in the third set of tests if the second set was normal. Patients were stratified to TIMI risk 0-4. A stress test was performed in 48% of the patients. 53% of patients with a TIMI=0 underwent stress testing, 37% with TIMI=1, 50% with TIMI=2, 52% with TIMI=3 and 60% with TIMI=4.There was no association between TIMI score and utilization of the stress test [p = 0.494]. 70% of stress tests were recommended by internists and 30% by cardiologists. None of the stress tests were positive for ischemia. 97.4% were negative, 2.6% [2/78] were read as positive and were followed by a cardiac catheterization which revealed normal coronary arteries [false positive stress test]. One patient with a recent negative outpatient stress test and recurrent chest pain underwent catheterization that showed normal coronaries. Performing inpatient stress tests increased the patient length of stay by 17 hours on average. There were no acute coronary syndromes, no deaths, and no 30 day re-hospitalizations due to cardiac complications in patients who did or did not had an inpatient stress test
Conclusion: Ordering stress tests in low risk chest pain patients is of low yield with a high false positive rate and increases the length of hospital stay. These patients can be safely managed with short term observation with rapid and early discharge from the hospital