ABSTRACT
AIMS: The aim was to describe outcomes among patients with stable coronary artery disease (CAD) with or without a history of myocardial revascularization in a large contemporary cohort. METHODS AND RESULTS: Patients with stable CAD were selected from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The cohort was divided into patients with ( n = 25 583) and without ( n = 13 133) a history of myocardial revascularization. Crude outcomes were described according to the use and type of revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The primary outcome was cardiovascular (CV) death. At baseline, the non-revascularized group was older and had more CV risk factors. At 36-month median follow-up, previous revascularization was associated with a lower risk of CV death [crude incidence rate (CIR): 6.82 vs. 9.08%, hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.66-0.80]; P < 0.01]. This association was seen for patients with a history of PCI (CIR 5.78 vs. 8.88%, HR 0.64 [0.58-0.71]; P ≤ 0.01), but not with CABG (HR 1.26 [1.14-1.49]; P < 0.01), and was consistent regardless of prior MI and the timing of prior revascularization. CONCLUSION: Among patients with stable CAD, a history of myocardial revascularization was associated with lower CV mortality, particularly when PCI was the mode of revascularization. Coronary artery disease patients managed non-invasively represent a high-risk group.
ABSTRACT
Transcatheter heart valve endocarditis is a rare, but life threatening complication. We describe the case of a patient who was successfully treated by transcatheter aortic valve-in-valve-in-valve replacement with a favorable 1-year outcome, despite severe early complications.
Subject(s)
Aortic Valve Stenosis/therapy , Bioprosthesis , Cardiac Catheterization/methods , Endocarditis/etiology , Endocarditis/therapy , Heart Valve Prosthesis Implantation/adverse effects , Aged , Aortic Valve Stenosis/diagnostic imaging , Cardiac Catheterization/adverse effects , Echocardiography, Transesophageal/methods , Endocarditis/diagnostic imaging , Follow-Up Studies , Heart Valve Prosthesis Implantation/methods , Humans , Magnetic Resonance Angiography/methods , Male , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/therapy , Radiography , Rare Diseases , Risk Assessment , Severity of Illness Index , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Stroke/diagnostic imaging , Stroke/etiology , Stroke/therapy , Treatment OutcomeSubject(s)
Calcinosis/surgery , Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/methods , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Aged , Calcinosis/complications , Calcinosis/diagnosis , Echocardiography, Transesophageal , Female , Heart Septum , Humans , Imaging, Three-Dimensional , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/etiology , Severity of Illness Index , Tomography, X-Ray ComputedSubject(s)
Aortic Valve/surgery , Cerebrovascular Disorders/surgery , Heart Valve Prosthesis Implantation , Middle Cerebral Artery/surgery , Percutaneous Coronary Intervention , Postoperative Complications/surgery , Stroke/surgery , Aged, 80 and over , Aortic Valve/pathology , Calcium , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/prevention & control , Female , Humans , Magnetic Resonance Angiography , Middle Cerebral Artery/diagnostic imaging , Middle Cerebral Artery/pathology , Radiography , Stents/statistics & numerical data , Stroke/etiology , Stroke/prevention & controlABSTRACT
Health related quality of life (HRQoL) is used increasingly as a measure of the outcome of CHD. As an improvement in survival of CHD continues, assessment of HRQoL has become an important and useful outcome measure complementing the traditional "hard outcomes" such as mortality for evaluating benefits of medical interventions. Increasing number of clinical trials is applying HRQoL as an outcome measure of CHD therapy. Assessment of HRQoL in CHD should comprise a disease-specific measure in addition to a generic measure. This review aims to provide an overview of generic, disease-specific, and utility measures used in the assessment of HRQoL in CHD.
