Cardiovascular Care Facts

Abstract

The NCDR provides a unique opportunity to understand the characteristics of large populations of patients with CVD, the centers that provide their care, quality of care provided, and important patient outcomes.

Differences in Short- and Long-Term Outcomes Among Older Patients With ST-Elevation Versus Non–ST-Elevation Myocardial Infarction With Angiographically Proven Coronary Artery Disease

“…[5][6][7][8] Furthermore, the widespread use of urgent coronary angiography and primary percutaneous coronary intervention (PCI) for patients with STEMI treated in routine practice compared with the more selective, risk-based decision-making that underlies the comparatively lower use of coronary angiography and revascularization for NSTEMI patients introduces unavoidable biases that confound the characterization of longterm outcomes between STEMI versus NSTEMI patients. 9 Therefore, to study a homogeneous, older group of STEMI versus NSTEMI patients treated in routine practice, we linked patients with acute MI included in the National Cardiovascular Data Registry ACTION Registry-Get With the Guidelines (GWTG) found to have significant coronary artery disease (CAD) during coronary angiography with Medicare claims data to investigate differential risks of mortality and nonfatal cardiovascular and cerebrovascular outcomes by MI classification.…”

Implantable Cardioverter‐Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review

“…Further, advances in medical therapy for left ventricular systolic dysfunction and coronary artery disease are likely to attenuate the risk of subsequent SCA in this population, potentially attenuating the benefits of ICD therapy. Observational studies of this population are relatively few compared with those focusing on primary prevention, despite the fact that a substantial proportion (nearly 25%) of ICDs implanted are for secondary prevention 3. Future investigations are needed to improve the quality of care provided to this large population of patients.…”

“…In 2011 the NCDR recorded 33 860 secondary prevention–indicated ICD implants alone, which underestimates national rates, as not all institutions submit data on secondary prevention ICDs to NCDR 3. Additional trials including patients with a secondary prevention ICD indication would be welcome, especially in those populations where the guidelines extrapolate beyond the RCTs, however, these may be difficult because of perceptions of the lack of equipoise in a “no‐ICD arm.” Advances in medical therapy, ICD technology and programming strategies, and structural heart disease are likely to have a significant impact among patients who are candidates for secondary prevention ICD.…”

“…Among patients with an aborted episode of sudden cardiac arrest (SCA) due to ventricular arrhythmias without a reversible cause, the ICD is considered an important therapy for secondary prevention of SCA and is supported by class IA guideline recommendations in selected patients 2. In the United States, a quarter of ICD procedures included in the National Cardiovascular Data Registry (NCDR) ICD Registry are performed for secondary prevention indications 3. Herein, we review the epidemiology and prognosis of patients suffering SCA, review the evidence for secondary prevention ICDs, and contemporary studies of this patient population.…”

Interventional Cardiology

“…These advances have resulted in improved acute success (>95%) and reduced mortality (0.7% in patients without myocardial infarction) and the need for emergency coronary artery bypass grafting (<0.3%) while reducing restenosis to <10%. 9 Despite the improved outcomes, PCI continues to be limited by significantly lower success or higher complication rates in patients with unfavorable coronary anatomy, such as diffuse disease, dense calcification, chronic total occlusion, and complex bifurcation lesions. In addition, the problem of early (<1 month.…”