Trends in U.S. Cardiovascular Care

Masoudi, Frederick A.; Ponirakis, Angelo; Lemos, James A. de; Jollis, James G.; Kremers, Mark S.; Messenger, John C.; Moore, John W.; Moussa, Issam; Oetgen, William J.; Varosy, Paul D.; Vincent, Robert; Wei, Jessica; Curtis, Jeptha P.; Roe, Matthew T.; Spertus, John A.

doi:10.1016/j.jacc.2016.12.005

Cited by 207 publications

(101 citation statements)

References 22 publications

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“…Overall, the use of low-molecular-weight heparin was 65.2% in patients with NSTE-ACS in our study, which is much higher than the 10% in patients with NSTEMI reported by a contemporaneous study from the ACC National Cardiovascular Data Registries. 19 The major explanation for this discrepancy is likely that few patients underwent immediate invasive procedures in this study, 76.1% of patients undergoing PCI >24 hours after admission. Fondaparinux as anew anticoagulant medication has been considered as the first-line anticoagulant agent for conservative strategies in the ESC guideline recommendations (COR I, LOE B); however, the proportion of patients receiving fondaparinux was low in both patients with PCI or conservative treatment groups in this study.…”

Section: Downloaded Frommentioning

confidence: 77%

Invasive Management Strategies and Antithrombotic Treatments in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome in China

Wang

Liu

et al. 2017

Circ: Cardiovascular Interventions

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Background— Early invasive strategies and antithrombotic treatments are key treatments of non–ST-segment–elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes. Methods and Results— A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients. Conclusions— There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02306616.

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Section: Downloaded Frommentioning

confidence: 77%

Invasive Management Strategies and Antithrombotic Treatments in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome in China

Wang

Liu

et al. 2017

Circ: Cardiovascular Interventions

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“…This is essentially unchanged from the last analysis of national ICD implant practice in NZ in 2010 . The primary prevention ICD implant ratio reported in several international registries over the past decade is as follows: 46% in Denmark, 55% in Germany, 57% in the United Kingdom, 59% in Sweden, 62% in Spain, 63% in France, 73% in Canada, 75% in the United States, and 82% in Italy . The proportion of ICDs implanted in NZ for primary prevention indications is thus on the lower end of the range of contemporary international implant practice.…”

Section: Discussionmentioning

confidence: 98%

Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Foo

Lee

Looi

et al. 2019

Journal of Arrhythmia

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on behalf of the ANZACS-QI investigatorsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects nationwide data on cardiac implantable electronic devices in New Zealand (NZ). We used the registry to describe contemporary NZ use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). Methods: All ICD and CRT Pacemaker implants recorded in ANZACS-QI DEVICEbetween 1 January 2014 and 31 December 2017 were analyzed. Results:Of 1579 ICD implants, 1152 (73.0%) were new implants, including 49.0% for primary prevention and 51.0% for secondary prevention. In both groups, median age was 62 years and patients were predominantly male (81.4% and 79.2%, respectively).Most patients receiving a primary prevention ICD had a history of clinical heart failure (80.4%), NYHA class II-III symptoms (77.1%) and LVEF ≤35% (96.9%). In the secondary prevention ICD cohort, 88.4% were for sustained ventricular tachycardia or survived cardiac arrest from ventricular arrhythmia. Compared to primary prevention CRT Defibrillators (n = 155), those receiving CRT Pacemakers (n = 175) were older (median age 74 vs 66 years) and more likely to be female (38.3% vs 19.4%). Of the 427 (27.0%) ICD replacements (mean duration 6.3 years), 46.6% had received appropriate device therapy while 17.8% received inappropriate therapy. The ICD implant rate was 119 per million population with regional variation in implant rates, ratio of primary prevention ICD implants, and selection of CRT modality. Conclusion:In contemporary NZ practice three-quarters of ICD implants were new implants, of which half were for primary prevention. The majority met current guideline indications. Patients receiving CRT pacemaker were older and more likely to be female.

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“…Moreover, high-dose statin treatment and other currently standard measures only prevent a fraction of recurrent events in survivors of myocardial infarction (MI) (15–17). This residual burden of events presents a pressing unmet medical need.…”

Section: Inflammatory and Immune Mechanisms Participate In Atherothromentioning

confidence: 99%

Interleukin-1 Beta as a Target for Atherosclerosis Therapy

Libby

2017

Journal of the American College of Cardiology

508

350

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Inflammatory pathways drive atherogenesis and link traditional risk factors to atherosclerosis and its complications. One inflammatory mediator has come to the fore as a therapeutic target in cardiovascular disease. The experimental and clinical evidence reviewed here support interleukin-1 beta (IL-1β) as both a local vascular and systemic contributor in this regard. Intrinsic vascular wall cells and lesional leukocytes alike can produce this cytokine. Local stimuli in the plaque favor the generation of active IL-1β through the action of a molecular assembly known as the inflammasome. Clinically applicable interventions that interfere with IL-1 action can improve cardiovascular outcomes, ushering in a new era of anti-inflammatory therapies for atherosclerosis. The translational path described here illustrates how advances in basic vascular biology may transform therapy. Biomarker-directed application of anti-inflammatory interventions promises to help us achieve a more precise and personalized allocation of therapy for our cardiovascular patients.

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Trends in U.S. Cardiovascular Care

Cited by 207 publications

References 22 publications

Invasive Management Strategies and Antithrombotic Treatments in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome in China

Invasive Management Strategies and Antithrombotic Treatments in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome in China

Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Interleukin-1 Beta as a Target for Atherosclerosis Therapy

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