The American journal of cardiology
-
The future of cardiology rests in the hands and minds of cardiovascular trainees and fellowship programs. Education and training is rapidly changing, and the paradigm of "see one, do one, teach one" has now been replaced by formal assessments of competency, the incorporation of practice improvement and systems-based practice, and a focus on duty hours. To keep up with the expanding knowledge and science in cardiovascular medicine, the cardiology community needs to understand new educational initiatives and formulate pathways to teach, mentor, and educate trainees to become competent cardiovascular specialists. The author highlights some of the present and future issues facing cardiovascular training.
-
Patients ≥ 80 years old with coronary artery disease constitute a particular risk group in relation to percutaneous coronary intervention (PCI). From 2002 through 2008 we examined the annual proportion of patients ≥ 80 years old undergoing PCI in western Denmark, their indications for PCI, and prognosis. From 2002 through 2009 all elderly patients treated with PCI were identified in a population of 3.0 million based on the Western Denmark Heart Registry. ⋯ In patients with SAP target vessel revascularization decreased from 7.1% in 2002 to 2.5% in 2008. In conclusion, the proportion of patients ≥ 80 years old treated with PCI increased significantly over an 8-year period. Patients with SAP had the lowest mortality rates and rates of clinically driven target vessel revascularization decreased over time.
-
Clinical Trial
Acute safety and 30-day outcome after percutaneous edge-to-edge repair of mitral regurgitation in very high-risk patients.
Percutaneous edge-to-edge mitral valve repair using the MitraClip device has evolved as a new tool for the treatment of severe mitral valve regurgitation. This technique has been evaluated in surgical low- and high-risk patients. Patients with advanced age, multiple morbidities, and heart failure will be the first to be considered for a nonsurgical approach. ⋯ Two patients developed a left atrial thrombus, 1 patient was on a ventilator for >12 hours, and 1 patient had significant access site bleeding. In conclusion, this study shows that percutaneous edge-to-edge mitral valve repair can be safely performed even in surgical high-risk patients with an STS score >15. At 1-month follow-up most patients showed persistent improvement in mitral regurgitation and a clinical benefit.
-
A published formula containing minimal aortic cross-sectional area and the flow deceleration pattern in the descending aorta obtained by cardiovascular magnetic resonance predicts significant coarctation of the aorta (CoA). However, the existing formula is complicated to use in clinical practice and has not been externally validated. Consequently, its clinical utility has been limited. ⋯ Indexed minimal aortic cross-sectional area and heart rate-corrected flow deceleration time in the descending aorta were independent predictors of CoA gradient ≥ 20 mm Hg (p <0.01 for both). A prediction tree combining these variables reached a sensitivity and specificity of 90% and 76%, respectively. In conclusion, the presented prediction tree on the basis of cutoff values is easy to use and may help guide the management of patients investigated for CoA.
-
Comparative Study
Comparison of characteristics, management practices, and outcomes of patients between the global registry and the gulf registry of acute coronary events.
The Arab Middle East is a unique region of the developing world where little is known about the outcomes of patients hospitalized with an acute coronary syndrome (ACS), despite playing an important role in the global burden of cardiovascular disease. The primary objectives of this observational study were to compare patients with ACS hospitalized in the Arab Middle East to patients enrolled in a multinational non-Arabian ACS registry. The study cohort consisted of patients hospitalized in 2007 with an ACS including 4,445 from the Global Registry of Acute Coronary Events (GRACE) and 6,706 from the Gulf Registry of Acute Coronary Events (Gulf RACE). ⋯ Multivariable adjusted in-hospital case-fatality rates were not significantly different between patients in Gulf RACE and those in GRACE. In conclusion, despite differences in patient characteristics and treatment practices, short-term mortality rates were comparable in patients with ACS enrolled in these 2 registries. Future studies should explore the effects of these differences on long-term prognosis and other pertinent patient outcomes.