...many of these recommendations are based on expert consensus. The defining principle is that this effort is a joint, institutionally-based activity for cardiologists and cardiac surgeons (1,4). ......the specialty that provides some of these components will vary from program to program.
A previously validated diagnostic test (Corus® CAD, CardioDx,Inc.) incorporating age, sex, and gene expression has a 96% negative predictive value among patients with low (<=15) scores in determining ...a patient's current likelihood of obstructive coronary artery disease (CAD).
Facilitating Interoperability1351 Overview1351 Historical Context1352 Integration Profile Development Cycle1352 Benefits of Interoperability/IHE1352 Cardiology Profiles1354 Overview of the ...Profiles1354 Cardiac Catheterization Workflow1354 Echocardiography Workflow1354 Retrieve Electrocardiogram for Display Content Profile1354 Resting Electrocardiogram Workflow Profile1354 Evidence Documents1355 Stress Testing Workflow1355 Displayable Reports Profile1355 Cardiac Imaging Report Content1355 Image-Enabled Office Workflow1355 Electrophysiology Laboratory Report Content-Implant/Explant1355 Implantable Device Cardiac Observations1356 Cardiac Cath Report Content1356 Registry Content Submission1356 Nuclear Medicine Image1356 Profiles in Development1356 Clinical Research and Quality Metrics1356 Promoting the IHE Interoperability Framework1356 Request for Proposals1357 Advantages to Vendors/Users1357 Office of the National Coordinator1358 Measuring Success1358 The Patient's Perspective on Interoperability and Quality1358 Conclusions1359 Appendix 1 Author Listing of Relevant Relationships With Industry and Other Entities--2016 ACC/ASE/ASNC/HRS/SCAI Health Policy Statement on Integrating the Healthcare Enterprise1361 Appendix 2 Peer Reviewer Listing of Relevant Relationships With Industry and Other Entities (Relevant)--2016 ACC/ASE/ASNC/HRS/SCAI Health Policy Statement on Integrating the Healthcare Enterprise1362 Appendix 3 Abbreviations1364 Preamble This document has been developed as a health policy statement by the American College of Cardiology (ACC), in conjunction with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions. By capturing and reporting high-quality data, the NCDR serves as a tool to measure, benchmark, and improve cardiovascular care (5).\n Jude Medical None None John S. Rumsfeld Official Reviewer--ACC Board of Trustees U.S. Veterans Health Administration--National Director of Cardiology None None None None None None Joyce Sensmeier Organizational Reviewer--HIMSS HIMSS North America--Vice President Informatics None None None None None None H. Vernon Anderson Content Reviewer--NCDR Management Board University of Texas Health Science Center, McGovern Medical School, Houston, Texas--Professor of Medicine None None None MedPace Medical Devices (DSMB) None None Shyam Bhakta Content Reviewer--Advocacy Steering Committee Northeast Ohio Medical University College of Medicine--Assistant Professor of Internal Medicine; Cleveland Clinic Akron General None None None None None None Gilead I. Lancaster Content Reviewer--Advocacy Steering Committee Bridgeport Hospital/Yale New Haven Health System--Director, Non-Invasive Cardiology None None None None None None William A. Van Decker Content Reviewer--Advocacy Steering Committee Temple University Hospital--Assistant Professor of Medicine None None None None None None Paul G. Varghese Content Reviewer--Data Standards Task Force Harvard Medical School--National Library of Medicine Informatics Fellow None None ChartWise Medicallow * None None None Siqin Kye Ye Content Reviewer--Informatics and Health Information Technology Task Force Columbia University Medical Center--Assistant Professor of Medicine, Division of Cardiology, Department of Medicine None None None None None None * This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant to this document.
Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with ...triglycerides >2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease.
Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 95% confidence intervals, 1.006 to 1.093 for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 95% confidence intervals, 1.004 to 1.096 for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up.
Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease.
Myocardial salvage is often suboptimal after percutaneous coronary intervention in ST-segment elevation myocardial infarction. Posthoc subgroup analysis from a previous trial (AMIHOT I) suggested ...that intracoronary delivery of supersaturated oxygen (SSO(2)) may reduce infarct size in patients with large ST-segment elevation myocardial infarction treated early.
A prospective, multicenter trial was performed in which 301 patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset were randomized to a 90-minute intracoronary SSO(2) infusion in the left anterior descending artery infarct territory (n=222) or control (n=79). The primary efficacy measure was infarct size in the intention-to-treat population (powered for superiority), and the primary safety measure was composite major adverse cardiovascular events at 30 days in the intention-to-treat and per-protocol populations (powered for noninferiority), with Bayesian hierarchical modeling used to allow partial pooling of evidence from AMIHOT I. Among 281 randomized patients with tc-99m-sestamibi single-photon emission computed tomography data in AMIHOT II, median (interquartile range) infarct size was 26.5% (8.5%, 44%) with control compared with 20% (6%, 37%) after SSO(2). The pooled adjusted infarct size was 25% (7%, 42%) with control compared with 18.5% (3.5%, 34.5%) after SSO(2) (P(Wilcoxon)=0.02; Bayesian posterior probability of superiority, 96.9%). The Bayesian pooled 30-day mean (+/-SE) rates of major adverse cardiovascular events were 5.0+/-1.4% for control and 5.9+/-1.4% for SSO(2) by intention-to-treat, and 5.1+/-1.5% for control and 4.7+/-1.5% for SSO(2) by per-protocol analysis (posterior probability of noninferiority, 99.5% and 99.9%, respectively).
Among patients with anterior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention within 6 hours of symptom onset, infusion of SSO(2) into the left anterior descending artery infarct territory results in a significant reduction in infarct size with noninferior rates of major adverse cardiovascular events at 30 days. Clinical Trial Registration- clinicaltrials.gov Identifier: NCT00175058.
Percutaneous coronary intervention (PCI) is the most common method of coronary revascularization. Over time, as operator skills and technical advances have improved procedural outcomes, the length of ...stay (LOS) has decreased. However, standardization in the definition of LOS following PCI has been challenging due to significant physician, procedural, and patient variables. Given the increased focus on both patient safety as well as the cost of medical care, system process issues are a concern and provide a driving force for standardization while simultaneously maintaining the quality of patient care. This document: (1) provides a summary of the existing published data on same-day patient discharge following PCI, (2) reviews studies that developed methods to predict risk following PCI, and (3) provides clarification of the terms used to define care settings following PCI. In addition, a decision matrix is proposed for the care of patients following PCI. It is intended to provide both the interventional cardiologist as well as the facilities, in which they are associated, a guide to allow for the appropriate LOS for the appropriate patient who could be considered for early discharge or outpatient intervention.
PDF
