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The goal of this study was to compare angiographic interpretation of coronary arteriograms by sites in community practice versus those made by a centralized angiographic core laboratory.The study population consisted of 2013 American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) records with 2- and 3- vessel coronary disease from 54 sites in 2004 to 2007. The primary analysis compared Registry (NCDR)-defined 2- and 3-vessel disease versus those from an angiographic core laboratory analysis. Vessel-level kappa coefficients suggested moderate agreement between NCDR and core laboratory analysis, ranging from kappa=0.39 (95% confidence intervals, 0.32-0.45) for the left anterior descending artery to kappa=0.59 (95% confidence intervals, 0.55-0.64) for the right coronary artery. Overall, 6.3% (n=127 out of 2013) of those patients identified with multivessel disease at NCDR sites had had 0- or 1-vessel disease by core laboratory reading. There was no directional bias with regard to overcall, that is, 12.3% of cases read as 3-vessel disease by the sites were read as <3-vessel disease by the core laboratory, and 13.9% of core laboratory 3-vessel cases were read as <3-vessel by the sites. For a subset of patients with left main coronary disease, registry overcall was not linked to increased rates of mortality or myocardial infarction.There was only modest agreement between angiographic readings in clinical practice and those from an independent core laboratory. Further study will be needed because the implications for patient management are uncertain. [ABSTRACT FROM AUTHOR]

The article investigates the temporal trends in the association between age and in-hospital mortality of stratified age groups after percutaneous coronary intervention using data from the U.S. National Cardiovascular Data Registry. It determines the difference between in-hospital mortality rates among the age groups who were admitted from January 1, 2001 to December 31, 2006. The largest reduction in in-hospital mortality was observed among patients 80 years of age or older.

Background: National trends in acute coronary syndrome (ACS) treatment strategy show increasing utilization of percutaneous coronary interventions (PCI) over coronary artery bypass graft (CABG). We evaluated whether the increased use of PCI in some hospitals results in high PCI:CABG ratios, leading to higher PCI or overall mortality due to aggressive case selection. Methodology: The National Inpatient Sample (NIS) for the year 2014 was queried. All patients (pts) admitted for ACS who received either CABG or PCI were selected. We identified the 100 hospitals with highest volume of either kind of revascularization. PCI:CABG ratio was calculated and overall and PCI mortality rate for each hospital collected. Pearson correlation coefficient was utilized to assess for linear correlation of mortality vs. ratio. Results: Out of 72,755 pts selected, 81.3% received PCI and 18.7% received CABG. Mean age was 63.6±12.4 years and 69.2% were women. Mean number of PCIs performed per hospital was 591.4±194.7 and for CABG was 136.2 ±70.7. The average PCI:CABG ratio per hospital was 5.18±2.55 (range 1.4-15.0). Mean PCI in-hospital mortality was 2.90±1.67% and for CABG was 3.32%±3.91% p=0.324. Combined mortality for either strategy was 2.97%±1.56%. There was no relationship between PCI:CABG ratio and overall mortality rate (r =.008, P=.940) or PCI related mortality (r= -.002, P=.984). Conclusions: Increased relative utilization of PCI versus CABG has had no deleterious impact on mortality in ACS. PCI vs CABG case selection in ACS does not appear to be useful as a quality indicator. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery calcium (CAC) is considered as an adverse cardiovascular events predictor. However, its prognostic impact on heart failure with preserved ejection fraction (HFpEF) patients in the absence of coronary artery disease history (CAD Hx) remains unclear and that is what we aimed to evaluate. Methods: In this cohort, we queried our institutional HF database and identified 249 patients with a new HFpEF diagnosis during 2006 who had CT coronary calcium score within 12 months of admission. Average follow up was 10 years (10.2±2.3). CAC Agatston score of >100 was considered significant. Measured outcomes were cardiovascular disease (CVD) mortality and HF re-admissions (poor outcome was defined as ≥2 HF re-admissions in 12 months) Results: Women constituted 56.6%. CAD Hx was documented in 124 patients , 70 patients had neither CAD Hx nor CAC, and 55 patients had no CAD Hx but demonstrated CAC score >100 on CT. Mean age was 72.1±13.4 years. The CVD mortality rate for patients with CAD Hx was relatively similar to those without CAD Hx but significant CAC, 25% and 23.6%, respectively. However, the CVD mortality rate for those with neither CAC nor CAD Hx was only 7.1% (p=0.008). Poor outcome was identified in 54.5% of patients with CAC and in 44.3% of those with no CAC (p=0.25). Only 36.4% of patients with CAC and no CAD Hx were on optimal therapy. Conclusions: In HFpEF patients, the presence of CAC >100 is significantly associated with CVD mortality despite the absence of CAD hx. Accordingly, screening for CAC in HFpEF patients should be considered for detecting those at risk for CVD mortality and to aid in optimizing medical therapy. [ABSTRACT FROM AUTHOR]

Background: The risks of late stent thrombosis with drug-eluting stents (DES) were intensely debated after the presentation of a number of studies highlighting this issue in September 2006. We evaluated trends in the use of DES for patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) from 2006 to 2008., Methods and Results: Temporal patterns of DES use were examined among non-ST-elevation myocardial infarction patients in the Can Rapid risk stratification of Unstable angina patients Supress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE; January 2006 to December 2006) and Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG; January 2007 to June 2008) registries to determine how practice patterns changed for patients with acute myocardial infarction undergoing PCI. Among the 54 662 patients analyzed, the percentage of patients undergoing PCI by quarter varied from 54% to 58% during the analysis time period. More than 90% of patients undergoing PCI received a DES in the first 3 quarters of 2006 before the public debate about the risks of DES began. Thereafter, the use of DES for PCI patients declined during the fourth quarter of 2006 through the first quarter of 2007 (82% to 67%), gradually declined during quarters 2 to 4 of 2007 (63% to 63% to 59%) but then slightly increased from the first to second quarter of 2008 (58% to 60%). Hospital characteristics did not seem to correlate with temporal changes in DES use, but by the last 2 quarters of the study period, patient characteristics such as white race, hypertension, diabetes mellitus, and private or managed care insurance were more common among patients who received a DES compared with the beginning 2 quarters of the study period., Conclusions: These findings highlight how rapidly treatment decisions in contemporary practice can be affected by public debate related to scientific presentations and publications.

Background: An American College of Cardiology/American Heart Association (ACC/AHA) Task Force periodically revises and publishes guidelines with evidence-based recommendations for appropriate use of percutaneous coronary intervention (PCI). Some studies have suggested that closer adherence to guidelines can reduce variations in care, can improve quality, and may ultimately result in better outcomes, but this finding is incompletely understood. Guidelines themselves must change to be responsive to continuously evolving clinical practice. Our goal here was to investigate whether any relationship existed between the most recent ACC/AHA recommended indications for PCI and short term in-hospital outcomes., Methods and Results: We analyzed the ACC National Cardiovascular Data Registry for the period of January 1, 2001, through March 31, 2004. We excluded PCI procedures performed for acute myocardial infarction (ST-segment elevation myocardial infarction); all others were grouped by their indications according to the standard ACC/AHA scheme: Class I, evidence and/or agreement that PCI is useful and effective; Class IIa, conflicting evidence and/or divergent opinions, weight is in favor; Class IIb, usefulness/efficacy is less well established; and Class III, evidence and/or agreement that PCI is not useful or effective and may be harmful. Clinical success was defined as angiographic success (<20% residual stenosis) at all lesions attempted without the adverse events of myocardial infarction, same-admission bypass surgery, or death. There were 412 617 PCI procedures included in the analysis. Frequency of indications was as follows: Class I, 64%; Class IIa, 21%; Class IIb, 7%; and Class III, 8%. Clinical success declined across the indications classes (92.8%, 91.7%, 89%, and 85.5%, respectively; P<0.001), whereas adverse events increased., Conclusions: In this large survey of contemporary PCI practice, most procedures were performed for Class I indications. A significant relationship between evidence-based indications recommended by the ACC/AHA Task Force and in-hospital outcomes was noted.

Coronary heart disease is the leading cause of morbidity and mortality in women older than the age of 50 in the United States today. Traditional cardiovascular risk factors (hyperlipidemia, glucose intolerance, and hypertension) are more clearly associated with significant cardiovascular risk after menopause. The increased incidence of cardiovascular events in postmenopausal women and the evidence that cardiovascular disease on average manifests a decade later in women compared with men suggests that estrogen deficiency may predispose women to a higher cardiovascular risk. Numerous biologic mechanisms have been proposed that relate use of hormone therapy (HT) to improved lipid profiles, insulin sensitivity, and vascular reactivity. Early observational trials in the last 2 decades showed a significant decrease in cardiovascular events. Recently published randomized clinical trial results, however, have led to uncertainty about the earlier established cardiovascular benefits of HT. To complicate issues further, alternative estrogenlike compounds, selective estrogen receptor modulators, are being introduced that appear to convey similar cardiovascular benefit and notably less cancer risk than HT. The newly released randomized trials on hormone and nonhormonal agents are reviewed.