Abstract:
BACKGROUND:In patients presenting with ST-segment-elevation myocardial infarction, percutaneous coronary intervention (PCI) reduces mortality when compared with fibrinolysis. In other forms of coronary artery disease (CAD), however, it has been controversial whether PCI reduces mortality. In this meta-analysis, we examine the benefits of PCI in (1) patients post-myocardial infarction (MI) who did not receive immediate revascularization; (2) patients who have undergone primary PCI for ST-segment-elevation myocardial infarction but have residual coronary lesions; (3) patients who have suffered a non-ST-segment-elevation acute coronary syndrome; and (4) patients with truly stable CAD with no recent infarct. This analysis includes data from the recently presented International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) and Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trials. METHODS AND RESULTS:We systematically identified all randomized trials of PCI on a background of medical therapy for the treatment of CAD. The ISCHEMIA trial, presented in November 2019, was eligible for inclusion. Data were combined using a random-effects meta-analysis. The primary end point was all-cause mortality. Forty-six trials, including 37 757 patients, were eligible. In the 3 unstable scenarios, PCI had the following effects on mortality: unrevascularized post-MI relative risk (RR) 0.68 (95% CI, 0.45-1.03); P=0.07; multivessel disease following ST-segment-elevation myocardial infarction (RR, 0.84 [95% CI, 0.69-1.04]; P=0.11); non-ST-segment-elevation acute coronary syndrome (RR, 0.84 [95% CI, 0.72-0.97]; P=0.02). Overall, in these unstable scenarios PCI was associated with a significant reduction in mortality (RR, 0.84 [95% CI, 0.75-0.93]; P=0.02). In unstable CAD, PCI also reduced cardiac death (RR, 0.69 [95% CI, 0.53-0.90]; P=0.007) and MI (RR, 0.74 [95% CI, 0.62-0.90]; P=0.002). For stable CAD, PCI did not reduce mortality (RR, 0.98 [95% CI, 0.87-1.11]), cardiac death (RR, 0.89 [95% CI, 0.71-1.12]; P=0.33), or MI (RR, 0.96 [95% CI, 0.86-1.08]; P=0.54). CONCLUSIONS:PCI prevents death, cardiac death, and MI in patients with unstable CAD. For patients with stable CAD, PCI shows no evidence of an effect on any of these outcomes.
journal_name
Circ Cardiovasc Qual Outcomesjournal_title
Circulation. Cardiovascular quality and outcomesauthors
Chacko L,P Howard J,Rajkumar C,Nowbar AN,Kane C,Mahdi D,Foley M,Shun-Shin M,Cole G,Sen S,Al-Lamee R,Francis DP,Ahmad Ydoi
10.1161/CIRCOUTCOMES.119.006363subject
Has Abstractpub_date
2020-02-01 00:00:00pages
e006363issue
2eissn
1941-7713issn
1941-7705journal_volume
13pub_type
杂志文章,meta分析abstract:BACKGROUND:As new techniques emerge to quantify patients' health status, new opportunities are created to validate patient-reported outcome questionnaires. The Seattle Angina Questionnaire (SAQ), a widely used coronary artery disease-specific health status tool, has not been validated against daily records of angina fr...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCOUTCOMES.113.000752
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patients presenting with noncerebrovascular conditions that closely resemble stroke (stroke mimics). However, there are limited dat...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005609
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The effects of lifestyle changes and evolving treatment practices on coronary disease incidence rates, demographic and clinical profile, and the short-term outcomes of patients hospitalized with acute myocardial infarction have not been well characterized. The purpose of this study was to examine multidecade...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.108.811828
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Several antiplatelet medications used during and after percutaneous coronary intervention (PCI) are contraindicated for specific patient groups. A broad assessment of contraindicated medication use and associated clinical outcomes is not well described. METHODS AND RESULTS:Using national Veterans Affairs Cl...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.002043
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The number of women veterans is increasing, yet little is known about their cardiovascular risk factors, coronary anatomy, cardiac treatments, and outcomes after cardiac catheterization. Prior studies have shown that nonveteran women have more risk factors, receive less aggressive treatment, and have worse o...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.114.001613
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. METHODS AND RESULTS:We used the IMS Health National Disease and Therapeutic Index, a nationally representative audi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.112.967299
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Whether measuring and reporting of coronary artery calcium scores (CACS) might lead to changes in cardiovascular risk management is not established. In this observational study, we examined whether high baseline CACS were associated with the initiation as well continuation of new lipid-lowering medication (L...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.109.893396
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Identifying patients at increased risk of contrast-associated acute kidney injury (CA-AKI) can help target risk mitigation strategies toward these individuals during percutaneous coronary intervention. Illuminating which risk models best stratify risk is an important foundation for such quality improvement e...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.005854
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Efforts to improve the quality of care for patients with cardiovascular disease frequently target the decrease of physician-level performance variability. We assessed how variability in providing β-blockers to ambulatory postmyocardial infarction (MI) patients was influenced by physician and patient level ch...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.110.942318
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children,validated methods to risk-standardize pediatric survival rates across sites do not currently exist. METHODS AND RESULTS:From 2006 to 2010, within the American Heart Association's Get With the Guidelines-...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.113.000691
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:In many countries, a majority of stroke patients are not assessed for long-term functional outcome owing to limited resources and time. We investigated whether automatic assessment of the modified Rankin Scale (mRS) based on a mobile phone questionnaire may serve as an alternative to mRS assessments at clini...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.002055
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.117.004029
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Despite ongoing efforts to improve the quality of pediatric resuscitation, it remains unknown whether survival in children with in-hospital cardiac arrest has improved. METHODS AND RESULTS:Between 2000 and 2009, we identified children (<18 years of age) with an in-hospital cardiac arrest at hospitals with >...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.112.967968
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Stress testing after percutaneous coronary intervention (PCI) in fee-for-service settings is common and rates vary by hospital. Rates of stress testing after PCI within integrated healthcare systems, such as the Veterans Affairs (VA) are unknown. METHODS AND RESULTS:We evaluated all VA patients who underwen...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.114.001561
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Prior studies suggest that low-risk ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention can be considered for early discharge. We describe the implementation of an STEMI risk score to decrease cost while maintaining optimal patient outcomes. METH...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.118.004553
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Percutaneous coronary intervention (PCI) for stable coronary artery disease does not reduce the risk of death and myocardial infarction compared with optimal medical therapy (OMT), but many patients think otherwise. PCI Choice, a decision aid (DA), was designed for use during the clinical visit and includes ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCOUTCOMES.116.002641
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education ...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
doi:10.1161/HCQ.0000000000000025
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Translation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may vary internationally. We examined common measures of quality of care in patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. METHO...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCOUTCOMES.113.000119
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Angina in patients with coronary artery disease is associated with worse quality of life; however, the relationship between angina frequency and resource utilization is unknown. METHODS AND RESULTS:Using data from the MERLIN-TIMI 36 trial, we assessed the association between the extent of angina after an ac...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCOUTCOMES.108.829523
更新日期:2009-07-01 00:00:00
abstract::Background Guidelines recommend against the use of intravenous tPA (tissue-type plasminogen activator; IV tPA) in acute ischemic stroke patients with prior ischemic stroke within 3 months. However, there are limited data on the safety of IV tPA in this population. Methods and Results A retrospective observational stud...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.119.006031
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Instruments to assess symptom burden and quality of life among patients with atrial fibrillation (AF) have not been well evaluated in community practice or associated with patient outcomes. METHODS AND RESULTS:Using data from 10 087 AF patients in the Outcomes Registry for Better Informed Treatment of AF (O...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCOUTCOMES.114.001303
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Patients with diabetes mellitus (DM) are at high risk for mortality after myocardial infarction (MI). Despite an overall trend of reduced mortality after MI, the mortality gap between MI patients with and without DM did not decrease over time in previous analyses. We assessed recent trends in hospital mortal...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.112.965491
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:Exposure to tobacco smoke is associated with markers of preclinical atherosclerosis in adults, but its effect on arterial structure in adolescents is unknown. METHODS AND RESULTS:Healthy 13-year-old adolescents from the atherosclerosis prevention trial STRIP were studied. Maximum carotid and aortic intima-m...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCOUTCOMES.109.857771
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:In response to the public health emergency created by the coronavirus disease 2019 (COVID-19) pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality imp...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,评审
doi:10.1161/CIRCOUTCOMES.120.006967
更新日期:2020-08-01 00:00:00
abstract::Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective revi...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.002614
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Using electronic health records data to predict events and onset of diseases is increasingly common. Relatively little is known, although, about the tradeoffs between data requirements and model utility. METHODS AND RESULTS:We examined the performance of machine learning models trained to detect prediagnost...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.116.002797
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. METHODS AND RESULTS:Four hundred patients were randomly selected fro...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.114.001067
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Percent time in therapeutic range (TTR) and international normalized ratio (INR) variability both measure warfarin control and are associated with outcomes independently. Here, we examine the advantages of a warfarin composite measure (WCM), which summarizes the 2 when measuring patient outcomes. We also exa...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.115.001789
更新日期:2015-11-01 00:00:00
abstract::Background Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype. Methods and Result...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章,meta分析
doi:10.1161/CIRCOUTCOMES.118.004757
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:The impact of polyvascular disease (peripheral arterial disease [PAD] and cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction has not been well studied. METHODS AND RESULTS:Patients with non-ST-segment-elevation myocardial infarction aged...
journal_title:Circulation. Cardiovascular quality and outcomes
pub_type: 杂志文章
doi:10.1161/CIRCOUTCOMES.111.964379
更新日期:2012-07-01 00:00:00