Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis

This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer’s perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents>3.0 mm followed by metallic stents
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI). Diagnoses: An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction. Intervention: The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin. Outcomes: After a few hours, his symptoms were alleviated. The patient was discharged after 6 day...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
AbstractBackgroundMany patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention.Methods and ResultsThirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest13N-NH3 PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4 &...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
CONCLUSIONS: In patients with low-risk ACS and normal range hsTnI without additional high-risk features, stress MPI has little additional value for the correct diagnosis and management. Prospective studies are warranted to confirm whether resting hsTnI could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and thus, improve patient management. PMID: 31542905 [PubMed - in process]
Source: The Israel Medical Association Journal - Category: General Medicine Tags: Isr Med Assoc J Source Type: research
ConclusionThere was no impact of lower intracoronary contrast injection pressure in comparison to higher injection pressure, during primary PCI in patients with acute STEMI, on myocardial reperfusion as assessed by MBG or ST segment changes in the ECG.The study was registered at registry ClinicalTrials.gov with the registration number: NCT03445364, on February 26th 2018.
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research
Conclusion The cost savings associated with a CCTA first strategy to evaluate chest pain were ~$1 200 244.10. For a self-insured health system such as the Chickasaw Nation, these are very important cost savings.
Source: Coronary Artery Disease - Category: Cardiology Tags: CT Angiography for CAD Source Type: research
Abstract Background and objectives: No-reflow (NR) phenomenon is defined as insufficient myocardial perfusion in coronary circulation in the absence of angiographic evidence of mechanical obstruction. The primary mechanisms of the NR occurrence are thought to be high platelet activity and thrombus burden. Soluble CD40 ligand (sCD40L), which is released into the plasma following platelet activation, accelerates the inflammatory process and causes further platelet activation. The aim of our study is to investigate the relationship between the NR phenomenon and sCD40L level in patients with ST-elevation myocardial in...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
This study evaluated clinical impact of concomitant CAD and coronary revascularization on recurrence of AF after catheter ablation.Methods and ResultsFrom April 2008 to December 2015, 700 consecutive patients were treated with pulmonary vein isolation (PVI) for AF as initial procedure. Of those, 681 patients who simultaneously underwent coronary angiography were investigated. Patients with at least one coronary stenosis ( ≥70%) were classified as having obstructive CAD. Of 681 patients, 90 patients had CAD, and 42 patients underwent percutaneous coronary intervention (PCI) for lesions with perfusion abnormalities on SPE...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ CLINICAL Source Type: research
AbstractClinical predictors for later adverse cardiovascular events in patients undergoing percutaneous coronary intervention (PCI) for silent myocardial ischemia remain undetermined. We investigated clinical features leading to later adverse cardiovascular events in patients who underwent PCI for silent myocardial ischemia. Of a total of 294 consecutive patients with a diagnosis of silent myocardial ischemia who successfully underwent contemporary PCI in our institute between January 2013 and December 2014, an initial event of any of all-cause death, hospitalized heart failure, acute coronary syndromes, and target vessel ...
Source: Heart and Vessels - Category: Cardiology Source Type: research
CONCLUSION:  Cangrelor produces more potent P2Y12 inhibition at the time of first coronary balloon inflation time compared with ticagrelor. Despite this enhanced P2Y12 inhibition, coronary microvascular function and final infarct size did not differ between groups. PMID: 31129911 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
1443Purpose: Myocardial perfusion PET has the ability to quantitatively assess regional myocardial perfusion. However, myocardial perfusion is rarely compared before and after revascularization.Coronary flow reserve (CFR) ratio is the value of relative analysis and has clinical usefulness of detecting regional coronary artery disease (CAD).The purpose of this study was to assess regional quantitative myocardial perfusion after successful percutaneous revascularization in patients with CAD using CFR ratio on N-13 ammonia PET. Materials and Methods: We assessed 19 patients (70±10 years old, 17 males) with CAD who unde...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
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