Hospital Variability Drives Inconsistency in Antiplatelet use following Coronary Bypass

Publication date: Available online 11 February 2020Source: The Annals of Thoracic SurgeryAuthor(s): Jared P. Beller, William Z. Chancellor, J. Hunter Mehaffey, Robert B. Hawkins, Matthew R. Byler, Alan M. Speir, Mohammed A. Quader, Andy C. Kiser, Leora T. Yarboro, Gorav Ailawadi, Nicholas R. TemanAbstractBackgroundContinuation of dual antiplatelet therapy (DAPT) following coronary artery bypass grafting (CABG) after acute myocardial infarction is recommended by current guidelines. We sought to evaluate guideline adherence over time and factors associated with post-operative DAPT within a regional consortium.MethodsIsolated CABG patients from 2011-2017 that had a myocardial infarction within 21 days prior to surgery were included. Patients were stratified by DAPT prescription at discharge and by time period, early (2011-2014) vs. late (2015-2017). Hierarchical regressions were then performed to evaluate factors influencing DAPT use after CABG.ResultsA total of 7,314 patients were included with an overall rate of DAPT utilization of 31.2% that increased from 29.6% in the early to 33.4% in the late era (p
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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Abstract BACKGROUND: Continuation of dual antiplatelet therapy (DAPT) following coronary artery bypass grafting (CABG) after acute myocardial infarction is recommended by current guidelines. We sought to evaluate guideline adherence over time and factors associated with post-operative DAPT within a regional consortium. METHODS: Isolated CABG patients from 2011-2017 that had a myocardial infarction within 21 days prior to surgery were included. Patients were stratified by DAPT prescription at discharge and by time period, early (2011-2014) vs. late (2015-2017). Hierarchical regressions were then performed to e...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Yasada et  al (N Engl J Med 2019;381:1103, PMID 31475793) conducted a prospective randomized multicenter trial of 2236 patients with atrial fibrillation (AF) who had undergone percutaneous coronary intervention or coronary artery bypass grafting more than 1 year earlier or who had angiographically confirmed coronary artery disease not requiring revascularization. Patients were randomized to monotherapy with rivaroxaban or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable ang ina requiring r...
Source: Heart Rhythm - Category: Cardiology Authors: Tags: EP News Source Type: research
We examined data collected in the American College of Cardiology's National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry ® for first HF patient visits between 1 May 2008 and 30 June 2016. Analysis was performed using ANOVAF‐tests (or Kruskal–Wallis tests for non‐normally distributed variables) for continuous parameters andχ2 tests for nominal covariates at the first diagnosed HF visit. Given the NCDR PINNACLE Registry ® is a US‐based registry, we opted to define HFmrEF as per the US guidelines, which define HFmrEF as LVEF 41–49% in contras...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Background: Hybrid coronary revascularization (HCR) combining minimally invasive grafting of the left internal mammary artery to the left anterior descending artery with percutaneous coronary intervention has become a viable option for treating coronary artery disease. The aim of this meta-analysis was to compare HCR with conventional coronary artery bypass grafting (CABG) in a range of clinical outcomes and hospital costs. Methods: To identify potential studies, systematic searches were carried out in various databases. The key search terms included “hybrid revascularization” AND “coronary artery by...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-analysis Source Type: research
This case comes from Sam Ghali  (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs:HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98%This is his 12-Lead ECG:He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads.ECG reading is all ab...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Publication date: March 2018 Source:Canadian Journal of Cardiology, Volume 34, Issue 3 Author(s): Shamir R. Mehta, Kevin R. Bainey, Warren J. Cantor, Marie Lordkipanidzé, Guillaume Marquis-Gravel, Simon D. Robinson, Matthew Sibbald, Derek Y. So, Graham C. Wong, Joseph G. Abunassar, Margaret L. Ackman, Alan D. Bell, Raymond Cartier, James D. Douketis, Patrick R. Lawler, Michael S. McMurtry, Jacob A. Udell, Sean van Diepen, Subodh Verma, G.B. John Mancini, John A. Cairns, Jean-François Tanguay Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, par...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Abstract BackgroundMost patients are recommended secondary prevention pharmacotherapies following an acute coronary syndrome (ACS). AimsTo identify predictors of adherence at 6 months and strategies to improve adherence to these therapies.Design and methodsPatients in the CONCORDANCE registry who were discharged on evidence‐based medications were stratified into those receiving ≥75% (‘adherent’) or
Source: Internal Medicine Journal - Category: Internal Medicine Authors: Tags: Original Article Source Type: research
Publication date: Available online 19 December 2017 Source:Canadian Journal of Cardiology Author(s): Shamir R. Mehta, Kevin R. Bainey, Warren J. Cantor, Marie Lordkipanidzé, Guillaume Marquis-Gravel, Simon D. Robinson, Matthew Sibbald, Derek Y. So, Graham C. Wong, Joseph G. Abunassar, Margaret L. Ackman, Alan D. Bell, Raymond Cartier, James D. Douketis, Patrick R. Lawler, Michael S. McMurtry, Jacob A. Udell, Sean van Diepen, Subodh Verma, G.B. John Mancini, John A. Cairns, Jean-François Tanguay, Paul W. Armstrong, Akshay Bagai, Claudia Bucci, Jean-Pierre Déry, Jean Diodati, Jocelyn Dupuis, David Fitch...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
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