Coronary artery disease
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Coronary artery disease · Jan 2015
ReviewQuality improvement in acute coronary syndromes: translating evidence into practice.
Despite the substantial progress in elucidating the pathophysiology of acute coronary syndromes (ACS) and developing an array of therapeutic advances for the management of these conditions, several challenges still persist. The use of guideline recommendations for the care of patients with ACS by both healthcare providers and hospitals can improve short-term and long-term outcomes and potentially reduce healthcare costs. ⋯ Several quality improvement programs, by both governmental and nongovernmental organizations, have been developed in an attempt to encourage maximal utilization of evidence-based interventions. In this review, we will examine the evidence for the importance of guideline adherence in the management of ACS, explore predictors of adherence to these guidelines, and provide evidence-based strategies for improving their implementation.
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Coronary artery disease · Nov 2014
Impact of intra-aortic balloon pumping on hypotension and outcomes in acute right ventricular infarction.
This study investigated the immediate hemodynamic effects of intra-aortic balloon pump (IABP) support and clinical outcomes in patients with acute right ventricular infarction (RVI) complicated by hypotension. ⋯ IABP support results in immediate hemodynamic improvement in patients with acute RVI complicated by shock. The majority of these shock patients survived and the magnitude of mean arterial pressure and peak systolic blood pressure augmentation may impart prognostic value.
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Coronary artery disease · Sep 2014
ReviewFunctional assessment of multivessel coronary artery disease: ischemia-guided percutaneous coronary intervention.
Invasive evaluation and treatment of coronary artery disease (CAD) has traditionally been based upon coronary angiography to determine the need for and the success of revascularization. However, coronary angiography augmented with fractional flow reserve (FFR) creates a paradigm shift, providing a more complete functional assessment of coronary lesions. Measuring FFR to identify ischemic lesions and guide revascularization results in fewer adverse outcomes, including persistent angina, myocardial infarction, and mortality. ⋯ Although the mechanism explaining this is unclear, it is likely multifactorial, including the impact of mechanical forces, upregulation of inflammatory mediators, and the amount of distal myocardial tissue at risk. Using both anatomic and ischemia-guided assessments (such as the Functional SYNTAX Score) aids in the therapeutic decision-making process in patients with multivessel CAD. This review focuses on the evidence for FFR-guided management of multivessel CAD.