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At least 19 recordsLinked to original sources
PubMedDate not supplied

The risk and cost of coronary angiography. I. Cost of coronary angiography in Washington State.

The National Guidelines for Health Planning require 300 cardiac studies per year in cardiac catheterization laboratories for adequate economic use and safety. To study how these guidelines would affect existing laboratories, data were collected on the cost of coronary angiography and use of all cardiac catheterization laboratories in Washington. The average cost of coronary angiography was $1,363, with the total cost affected by the duration of hospital stay, cardiac laboratory charges, and professional fees. Total angiographic use ranged from 293 to 791 studies per room, but eight laboratories did not perform 300 cardiac studies during 1977. Health planners recommend high use rates based on the theory that there is an inverse correlation between the number of studies and cost. In this study, the regression equation showed no fall in charges with increased number of studies. Therefore, while it may be reasonable from an economic point of view to expect 300 angiographic cases per year in existing laboratories, there is no economic justification for requiring a certain number of cardiac studies per year.

Angiography↗
PubMedDate not supplied

The risk and cost of coronary angiography. II. The risk of coronary angiography in Washington State.

The risk of coronary angiography has been decreasing since development of the procedure 19 years ago. Deaths resulting from angiography now occur only in high-risk clinical circumstances. Whether a certain case load per angiographer or laboratory is necessary for adequate safety is still a question. Even though little available data exist on the relationship of case loads to risk, the National Guidelines for Health Planning now require 300 cardiac catheterizations per laboratory per year and forbid development of new laboratories in hospitals without heart surgery programs. Data collected from all 16 laboratories in Washington showed 26 deaths (0.19%) during 14,050 coronary angiograms. Eighteen of those who died had a severe left main coronary obstruction, and three had severe triple-vessel disease. There were 18 myocardial infarctions (0.13%) and nine strokes (0.06%). The risks in hospitals without cardiac surgery programs and in hospitals performing fewer than 200 cases per year were no higher than in the other hospitals studied. The National Guidelines should be reevaluated before they are used to change the existing pattern of health care.

Angiography↗
PubMed2026

Complete Revascularization Guided by Functional Coronary Angiography in STEMI.

BACKGROUND: Complete coronary-artery revascularization is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, but the preferred strategy for identifying nonculprit lesions that warrant treatment remains uncertain. METHODS: In this international, randomized trial, we assigned patients with STEMI and multivessel disease in whom the culprit lesion had been successfully treated to undergo complete coronary-artery revascularization guided by functional coronary angiography (physiology-guided group) or by conventional angiography (angiography-guided group). The primary outcome was a composite of death from any cause, myocardial infarction, cerebrovascular accident (stroke or transient ischemic attack), or ischemia-driven revascularization, assessed in a time-to-event analysis. The primary safety outcome was a composite of contrast-associated acute kidney injury or major bleeding. RESULTS: A total of 1823 patients underwent randomization; 913 were assigned to the physiology-guided group and 910 assigned to the angiography-guided group. The median age of the patients was 66 years (interquartile range, 58 to 76), and 24% were women. At a median follow-up of 17.9 months, a primary-outcome event had occurred in 81 patients (8.9%) in the physiology-guided group and in 125 patients (13.7%) in the angiography-guided group (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.83; P<0.001). A primary-safety-outcome event occurred in 42 patients (4.6%) in the physiology-guided group and in 65 patients (7.1%) in the angiography-guided group (hazard ratio, 0.63; 95% CI, 0.43 to 0.93; P&#x2009;=&#x2009;0.02). CONCLUSIONS: In patients with STEMI and multivessel coronary artery disease, a strategy of complete coronary-artery revascularization guided by functional coronary angiography resulted in a lower risk of a primary-outcome event (death, myocardial infarction, cerebrovascular accident, or ischemia-driven revascularization) than a strategy guided by conventional angiography. (Funded by the Italian Health Ministry and others; AIR-STEMI ClinicalTrials.gov number, NCT05818475.).

Aged↗
PubMed1977

[Exercise test after myocardial infarct. Correlations with data of coronary angiography and ventriculography].

The authors have studied the exercise test carried out at least three months (3-6 months: 52 cases; greater than 6 months: 48 cases) after myocardial infarction in the anterior position (50 cases), in the "inferior" position (42 cases), and of a diffuse type (8 cases), in patients who were taking no treatment which might interfere with interpretation of the test. For the anterior infarctions there was a good correlation between ST elevation (J max greater than or equal to 1 mm, or better than the sun of the J greater than or equal to 2 mm) and the presence of severe involvement of the left ventricle. A depressed ST segment beyond the area of necrosis corresponds to a stenosis greater than or equal to 75 p. 100 in 36 p. 100 of cases. In inferior infarctions, the correlation between ST elevation and left ventricular involvement is also specific but less sensitive. ST depression outside the area of necrosis corresponds to a stenosis greater than or equal to 75 p. 100 in 66 p. 100 of cases; it is then lateral, but may extend as far as V2. They also indicate a mirror image, especially when the depressed area slopes upwards, and is localised in V2-V3. The other changes which were found have no practical application.

Adult↗
PubMed1979

[Selective coronary angiography with jodamide (author's transl)].

In 188 coronary angiographies Jodamide was found to be a substance which resulted in good to excellent contrasts and is so the best basis for an exact evaluation. It caused a transient fall of heart rate and blood pressure. Changes of E.C.G. disappeared quickly. Severe disturbances of the heart rhythm didn't appear. Severe general reactions were seldom and never fatal. More frequently mild reactions occurred, but only in two cases a therapy was necessary. The results show that Jodamide is an excellent contrast medium for selective coronary angiography.

Aortic Valve Insufficiency↗
PubMed1979

Predicting results of coronary angiography.

This study compares the ability of various risk factor combinations to predict the extent of coronary artery disease found on coronary angiography. Risk factors were measured in 99 patients prior to coronary angiography. Clinical, epidemiological, psychosomatic, and combined orientations were compared as to their ability to predict angiography results. The clinical orientation was the most successful in predicting vessel disease (p less than .0001), followed by the epidemiological model, which was also successful (p less than .03). In contrast, psychosomatic factors were not accurate predictors of vessel disease. By combining all of the orientations, the accuracy of prediction is improved.

Adult↗
PubMed1978

Enzyme changes after coronary angiography.

The enzymatic response to contrast media after coronary angiography was observed in 24 patients. The enzymes studied were glutamic oxaloacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), gamma-glutamyl transferase (gamma-GT), creatine phosphokinase (CPK), and the myocardial-specific isoenzyme of CPK (CK-MB). Angiography produced no significant elevations in SGOT, SGPT, alpha-HBDH, LDH, or CK-MB activities; gamma-GT increased up to the twelfth hour. High levels of CPK and CK-MB observed in one patient were found to be products of a thymus carcinoma. In vitro examinations also showed that concentrations of contrast media used in coronary angiography do not inhibit gamma-GT, LDH, and CPK activities.

Adult↗
PubMed1978

A computer generated index for the assessment of coronary angiography.

Mortality in patients with coronary artery disease is related to its severity. The commonly used classification of 1, 2 or 3 vessel disease is relatively insensitive. We have designed a new classification which takes into account site, severity and effect of multiple lesions in the coronary circulation. Data is recorded on Mark Sense computer cards and a coronary index (CI) obtained. We have collected data from 1100 patients and shown correlations of the index with clinical variables, ventricular function and in particular, mortality.

Angina Pectoris↗
PubMed1979

Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial revascularization in patients with peripheral vascular disease.

Routine coronary angiography to determine the prevalence of severe coronary artery disease (CAD) has been recommended to all patients under consideration for elective peripheral vascular reconstruction at the Cleveland (Ohio) Clinic since April 1978. Those found to have severe, correctable CAD have been advised to undergo myocardial revascularization prior to performance of elective peripheral vascular operations. Forty-one of the 68 patients with abdominal aortic aneurysms (AAA) and 26 of the 71 patients with aortoiliac occlusive arterial disease (AI) had clinical evidence of CAD; coronary angiography demonstrated severe, correctable CAD in 23 patients with AAA and in 14 patients with AI. Twenty-seven patients with AAA and 45 patients with AI had no clinical evidence of CAD; severe, correctable CAD was found in six patients with AAA and in six patients with AI. Ninety-six patients, including 26 who had staged cardiac procedures performed, have had elective aortic reconstruction, with one operative death.

Adult↗
PubMed1977

Amipaque: a new contrast medium in coronary angiography. Report of a double-blind study in man.

Isopaque Coronar and Amipaque (metrizamide) were evaluated in a comparative double-blind study of 30 patients with heart disease undergoing selective coronary angiography. Amipaque alone was also used for 9 additional patients undergoing left ventriculography, aortic root injection, and selective coronary angiography. Amipaque resulted in significantly less of a decrease in diastolic pressure and heart rate, reduced chest pain and heat sensation, and longer coronary contrast transit time. Electrorocardiographic parameters and image quality were equivalent with the 2 agents. No pathological changes were noted in the 9 patients undergoing complete angiocardiographic study.

Adult↗
PubMed2026

Baseline Computed Tomography Coronary Angiography and Polygenic Risk Profiles in Adults With Type 2 Diabetes: A Cross-Sectional Analysis From the VOLTAIRE Study.

AIMS: To characterise baseline clinical, anatomical, and genetic cardiovascular risk profiles in participants enrolled in the VOLTAIRE (Evaluation of Polygenic Scores and CT Imaging in Risk Factor Modification in Patients with Type 2 Diabetes) study and examine concordance across these domains. METHODS: This analysis included adults with T2D who completed baseline computed tomography coronary angiography (CTCA) and polygenic risk score (PRS) assessment prior to randomisation in the VOLTAIRE study. Coronary atherosclerosis was evaluated using coronary artery calcium (CAC) score and CTCA-derived stenosis severity. Clinical risk was assessed using the New Zealand Society for the Study of Diabetes 5-year cardiovascular risk calculator. Polygenic risk for coronary artery disease was assessed using a genome-wide PRS and categorised into tertiles. RESULTS: Among 126 participants with T2D (mean age 57.5&#x2009;&#xb1;&#x2009;8.7&#x2009;years; 62.7% male), coronary atherosclerotic burden was highly heterogeneous: 34.9% had CAC&#x2009;=&#x2009;0, whereas 19.8% had CAC &#x2265;&#x2009;400. Moderate-to-severe coronary stenosis (&#x2265;&#x2009;50%) was present in 40.5% of participants overall, including 20.4% of those classified as low clinical risk. PRS distribution was variable (low 37.3%, intermediate 35.7%, high 27.0%). Overlap between anatomical, genetic, and clinical domains&#xa0;was limited, with only 8.7% of participants classified as high risk across all three. CONCLUSIONS: Substantial heterogeneity and limited overlap&#xa0;exist between anatomical, genetic, and clinical cardiovascular risk measures in T2D. These findings support a multimodal approach to risk assessment integrating imaging and genetic profiling. TRIAL REGISTRATION: https://www. CLINICALTRIALS: gov; ID: NCT07091162.

Aged↗
PubMed1979

Amipaque in coronary angiography.

Comparative studies between Isopaque Coronar and Amipaque with equal concentration of iodine (370 mg I/ml), have been carried out in more than 130 patients. Hemodynamic and electrocardiographic registrations before, during and after selective coronary angiography showed that the diastolic blood pressure and heart rate decreased significantly less with Amipaque, while no significant differences were observed in various ECG parameters. Interestingly, it was observed that the left coronary artery contrast transit time was longer when using Amipaque. This phenomenon may reflect a difference between ionic and nonionic contrast media, but also a difference in viscosity. The quality of the angiograms was the same irrespectively of the contrast medium used.

Blood Pressure↗