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  • Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain: A Secondary Analysis of the ROMICAT-II Randomized Clinical Trial

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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.7360

    This secondary analysis of data from a randomized clinical trial examines differences in outcomes with clinical evaluation and noninvasive testing vs clinical evaluation alone.

  • JAMA Internal Medicine August 1, 2017

    Figure: Subgroup Analyses of Effect of Cardiac Testing Per 1000 Patients at 1 Year

    Results are presented as the change in outcome associated with performing testing in 1000 patients (standard error) in each subgroup, estimated using the average marginal effect for each subgroup. Presented P values are the difference between the average marginal effects in paired subgroups (ie, women and men) in 1000 bootstrapped samples. Cardiac testing includes either noninvasive test (exercise electrocardiography, stress echocardiography, myocardial perfusion scan, and cardiac computed tomographic angiography) or coronary angiography. Analyses were adjusted for age; sex; comorbid conditions (diabetes, hypertension, hyperlipidemia, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, tobacco use); and history of ischemic heart disease, noninvasive test in the previous year, coronary angiography in the previous year, antiplatelet medication use, and antihyperlipidemic medication use. Revascularization is either coronary artery bypass graft surgery or percutaneous coronary intervention. AMI indicates acute myocardial infarction; ED, emergency department. Error bars indicate standard error.
  • Update on Percutaneous Coronary Intervention in Stable Coronary Artery Disease

    Abstract Full Text
    JAMA Intern Med. 2016; 176(12):1855-1856. doi: 10.1001/jamainternmed.2016.6656

    This Evidence to Practice report compares the efficacy, safety, and cost-effectiveness of initial percutaneous coronary intervention with stenting plus guideline-directed medical therapy vs medical therapy alone in patients with stable coronary artery disease.

  • Reexamining the Efficacy and Value of Percutaneous Coronary Intervention for Patients With Stable Ischemic Heart Disease

    Abstract Full Text
    JAMA Intern Med. 2016; 176(8):1190-1194. doi: 10.1001/jamainternmed.2016.3071

    This article examines the role of percutaneous coronary intervention in the treatment of patients with stable ischemic heart disease.

  • Continuing Use of Prophylactic Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease Despite Evidence of No Benefit: Déjà Vu All Over Again

    Abstract Full Text
    JAMA Intern Med. 2016; 176(5):597-598. doi: 10.1001/jamainternmed.2016.0600
  • Characteristics of Patients Undergoing Cardiac Catheterization Before Noncardiac Surgery: A Report From the National Cardiovascular Data Registry CathPCI Registry

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    JAMA Intern Med. 2016; 176(5):611-618. doi: 10.1001/jamainternmed.2016.0259

    This study describes the characteristics, angiographic findings, and treatment patterns of patients with stable angina symptoms undergoing cardiac catheterization and/or percutaneous coronary intervention before noncardiac surgery in a large national registry.

  • Incidence of Cataract Surgery in Patients After Percutaneous Cardiac Intervention in Taiwan

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    JAMA Intern Med. 2016; 176(5):710-711. doi: 10.1001/jamainternmed.2016.0554

    This matched-cohort study evaluates the risk of cataract in the population undergoing percutaneous cardiac intervention procedures.

  • JAMA Internal Medicine May 1, 2016

    Figure 2: Number of Vessels With Obstructive Disease

    Cath indicates diagnostic catheterization; PCI, percutaneous coronary intervention.
  • Coronary Catheterization and Percutaneous Coronary Intervention in China: 10-Year Results From the China PEACE-Retrospective CathPCI Study

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    JAMA Intern Med. 2016; 176(4):512-521. doi: 10.1001/jamainternmed.2016.0166

    The China PEACE-Retrospective CathPCI Study evaluates the change in the use of coronary artery catheterization and percutaneous coronary intervention in Chinese urban hospitals.

  • JAMA Internal Medicine April 1, 2016

    Figure 1: Trends in Hospital Admissions and Percutaneous Coronary Intervention (PCI) Indication

    A, Hospital admissions for coronary artery catheterization and PCI (P < .001). B, Proportion of PCI procedures for stable coronary artery disease (CAD) (P < .001), unstable angina (P < .001), ST-segment elevation myocardial infarction (STEMI) (P < .001), and non-STEMI (NSTEMI) (P < .001) among all the PCI procedures. C, Trends in the proportion of primary PCI (P = .51), PCI after fibrinolytic therapy (P < .001), and late reperfusion for patients who did not receive fibrinolytic therapy or primary PCI during the same admission (P < .001) among all the PCI procedures for patients with STEMI.
  • JAMA Internal Medicine April 1, 2016

    Figure 2: Trends in Percutaneous Coronary Intervention (PCI) Quality Metrics

    A, Proportion of primary PCI procedures with recording of hospital arrival time (P = .10) and balloon dilation time (P = .86). B, Proportion of documentation of PCI with missing procedural success indicators (P = .03) and successful procedures among PCIs with complete documentation of success indicators (P < .001). C, Proportion of PCI procedures with serum creatinine levels assessed before (P < .001) and after (P < .001) PCI, and cardiac biomarkers assessed after PCI (P = .64) (for the first PCI procedure if more than 1 procedure was performed during a hospitalization), as well as procedures with documentation of contrast volume (P < .001). D, Proportion of patients with missing discharge medications (P = .13) and documentation of statin (P < .001), aspirin (P < .001), and thienopyridine (clopidogrel or ticlopidine) use (P < .001) among patients with stents.
  • JAMA Internal Medicine April 1, 2016

    Figure 3: Unadjusted Rate and Adjusted Odds Ratios (ORs) of Adverse Outcomes in Patients Undergoing Percutaneous Coronary Intervention

    Adjusted ORs of patient outcomes are shown along the horizontal axis with the vertical line demarking an OR of 1 (ie, no difference from year 2001); estimates to the right (ie, >1) are associated with higher risk of the outcome, and those to the left (ie, <1) indicate a lower risk of the outcome. The variables for risk adjustment include cardiogenic shock, ST-segment elevation myocardial infarction (STEMI) vs non-STEMI, estimated glomerular filtration rate, sex, and age. C = 0.77 for death, 0.76 for death or treatment withdrawal, 0.70 for composite complications, 0.64 for any bleeding, 0.63 for major bleeding, 0.69 for access bleeding, and 0.71 for blood transfusion. Composite end points were: death or withdrawal, stroke, or repeated target vessel revascularization.
  • Caring for Coronary Artery Disease in China: Managing Modernization

    Abstract Full Text
    JAMA Intern Med. 2016; 176(4):521-523. doi: 10.1001/jamainternmed.2016.0198
  • JAMA Internal Medicine January 1, 2016

    Figure: Frequency of Exclusion of Patients With Kidney Disease From Trials of Cardiovascular Interventions

    Percentage of trials excluding patients with kidney disease based on specific intervention categories (A) and specific diagnostic categories (B). The bar graphs represent the percentage of trials out of the total that evaluate a particular intervention or a particular diagnostic category. HFpEF indicates heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; NSTEMI, non–ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; RAAS, renin-angiotensin-aldosterone system; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.aIncludes management, exercise, oxygen therapy, and systems-wide quality improvement initiatives.
  • Use of Intra-aortic Balloon Pump in a Japanese Multicenter Percutaneous Coronary Intervention Registry

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    JAMA Intern Med. 2015; 175(12):1980-1982. doi: 10.1001/jamainternmed.2015.5119

    This study investigates the prognostic effect of intra-aortic balloon pump use in Japanese patients undergoing percutaneous coronary intervention for nonacute and acute indications.

  • Patterns of Institutional Review of Percutaneous Coronary Intervention Appropriateness and the Effect on Quality of Care and Clinical Outcomes

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(12):1988-1990. doi: 10.1001/jamainternmed.2015.6217

    This Research Letter reports heterogeneity in institutional review of percutaneous coronary intervention appropriateness and calls for the identification of effective strategies to improve institutional review.

  • JAMA Internal Medicine December 1, 2015

    Figure: Unadjusted and Adjusted Effects of Intra-aortic Balloon Pump (IABP) Use on In-Hospital Mortality in Various Situations

    A and B, Intra-aortic balloon pump use was adversely associated with patient outcome, regardless of situation, in crude (A) and multivariable (B) analyses. In the logistic regression model, adjustments were made using all variables exhibiting a bivariate association with the use of IABP with P < .001 in the Table, which included all variables except the following: diabetes mellitus, previous coronary artery bypass graft, chronic lung disease, stable angina or silent ischemia, and 1-vessel disease. C, For evaluating the baseline inequality index, we redefined a list of the following baseline characteristics that are recognized markers of mortality risk: age, cardiogenic shock, prior heart failure, peripheral vascular disease, chronic lung disease, renal dysfunction, NYHA functional classification of at least 3 at the time of percutaneous coronary intervention, and clinical presentation (STEMI or NSTEMI). LMT indicates left main trunk; NSTEMI, non–ST-segment elevation myocardial infarction; NYHA, New York Heart Association; and STEMI, ST-segment elevation myocardial infarction.
  • Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease

    Abstract Full Text
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    JAMA Intern Med. 2015; 175(7):1199-1206. doi: 10.1001/jamainternmed.2015.1657

    This cross-sectional analysis found that informed decision making is often incomplete in conversations between cardiologists and patients with stable angina.