Improving patients' readiness for coronary artery bypass graft surgery.

Background: Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG).

Objective: To reduce mortality for patients undergoing urgent CABG.

Methods: Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.

Extended Outcomes of Complex Coronary Disease in the Drug Eluting Stent Era.

Background: Several randomized trials comparing bare-metal stents to Drug-Eluting Stents (DES) have demonstrated a significant reduction in Target Vessel Revascularization (TVR) and Target Lesion Revascularization (TLR) exists with the use of drug-eluting stents, without compromising survival. These conclusions are based on restricted inclusion criteria for patients and lesion. It is unknown if these results can be generalized to an unselected patient population and more complex disease.

Serious renal dysfunction after percutaneous coronary interventions can be predicted.

Background: A prediction rule for determining the post-percutaneous coronary intervention (PCI) risk of developing contrast-induced nephropathy (> or = 25% or > or = 0.5 mg/dL increase in creatinine) has been reported. However, little work has been done on predicting pre-PCI patient-specific risk for developing more serious renal dysfunction (SRD; new dialysis, > or = 2.

Long-term survival after surgery versus percutaneous intervention in octogenarians with multivessel coronary disease.

Background: There is limited information comparing long-term survival after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients aged 80 years and older. We studied the long-term survival of octogenarians with multivessel coronary artery disease undergoing PCI or CABG who might have been candidates for either procedure.

Methods: We identified 1693 patients, aged 80 to 89, with two-vessel disease (57.

Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England.

Background: Randomized trials comparing coronary artery bypass graft surgery (CABG) with percutaneous coronary interventions (PCIs) for patients with multivessel coronary disease (MVD) report similar long-term survival for CABG and PCI. These studies used a highly selected population of patients and providers, and their results may not be generalizable to actual care. Our goal in this study was to compare long-term survival of MVD patients treated with CABG vs PCI in contemporary practice.

Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock: a multicenter, decade-long experience.

Objectives: The objective of this study was to determine the characteristics and hospital mortality rate for elderly patients in cardiogenic shock undergoing emergent percutaneous coronary intervention (PCI).

Background: Early revascularization for patients with acute myocardial infarction complicated by cardiogenic shock is recommended for patients < 75 years of age. This age-restricted recommendation is based upon evidence that elderly shock patients undergoing early revascularization have extremely high hospital mortality rates.

Predicting vascular complications in percutaneous coronary interventions.

Objectives: Using a large, current, regional registry of percutaneous coronary interventions (PCI), we identified risk factors for postprocedure vascular complications and developed a scoring system to estimate individual patient risk.

Background: A vascular complication (access-site injury requiring treatment or bleeding requiring transfusion) is a potentially avoidable outcome of PCI.

Methods: Data were collected on 18,137 consecutive patients undergoing PCI in northern New England from January 1997 to December 1999.

Brachial gradient in cardiac surgical patients.

Background: Review of the clinical and therapeutic implications of difference in arm blood pressure detected preoperatively in patients having heart surgery.

Methods And Results: Prospective study of 53 patients (Group 1) with gradient and comparison with a group of 175 patients without gradient (Group 2). All patients had preoperative carotid duplex interrogation and operative epiaortic scanning.