Revascularization procedure

Coronary angiography detects the location and degree of coronary atherosclerosis and is used to evaluate the potential benefit from revascularization procedures. Stenosis of at least 70% of the diameter of at least one of the major epicardial arteries on coronary angiography is indicative of significant IHD. 

In patients with NSTE ACS, clinical practice guidelines recommend either PCI or coronary artery bypass grafting revascularization as an early treatment for high-risk patients, and that such an approach also be considered for moderate-risk patients. An early invasive approach results in fewer Mis, less need for revascularization procedures over the next year after hospitalization, and lower cost than the conservative medical stabilization approach. 

Nuclear imaging techniques, like single photon emission tomography (SPECT) and positron emission tomography (PET), directly assess myocardial perfusion, cell membrane integrity, cellular metabolism, and the molecular mechanisms of ischemic viable or necrotic myocardium, thereby indicating revascularization procedures or not. 

Not all severe perfusion defects require revascularization procedures for patients with stable,... 

Transepicardial injection of stem cells has been performed during open surgical revascularization procedures to deliver the cells to infarct border zones or areas of infarcted or scarred myocardium. Because a sternotomy is required, this approach is highly invasive and associated with surgical complications. However, in the setting of a planned open... 

The risk of recurrent ipsilateral neurologic events with medical management is much lower for moderate (50-69% by the NASCET criteria) compared with severe carotid lesions (10). Since the potential benefit of any revascularization procedure is dependent on lesion severity (45) in patients with moderate or borderline stenoses the risk-benefit ratio of carotid stenting should carefully be weighed. 

The main argument in favor of a beneficial effect of ACE inhibition on coronary heart diseases comes from the pooled results of the SOLVE) treatment trial, the SOLVE) prevention trial, and the SAVE, AIRE, and TRACE studies, which indicate a 21% (95% Cl, 11-29%, p <. 001) relative risk reduction for myocardial infarction associated with ACE inhibitor therapy. Enalapril (SOLVE)) significantly reduced hospitalization for unstable angina, and captopril (SAVE) reduced revascularization procedures (291). In patients treated for 38 to 42 months with enalapril or captopril and selected on the basis of a reduction in ejection fraction with or without heart failure, it is necessary to treat 49 patients to avoid one myocardial infarction (95% Cl 32-117). 

The means of identification of patients. This could vary from seeing potentially low-risk patients, such as any patient followed in a general medicine clinic or referred by a primary care provider, to identifying high-risk patients, such as anyone discharged from the hospital with a diagnosis of myocardial infarction or after a revascularization procedure or with other evidence of CHD risk. 

Dipyridamole testing has been shown to be safe and effective in the elderly and in those with unstable angina immediately after MI (within days). It also may be used to assess the status of revascularization procedures. As a prognostic test, dipyridamole testing is very useful. In several studies, abnormal scans have shown about a 10-fold increase in event rates over 1 to 2 years of follow-up. Abnormal scans also have been shown to be an independent risk factor for myocardial infarction and death with a relative risk of 3.1. Reversible defects correlate best with events, with one study demonstrating a 4.41 relative risk for cardiac events. 

Cardiac catheterization and coronary arteriography are used to determine coronary artery anatomy and if the patient would benefit from angioplasty, coronary artery bypass grafting (CABG), or other revascularization procedures. 

In AFCAPS/TexCAPS, a primary prevention trial conducted in 6605 men and women aged 57 to 63 years with average total cholesterol and LDL concentrations (<221 mg/dL and <150 mg/dL, respectively) who were treated with lovastatin 20-40 mg/day for 5.2 years, a 37% reduction p <. 001) was shown in the risk for first acute major coronary event (fatal or nonfatal MI, unstable angina, or sudden cardiac death)." The need for revascularization procedures also was reduced by 33% p <. 001). The implications of this trial are enormous potentially millions of normal people could benefit... 

Enthusiasm for the results from these preliminary studies must be tempered by their limitations, which include small sample size, lack of controls, open-label and non-randomized design. In addition, because angiogenic therapy is sometimes administered in conjunction with revascularization procedures, it is difficult to discern the relative contributions of each. Safety concerns surrounding the use of angiogenic genes for humans have yet to be adequately addressed. These include potential formation of hemangiomas, retinopathy, edema, and tumor progression. He-... 

Atherosclerosis use to slow the progression of coronary atherosclerosis. Hypercholesterolemia nse for reduction of elevated total cholesterol, LDL, apo-B, and triglyceride cholesterol levels and to increase HDL levels. Secondary prevention of coronary events used to reduce the risk of undergoing coronary revascularization procedures in patients with coronary heart disease. 

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