المؤلفون: Ariyaratne, Thathya V., Ademi, Zanfina, Ofori-Asenso, Richard, Huq, Molla M., Duffy, Stephen J., Yan, Bryan P., Ajani, Andrew E., Clark, David J., Billah, Baki, Brennan, Angela L., New, Gishel, Andrianopoulos, Nick, Reid, Christopher M.

المصدر: Current Medical Research & Opinion; Mar2020, Vol. 36 Issue 3, p419-426, 8p

مصطلحات موضوعية: DRUG-eluting stents, COST effectiveness, PERCUTANEOUS coronary intervention, WILLINGNESS to pay, DIRECT costing, MEDICAL economics, SURGICAL stents, MEDICAL care, CARDIOVASCULAR system, TREATMENT effectiveness, PROBABILITY theory

مصطلحات جغرافية: AUSTRALIA

مستخلص: Background: In routine clinical practice, the implantation of a drug-eluting stent (DES) versus a bare metal stent (BMS) for percutaneous coronary intervention (PCI) has been guided by criteria for appropriate use. The cost-effectiveness (CE) of adopting these guidelines, however, is not clear, and was investigated from the perspective of the Australian healthcare payer.Methods and results: Baseline and 12-month follow-up data of 12,710 PCI patients enrolled in the Melbourne Interventional Group (MIG) registry between 2004 and 2011 were analysed. Costs inputs were derived from a clinical costing database and published sources. Propensity-score-matching was performed for DES and BMS groups within sub-groups. Incremental cost-effectiveness ratios (ICERs) were evaluated for all patients, and sub-groups of patients with '0', 1, 2, or ≥3 indications for a DES. The incremental cost per target vessel revascularization avoided for the overall population was $24,683, and for patients with 0, 1, and 2 indications for a DES was $44,635, $33,335, and $23,788, respectively. However, for those with >3 indications, DES compared with BMS was associated with cost savings. At willingness to pay thresholds of $45,000-$75,000, the probability of cost-effectiveness of DES for the overall cohort was 71-91%, '0' indications, 49-67%, 1 indication, 56-82%, 2 indications, 70-90%, and ≥3 indications, 97-99%.Conclusions: The cost-effectiveness of DES compared with BMS increased with increasing risk profile of patients from those who had 1, 2, to ≥3 indications for a DES. When compared with BMS, DES was least cost effective among patients with '0' indications for a DES. Based on these results, selective use of DES implantation is supported. These findings may be useful for evidence-based clinical decision-making. [ABSTRACT FROM AUTHOR]

: Copyright of Current Medical Research & Opinion is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Chi, Wai Kin, Tam, Gormin, Yan, Bryan P.

المصدر: Vascular & Endovascular Surgery; Mar2019, Vol. 53 Issue 2, p147-149, 3p

مصطلحات موضوعية: TREATMENT of chronic kidney failure, ANGIOGRAPHY, VASCULAR diseases, VASCULAR surgery, ARTERIOVENOUS fistula, HEMODIALYSIS, COMPLICATIONS of prosthesis, SURGICAL stents, TRANSLUMINAL angioplasty, VEINS, VENOGRAPHY, VENA cava superior, DISEASE relapse, CHEST (Anatomy), SUBCLAVIAN veins

مستخلص: The article presents a case study of a 67-year-old man with end-stage failure on hemodialysis and with recurrent symptomatic thoracic central vein obstruction (TCVO). Topics mention including application of double chimney techniques using the interwoven self-expanding nitinol stents to treat nonmalignant TCVO, endovascular intervention with balloon angioplasty and venoplasty procedure.

المؤلفون: Yan, Bryan P., Ajani, Andrew E., Clark, David J., Duffy, Stephen J., Andrianopoulos, Nick, Brennan, Angela L., Loane, Philippa, Reid, Christopher M.

المصدر: Medical Journal of Australia; 8/1/2011, Vol. 195 Issue 3, p122-127, 6p

مصطلحات موضوعية: CORONARY heart disease treatment, PUBLIC hospitals, SURGICAL stents, PLATELET aggregation inhibitors

مصطلحات جغرافية: VICTORIA

مستخلص: The article discusses a study that evaluated percutaneous coronary intervention (PCI) practice trends and 12-month outcomes from April 1, 2004 to March 31, 2008 at seven public hospitals in Victoria. It reports on the decline in the use of drug-eluting stents (DES) despite the increase in patient risk profile and lesion complexity. The study reveals that 12-month adverse outcomes remained low, while procedural success remained high, with the use of prolonged dual anti-platelet therapy.

المؤلفون: Yan, Bryan P., Clark, David J., Jaff, Michael R., Kiernan, Thomas J., Schainfeld, Robert M., Lessio, Sara, Rosenfield, Kenneth

المصدر: Circulation: Cardiovascular Interventions; Oct2009, Vol. 2 Issue 5, p438-443, 6p, 5 Charts, 3 Graphs

مصطلحات موضوعية: CAROTID artery surgery, SURGICAL stents, CORONARY restenosis, DUPLEX ultrasonography, INTRAVASCULAR ultrasonography

مستخلص: The article discusses a study which analyzed patients who underwent carotid artery (CA) stenting with baseline and follow-up carotid duplex ultrasonography and intravascular ultrasound. Results showed that optimal peak systolic velocity (PSV), end-diastolic velocity and internal-to-common CA PSV ratio criteria to detect CA in-stent restenosis were greater compared with those for native CA. It was concluded that the combination of duplex velocity criteria increases diagnostic accuracy.

المؤلفون: Yan, Bryan P.¹, Ajani, Andrew E.^1,2,3, New, Gishel⁴, Duffy, Stephen J.⁵, Farouque, Omar^3,6, Shaw, James⁵, Sebastian, Martin⁷, Lew, Robert⁸, Brennan, Angela², Andrianopoulos, Nick², Reid, Chris², Clark, David J.^3,6 clarkdavidj@hotmail.com

المصدر: International Journal of Cardiology. Nov2008, Vol. 130 Issue 3, p374-379. 6p.

مصطلحات موضوعية: *CORONARY artery surgery, *SURGICAL stents, *HEALTH outcome assessment, *MULTIVARIATE analysis, *MYOCARDIAL revascularization, HEART disease epidemiology

مستخلص: Abstract: Background: Restenosis rates are low in large coronary vessels ≥3.5 mm after bare-metal stent (BMS) implantation. The benefit of drug-eluting stents (DES) in large vessels is not established. Objective: We aim to assess clinical outcomes after deployment of BMS compared to DES in patients with large coronary vessels ≥3.5 mm. Methods: We analysed 672 consecutive patients undergoing percutaneous coronary interventions with ≥3.5 mm stent implantation in native coronary artery de-novo lesions from the Melbourne Interventional Group (MIG) registry. Baseline characteristics, 30-day and 12-month outcomes of patients receiving BMS were compared to DES. Multivariate analysis was performed to identify predictors of major adverse cardiac events [MACE, consisting of death, myocardial infarction (MI) and target vessel revascularisation (TVR)]. Results: Of the 672 PCIs performed in 844 lesions, DES was implanted in 39.5% (n =333) and BMS in 60.5% (n =511) of lesions. Patients who received DES compared to BMS were older, more likely to be diabetic, had left ventricular dysfunction <45% or complex lesions. Significantly fewer patients who presented with ST-elevation MI received DES compared to BMS. There were no significant differences in 12-month mortality (0.5 vs. 2.9%, p =0.07), TVR (3.6 vs. 4.8%, p =0.54), MI (6.3 vs. 3.4%, p =0.15), stent thrombosis (0.9 vs. 1.0%, p =0.88), or MACE (9.4 vs. 9.4%, p =0.90) in patients who received DES vs. BMS. Stent length ≥20 mm was the only independent predictor of 12-month MACE (Odds Ratio 2.07, 95% CI 1.14–3.76, p =0.02). Conclusion: In this registry, BMS implantation in large native coronary vessels ≥3.5 mm was associated with a low risk of MACE and repeat revascularization at 12 months that was comparable to DES. [Copyright &y& Elsevier]

المؤلفون: Ajani, Andrew E., Reid, Christopher M., Duffy, Stephen J., Andrianopoulos, Nick, Lefkovits, Jeffrey, Black, Alexander, New, Gishel, Lew, Robert, Shaw, James A., Yan, Bryan P., Gurvitch, Ronen, AI-Fiadh, Ali, Brennan, Angela L., Clark, David J., Al-Fiadh, Ali

المصدر: Medical Journal of Australia; 10/20/2008, Vol. 189 Issue 8, p423-428, 6p

مصطلحات موضوعية: CORONARY disease, SURGICAL stents, HEALTH care intervention (Social services), RETROSPECTIVE studies, DATA analysis, PATIENTS, MYOCARDIAL infarction treatment, TREATMENT of acute coronary syndrome, TICLOPIDINE, RESEARCH, TRANSLUMINAL angioplasty, DRUG-eluting stents, RESEARCH methodology, ACQUISITION of data, ACUTE coronary syndrome, MYOCARDIAL infarction, EVALUATION research, MEDICAL cooperation, TREATMENT effectiveness, HOSPITAL mortality, COMPARATIVE studies, MYOCARDIAL revascularization, PLATELET aggregation inhibitors, COMORBIDITY

مصطلحات جغرافية: AUSTRALIA, VICTORIA

مستخلص: Objective: To examine short- and medium-term outcomes of percutaneous coronary interventions (PCIs), with a focus on comparing drug-eluting stents (DESs) with bare-metal stents (BMSs).Design, Setting and Participants: Retrospective analysis of data from the Melbourne Interventional Group (MIG) registry, a large multicentre Australian registry. The study cohort consisted of 6364 consecutive patients undergoing 7167 PCIs between April 2004 and August 2007.Main Outcome Measures: Clinical events including death, myocardial infarction (MI), target lesion revascularisation (TLR), target vessel revascularisation (TVR) and major adverse cardiac events (MACE) (a composite of death, MI and TVR), at 30 days and at 12 months.Results: The cohort was predominantly male (74%), with a mean age of 64.7 years (SD, 12.0 years). DESs were used in 3482 (51.4%) of PCIs. In the overall cohort, rates of clinical events were low at 30 days: mortality (1.9%), MI (2.4%), TLR (2.0%), TVR (2.4%) and MACE (5.7%). At 12 months, event rates were: mortality (5.2%), MI (6.0%), TLR (5.8%), TVR (8.2%) and MACE (16.2%). Patients receiving DESs had similar mortality rates to those receiving BMSs (4.0% v 6.0%; P = 0.62 [propensity score-adjusted]); late thrombosis rates were also similar in the two groups (0.8% v 1.1%; P = 0.38). The proportion of patients receiving DESs fell significantly over time, from 54.9% in the first 24 months to 44.7% in the last 15 months of the study period (P < 0.01). Independent predictors of 12-month mortality included diabetes, renal failure, ST-segment-elevation MI and cardiogenic shock.Conclusion: Our clinical event rates were comparable with international registry outcomes. Rates of mortality and stent thrombosis were no higher in patients with DESs than those with BMSs. Although DESs were used in about half the procedures (preferentially for higher-risk lesions), recent trends suggest their use is in decline. [ABSTRACT FROM AUTHOR]

: Copyright of Medical Journal of Australia is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Yan, Bryan P.¹, Duffy, Stephen J.², Clark, David J.³, Lefkovits, Jeffery⁴, Warren, Roderic⁴, Gurvitch, Ronen⁴, Lew, Robert⁵, Sebastian, Martin⁶, Brennan, Angela⁷, Andrianopoulos, Nick⁷, Reid, Christopher M.⁷, Ajani, Andrew E.^4,7,8 andrew.ajani@mh.org.au

المصدر: American Journal of Cardiology. Jun2008, Vol. 101 Issue 12, p1716-1722. 7p.

مصطلحات موضوعية: *SURGICAL stents, *THROMBOSIS, *MULTIVARIATE analysis

مصطلحات جغرافية: AUSTRALIA

مستخلص: Recent reports suggest that drug-eluting stents (DESs) may increase the risk of stent thrombosis (ST) relative to bare-metal stents (BMSs). Therefore, the aim of this study was to compare DES and BMS outcomes with a specific focus on ST. We analyzed 30-day and 1-year outcomes of 2,919 patients who underwent percutaneous coronary intervention with stent implantation from the Melbourne Interventional Group registry. Academic Research Consortium definitions of ST were used: (1) definite ST (confirmed using angiography in patients with an acute coronary syndrome), (2) probable ST (unexplained death <30 days or target-vessel myocardial infarction without angiographic confirmation), and (3) possible ST (unexplained death >30 days). Multivariate analysis was performed to identify predictors of ST. The incidence of ST (early or late) was similar between BMSs and DESs (1.6% vs 1.4%; p = 0.66), and DES use was not predictive of ST. Independent predictors of ST included the absence of clopidogrel therapy at 30 days (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.29 to 5.29, p <0.01), renal failure (OR 3.30, 95% CI 1.43 to 7.59, p <0.01), index procedure presentation with an acute coronary syndrome (OR 2.59, 95% CI 1.14 to 5.87, p = 0.02), diabetes mellitus (OR 2.25, 95% CI 1.19 to 4.23, p = 0.01), and total stent length ≥20 mm (OR 1.85, 95% CI 1.00 to 3.42, p = 0.04). In conclusion, DESs were not associated with increased risk of ST compared with BMSs at 12 months in this large Australian registry that selectively used DESs for patients at high risk of restenosis. [Copyright &y& Elsevier]