From chest pain to coronary functional testing: Clinical and economic impact of coronary microvascular dysfunction.

Autor: Merdler I; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Wallace R; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Hill AP; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Chitturi KR; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Medranda GA; Division of Cardiology, NYU Langone Hospital - Long Island, Mineola, NY, United States of America., Reddy P; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Zhang C; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Ozturk ST; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Sawant V; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Weintraub WS; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Lopez K; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Ben-Dor I; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Waksman R; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America. Electronic address: ron.waksman@medstar.net., Hashim HD; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America., Case BC; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2024 Sep; Vol. 66, pp. 56-60. Date of Electronic Publication: 2024 Mar 28.
DOI: 10.1016/j.carrev.2024.03.026
Abstrakt: Background: Coronary functional testing to formally diagnose coronary microvascular dysfunction (CMD) reduces cardiovascular events and alleviates angina. This study aims to investigate the extensive and complex journey that patients with CMD undergo, from the onset of chest pain to eventual diagnosis.
Methods: Data from the Coronary Microvascular Disease Registry (CMDR) were analyzed, including information on the date of first documentation of chest pain, number of non-invasive and invasive tests the patient underwent, emergency department visits, and hospitalizations. In addition, we estimated the total cost per patient. A total of 61 patients with CMD diagnosis were included in this analysis.
Results: Most patients in our cohort were older than 50 years of age. The median time from initial chest pain symptoms to diagnosis was 0.62 (interquartile range [IQR]: 0.06-2.96) years. During this period, patients visited the emergency department a median of 1.0 (IQR: 0.0-2.0) times. Diagnostic tests included 3.0 (IQR: 2.0-6.0) electrocardiograms, 3.0 (IQR: 0.0-6.0) high-sensitivity troponin tests, and 1.0 (IQR: 1.0-2.0) echocardiograms. Prior to diagnosis of CMD, 13 (21.3 %) patients had left heart catheterization without coronary functional testing. Non-invasive testing for ischemia was conducted in 43 (70.5 %) patients. Alternative non-cardiac diagnoses were given to 11 (18.0 %) patients during the diagnostic process, with referrals made to gastroenterology for 16 (26.2 %) and pulmonology for 10 (16.4 %) patients. The cost was almost $2000/patient.
Conclusion: Timely identification of CMD offers promising opportunities for prompt symptom alleviation, accompanied by reduced visits to the emergency department, cardiovascular testing, invasive medical procedures, and consequently reduced healthcare expenses.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Brian C. Case – Speaker: Zoll Medical. Hayder D. Hashim – Advisory Board, Speaker: Abbott Vascular, Boston Scientific, Philips IGT. Ron Waksman – Advisory Board: Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, Pi-Cardia Ltd.; Consultant: Abbott Vascular, Append Medical, Biotronik, Boston Scientific, JC Medical, MedAlliance/Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional/SIS Medical AG, Transmural Systems Inc.; Institutional Grant Support: Biotronik, Medtronic, Philips IGT; Investor: Transmural Systems Inc. All other authors – None.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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