Keisha R. Sandberg

Coronary calcification and cardiac events after percutaneous intervention in dialysis patients.

Background: Previous studies have described increased vascular calcification in renal dialysis patients. The clinical significance of this finding with respect to outcomes after percutaneous coronary intervention in this population is unknown. Methods: We analysed a prospective interventional database at a single tertiary center and identified 41 dialysis patients who underwent coronary angioplasty. All studies were reviewed for the presence of coronary calcium in the target and reference vessels and compared with respect to baseline clinical factors and cardiovascular outcomes. Results: The mean ages for those with and without coronary calcification were 63.6 ± 11.0 and 67.3 ± 11.0, respectively, P = 0.30. The groups were similar in years on dialysis, diabetes, hypertension, smoking, and measures of calcium and phosphate balance. The total cholesterol, LDL-C, HDL-C, and triglycerides were 162.5 ± 42.3 and 202.0 ± 54.5, P = 0.02; 94.9 ± 39.6 and 121.2 ± 48.1, P = 0.18; 39.3 ± 12.4 and 47.3 ± 12.2, P = 0.15; 157.4 ± 100.4 and 181.3 ± 187.4, P = 0.15, for those with and without calcification, respectively. The composite of target vessel revascularization, myocardial infarction, or death was 47.4% and 77.3% for those with and without calcification, respectively, P = 0.06. The Cox proportional hazards model, controlling for years on dialysis, showed a significant, event-free survival in those with coronary calcium seen fluoroscopically, P = 0.05. Conclusions: In dialysis patients, coronary calcification identified in the target or reference vessels is associated with lower total cholesterol and favourable interventional outcomes. J Cardiovasc Risk 8:133-137

Clinical effectiveness evaluation of an emergency department cardiac decision unit

The aim was to test the feasibility of using automated data, and evaluate the impact of an emergency cardiac decision unit (CDU) on the overall outcomes of patients seen for chest discomfort. We used a retrospective, quasi‐experimental design to identify patients who had cardiac enzymes measured and an electrocardiogram performed during an ED visit in two six‐month periods, pre‐CDU (1 January‐30 June 1995) and post‐CDU (1 January‐ 30 June 1996). A total of 4,336 patients had outcomes assessed. After opening, 14.8 per cent of all chest pain cases were treated in the CDU. Hospital admission rates were reduced from 81.1 per cent to 66.7 per cent. Length of stay, myocardial infarction rates, and mortality were unchanged. The 14‐day revisit rates increased from 5.3 per cent to 10.3 per cent. We conclude that cardiac decision units decrease hospital admissions but increase ED revisit rates as a consequence of this now frequently used care pathway.