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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDespite high levels of compliance with antiplatelet and statin medications, the proportion of middle aged, East Asian patients who meet guideline recommended cardiovascular disease (CVD) management targets prior to catheterization is suboptimal. This article reports the results of a prospective study designed to determine whether patients referred for a coronary angiogram or percutaneous coronary intervention (PCI) at a single center in the West Indies were meeting guideline recommended CVD management targets.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDespite high levels of compliance with antiplatelet and statin medications, the proportion of middle aged, East Asian patients who meet guideline recommended cardiovascular disease (CVD) management targets prior to catheterization is suboptimal, reported Godfrey Aleong, MD, FESC, Eric Williams Medical Science Complex, Trinidad, West Indies.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ECVD is the number one cause of death in Trinidad and Tobago. The large burden of disease is associated with long waits for, and limited access to, coronary angiography. Dr. Aleong reported the results of a prospective study designed to determine whether patients referred for a coronary angiogram or percutaneous coronary intervention (PCI) at a single center in the West Indies were meeting guideline recommended CVD management targets.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe investigators collected data on characteristics and medications in 41 patients, as well as lifestyle advice (dietary and exercise), and the following parameters of CVD management:\u003C\/p\u003E\u003Cp\u003E\n         \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-6\u0022\u003E\u25aa Body mass index (BMI; \u0026lt;24.9 kg\/m\u003Csup\u003E2\u003C\/sup\u003E)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003E\u25aa Blood pressure (BP; nondiabetics \u0026lt;140\/90 mm Hg; diabetics \u0026lt;130\/80 mm Hg)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003E\u25aa Heart rate (\u0026lt;70 bpm after 5 minutes in a supine position)\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003E\u25aa Fasting LDL \u0026lt;70 mg\/dL\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-10\u0022\u003E\u25aa Fasting glucose \u0026lt;130 mg\/dL and HbA1C \u0026lt;7.0% for diabetic patients\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ESubjects had a mean age of 57.1\u00b19.3 years, and the majority were men (82.9%). More than 80% were East Asian. The risk factors for CVD included current or past smoker (46.3% of subjects), a diagnosis of diabetes (26.8%), hypertension (41.5%), dyslipidemia (31.7%), and\/or a family history of premature coronary artery disease (41.5%). A majority of the patients had a history of myocardial infarction (68.3%). Almost all subjects reported angina (92.7%); approximately two thirds (68.3%) had dyspnea.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ENearly all subjects (97%) were on antiplatelet therapy (aspirin 87.8%; clopidogrel 78.0%). Approximately two thirds of patients were taking \u03b2-blockers (65.9%). All subjects were on statins (100.0%) and the most commonly used statin was simvastatin (65.9%). More than three quarters of subjects were on either an angiotensin-converting-enzyme inhibitor (84.4%) or an angiotensin II receptor blocker (15.6%). More than half of the subjects (53.7%) were on a proton pump inhibitor.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EOf those receiving dietary (n=18) or exercise (n=21) advice, 57.9% and 47.6% were compliant, respectively. Among subjects with diabetes (n=11), 63.6% had a BMI of \u0026lt;24.9 kg\/m\u003Csup\u003E2\u003C\/sup\u003E and 54.5% had a fasting glucose \u0026lt;130 mg\/dL. In the diabetic population, 63.6% followed advice on regular blood sugar monitoring (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13684\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13684\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13684\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EProportion of Subjects (n=41) Achieving Target\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EThe investigators hypothesized that the low rate of subjects achieving the target LDL of \u0026lt;70 mg\/dL may be attributable to the large proportion of subjects receiving simvastatin (65.9%), a less potent lipid-lowering drug. The use of lifestyle advice (diet or exercise), which ranged between 40% and 50%, was low and may reflect the large volume of patients seen in the public sector clinics. Despite adequate prescribing, the proportion of patients in this study who achieved guideline targets was suboptimal.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPCI AND SAME-DAY DISCHARGE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EMost patients undergoing PCI remain in the hospital overnight to be monitored for postprocedural complications such as myocardial infarction, bleeding, acute stent thrombosis, and renal failure. However, InterQual criteria have now classified elective PCI as an outpatient procedure. Since the Centers for Medicare and Medicaid Services use the InterQual criteria to determine inappropriate admissions related to 1-day inpatient stays and reimbursement rates, hospitals are now working to shift uncomplicated PCI surgery to be classified as same-day discharge (SDD).\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003ECandidates for SDD should have stable vital signs, no cardiac chest pain, a stable vascular access site, be taking oral medications, and have an initial supply of dual antiplatelet therapy. Howard Bush, MD, Cleveland Clinic Florida, Weston, Florida, presented evidence suggesting that increased utilization of the transradial approach for PCI may increase the likelihood of being able to discharge post-PCI patients on the same day. Cardiac catheterization using a radial approach offers several advantages: improved patient comfort, avoidance of prolonged bed rest, shorter postprocedural hospital stays, lower cost, and reduction\/avoidance of access site bleeding complications.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EIn a multicenter cohort study of 107,018 patients aged \u0026gt;65 years who underwent PCI, SDD, although rarely implemented (prevalence 1.25%), was not associated with a greater risk of 2-day death or rehospitalization compared with overnight observation (0.37%; 95% CI, 0.16 to 0.87 vs 0.50%; 95% CI, 0.46 to 0.54; p=0.51) [Rao SV et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EIn the Early Discharge After Transradial Stenting of Coronary Arteries trial [EASY; Rinfret S et al. \u003Cem\u003EJ Am Coll Cardiol Intv\u003C\/em\u003E 2010], the mean post-PCI hospital stay was significantly shorter (p\u0026lt;0.001) for outpatients (8.9 hours) versus overnight-stay patients (26.5 hours). At 30-day follow-up, the outpatient PCI group achieved an \u223c50% savings in post-PCI costs, due mostly to the extra cost of the overnight stay. Hospital stays also carry the added risk of adverse drug reactions, infection, and skin ulcers (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Each additional night in the hospital increases the risk by 0.5% for adverse drug reactions, 1.6% for infections, and 0.5% for ulcers [Hauck K and Zhao X. \u003Cem\u003EMed Care\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Hazards of Hospitalization\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-486205566\u0022 data-figure-caption=\u0022Hazards of Hospitalization\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13682\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-21\u0022 class=\u0022first-child\u0022\u003EHazards of Hospitalization\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from H Bush, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EAcceptance of SDD as standard protocol among hospitals and cardiologists has been slow. There is a pressing need for large-scale randomized clinical trials to provide specific evidence-based guidelines. In a recent editorial, Eltigani Abdelaal, MD, and Olivier F. Bertrand, MD, PhD, of the Quebec Heart \u0026amp; Lung Institute, proposed seven essential components of a safe and successful outpatient program [Abdelaal E, Bertrand OF. \u003Cem\u003ECatheter Cardiovasc Interv\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EThe benefits of SDD lie in the potential to reduce procedural costs, increase hospital efficiency, and improve patient satisfaction related to the avoidance of an overnight hospital stay. SDD could potentially open up beds for other inpatient admissions in hospitals operating at near maximal capacity. A strategy that shifts uncomplicated PCI to SDD has become a priority to better align hospital resource utilization with payer expectations.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the Caribbean Cardiac Society presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-486205566\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the Caribbean Cardiac Society presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/20\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13683\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n               \u003Cp id=\u0022p-24\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the Caribbean Cardiac Society presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/14\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzno8e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzno8e\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzno8e\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}