Cardiovascular Institute and Center for Cardiovascular Health
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What's New Clinical Advances 05/04/04 Mount Sinai and Dr. Sharma Lead in Angioplasty Safety Rates Again The Mount Sinai Hospital has the best angioplasty outcomes of any major hospital in New York City, according to a recently released report from the New York State Department of Health. The report also shows that Samin Sharma, MD, Director of Interventional Cardiology and the Cardiac Catheterization Laboratory, performs more angioplasties than any other cardiologist in the state and is the only one with risk-adjusted survival rates significantly below the statewide average for both non-emergency cases and emergency and non-emergency cases combined. The annual report provides mortality rates for the three-year period 1999-2001 for the 39 hospitals in the state, as well as the individual cardiologists who perform angioplasty, the non-surgical procedure used to open arteries clogged by the accumulation of cholesterol and other catty molecules inside the artery. The risk-adjusted mortality rate for the 6,028 angioplasty cases performed at Mount Sinai during the three-year period was 0.58 percent, the lowest among the city's major hospitals. The risk adjusted mortality rate for the 338 emergency cases performed at Mount Sinai during the three-year period was 2.00 percent, significantly lower than the statewide average. Mount Sinai was the only hospital in New York City to achieve that distinction in emergency cases, as indicated in the report by a coveted double-star notation of excellence. "I am delighted that Mont Sinai continued to remain on top," says Dr. Sharma, who performed 3,100 angioplasty procedures during the three-year reporting period. "This is the seventh year in a row that the Hospital has the lowest complication rates for angioplasty. I attribute this phenomenal and constant success to the teamwork and coordination among the various disciplines, including the Cardiac Care Unit, Cardiac Care Center and Department of Cardiothoracic Surgery." Dr. Sharma also credits his team's successes-both in emergency procedures and complex cases referred from other hospitals (of which Mount Sinai receives many)-to "the way we prepare the patient and their confidence, the teamwork in the Cath Lab, and the use of various established and emergency devices and technologies. That is why, despite the increased volume of patients we treat, we have the lowest complications." 04/26/04 Getting a better look at blood vessels A full-blown heart attack occurs when blood flow is blocked (due to plaque buildup) and tissue death occurs from loss of oxygen, severely damaging the heart. Recently scientists have discovered that barely-visible amounts of plaque along the vessel walls could also rupture down the road, putting people at risk for heart attacks and sudden cardiac death, according to Dr. Valentin Fuster, director of the Cardiovascular Institute at Mount Sinai and past president of the American Heart Association. To spot the dangerous plaque, physicians are now starting to use MRI's and ultra-fast CT scans to identify hard-to-spot plaque within those vulnerable arteries and patients on a treatment right away. 04/25/04 01/28/04 "For years, the only way to assess a person's risk for heart attack has been with a coronary angiogram. During the procedure, a catheter is inserted into the groin and threaded through the femoral artery until it reaches the heart. A dye is injected and an X-ray is taken to gauge just how much the arteries have been narrowed by years of plaque and calcium buildup. But while the angiogram is a useful tool, it's also invasive, and doctors typically only perform them on people with symptoms, like chest pain, or following a positive stress test. The catheter can damage an artery or trigger a life-threatening blood clot. The expensive and time-consuming procedure requires sedation, hospitalization and several hours of recovery. But rapid advances in CT scan and MRI technology are changing the rules of angiography. New, faster CT machines take clear pictures of a beating heart without a catheter, sedation or hospitalization. And now, combined with MRI, doctors have begun to glean far more information about a patient's heart health than was ever available from a traditional catheter procedure alone. The MRI can show blood vessels, blood flow, scar tissue and the workings of the heart muscle and valves. But most important, using the CT angiogram as a road map, doctors now can use the MRI to assess whether plaque buildup is benign or risky -- a virtual biopsy for the heart. Although the start-up costs of scanning angiography and heart MRI studies are high, over time the tests should prove far less expensive, costing about $600 to $800 for a CT or MRI heart scan, compared with the $3,000 cost of the catheter version. More important, the tests are a better option for patients who don't have obvious symptoms but still have risk factors. Most doctors would never consider performing an invasive catheter angiogram on an otherwise healthy person, but have no health concerns about offering the relatively risk-free scans. "This is a technology that will provide us with everything we need to know about the cardiac status of an individual," says Valentin Fuster, director of the cardiovascular institute at Mount Sinai Hospital in New York and a pioneer in heart-disease research. "It's a breakthrough in the way we examine a patient with cardiac disease, and it's leading us into a fascinating future." |