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Shamkhani W, Rashid M, Moledina S, Ludman P, Curzen N, Wijeysundera HC, Grines CL, Mamas MA. Complex High-Risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Nonsurgical Centres. Can J Cardiol 2024; 40:1237-1246. [PMID: 38215968 DOI: 10.1016/j.cjca.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Limited data are available on complex high-risk percutaneous coronary intervention (CHiP) trends and outcomes in nonsurgical centres (NSCs), particularly in health care systems where most centres are NSCs. METHODS Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina from 2006 to 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE). RESULTS Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor left ventricular function (41.6%), chronic renal failure (38.8%), and chronic total occlusion percutaneous coronary intervention (31.1%). NSC-based CHiP is associated with lower odds of mortality (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.5-0.8) and major bleeding (aOR 0.7, 95% CI 0.6-0.8). In both groups, MACCE odds were similar (aOR 1.0, 95% CI 0.9-1.1). CONCLUSIONS CHiP numbers have steadily increased in NSCs. NSC patients were older and had a higher prevalence of cardiovascular risks than SC patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton, Southampton, United Kingdom
| | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Gilpin TR, Maznyczka A, Anantharam B, Dana A. Procedural Results and Long-term Outcome of Chronic Total Occlusion Percutaneous Coronary Intervention in a UK Non-surgical Centre. Interv Cardiol 2024; 19:e05. [PMID: 38808283 PMCID: PMC11131147 DOI: 10.15420/icr.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/08/2023] [Indexed: 05/30/2024] Open
Abstract
Background Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved a great deal over recent years, with increased procedural success and lower complication rates being reported. This study aims to evaluate the feasibility, safety and success of a dedicated CTO programme in a large UK PCI centre without on-site cardiothoracic surgery facilities. Methods Clinical and procedural data were retrospectively collected for consecutive unselected patients undergoing CTO PCI between 2015 and 2019 from the local database and regional electronic patient records. In-hospital outcomes and long-term major adverse cardiovascular events (all-cause mortality, MI, stroke and target vessel revascularisation) were recorded. Results A total of 170 patients underwent 191 CTO procedures during the study period. The mean age was 63 ± 10 years and 80.6% of patients were male (n=137). The clinical indications were: stable chronic coronary syndromes in 88.5% (n=169) of patients; staged procedures in the context of acute coronary syndromes in 1.6% (n=3); and presentation with acute coronary syndrome in 9.9% (n=19). The procedural success rate was 50.0% (n=25) for general interventional cardiologists and 90.1% (n=127) for dedicated CTO operators. In-hospital major adverse cardiovascular events occurred once (0.5%) and interhospital transfer for emergency salvage cardiac surgery was not required. Long-term follow-up data at a median duration of 3.8 years revealed 4 (2.4%) cardiac deaths, 14 (8.3%) spontaneous MI events and 10 (5.9%) target vessel revascularisations. Conclusion These data suggest CTO PCI using contemporary techniques is both safe and effective when undertaken in a high-volume non-surgical centre by experienced operators.
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Affiliation(s)
- Thomas R Gilpin
- Faculty of Medicine, University of SouthamptonSouthampton, UK
- Portsmouth Hospitals University NHS Trust, Queen Alexandra HospitalPortsmouth, UK
| | - Annette Maznyczka
- Portsmouth Hospitals University NHS Trust, Queen Alexandra HospitalPortsmouth, UK
| | - Brijesh Anantharam
- Portsmouth Hospitals University NHS Trust, Queen Alexandra HospitalPortsmouth, UK
| | - Ali Dana
- Portsmouth Hospitals University NHS Trust, Queen Alexandra HospitalPortsmouth, UK
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Alaour B, Onwordi E, Khan A, Menexi C, Carta S, Strike P, Griffiths H, Anantharam B, Hobson A, Dana A. Outcome of left main stem percutaneous coronary intervention in a UK nonsurgical center: A 5-year clinical experience. Catheter Cardiovasc Interv 2021; 99:601-606. [PMID: 33576157 DOI: 10.1002/ccd.29530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/03/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the outcome of unprotected left main stem (LMS) percutaneous coronary intervention (PCI) in a large UK nonsurgical center. BACKGROUND PCI on unprotected LMS is increasingly regarded as a viable alternative to coronary artery bypass grafting (CABG) with comparable outcome and safety profile in select groups. The safety and efficacy of unprotected LMS PCI without on-site surgical back up has not been reported. METHODS Data on all unprotected LMS PCI performed between January 2011 and December 2015, was collected from the local PCI database and electronic patient records. In hospital and 1-year major adverse cardiovascular events (MACE) (all-cause mortality, myocardial infarction [MI], stroke, and target vessel revascularization [TVR]) was recorded. RESULTS 249 patients had unprotected LMS intervention during the study period. 77% of patients (n = 192) were male and mean age was 70 ± 12 years. 31% (n = 78) of cases were elective, 44% (n = 109) NSTEMI, and 25% (n = 62) STEMI. Anatomical distribution: 19% (n = 47) ostial left main, 31% (n = 77) shaft, and 50% (n = 125) bifurcation. The mean SYNTAX score was 24.4 ± 10.6. 22% (n = 55) of patients had severe LV impairment preprocedure and 13% (n = 33) were in cardiogenic shock at presentation. 35% (14%) required IABP support. The vast majority (98.4%) of procedures were successful. No patients required emergency transfer for CABG surgery. There were 25 (10%) in-hospital deaths. 68% of in-hospital deaths occurred in patients undergoing primary PCI for STEMI. 72% of patients who died were in cardiogenic shock at presentation. The 12-month MACE rate was 17.2%. Death occurred in 11.6%, MI in 2.4%, TVR in 2.4%, and stroke in 0.8% of patients. CONCLUSION These results highlight the safety and efficacy of unprotected LMS PCI in a high volume non-surgical center.
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Affiliation(s)
- Bashir Alaour
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Eunice Onwordi
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Asif Khan
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Sabrina Carta
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Philip Strike
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Huw Griffiths
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Brijesh Anantharam
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Alexander Hobson
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Ali Dana
- Portsmouth Hospitals University NHS trust, Queen Alexandra Hospital, Portsmouth, UK
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Hannan EL, Zhong Y, Wu Y, Berger PB, Jacobs AK, Walford G, Venditti FJ, Ling FSK, Tamis-Holland J, King SB. Treatment of Coronary Artery Disease and Acute Myocardial Infarction in Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2019; 12:e007097. [PMID: 30616362 DOI: 10.1161/circinterventions.118.007097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies have revealed no outcome differences among patients undergoing percutaneous coronary intervention (PCI) in hospitals with and without surgery on-site (SOS), but one earlier study found differences in target vessel PCI rates and in mortality for patients with acute myocardial infarction who did not undergo PCI. It is important to examine outcome differences between SOS and non-SOS hospitals with more contemporary data. METHODS AND RESULTS A total of 21 924 propensity-matched patients who were discharged between January 1, 2013, and November 30, 2015, who were in the New York PCI registry and other hospital databases were used to compare outcomes in hospitals with and without SOS for all patients and for patients with and without ST-segment-elevation myocardial infarction (STEMI) undergoing PCI. Also, 30-day mortality was compared for patients with STEMI regardless of whether they underwent PCI. For all patients with PCI and patients without STEMI, there were no significant differences in in-hospital/30-day mortality, 2-year mortality, or 2-year repeat target lesion PCI. For patients with STEMI, there were no significant mortality differences between patients in SOS and non-SOS hospitals. Patients with STEMI in SOS hospitals had significantly lower 2-year repeat target lesion PCI rates (adjusted hazard ratio, 0.68 [0.49-0.94]). There was no difference in the percentage of patients undergoing PCI in the 2 types of hospitals (75.7% versus 74.6%; P=0.21) or in 30-day mortality of all patients with STEMI (patients who did and did not undergo PCI, 10.86% versus 11.32%; adjusted odds ratio, 1.06 [0.88-1.29]). CONCLUSIONS Short-term and long-term outcomes were not different in SOS and non-SOS hospitals except that 2-year repeat target lesion PCI rates were lower in SOS hospitals for patients with STEMI.
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Affiliation(s)
- Edward L Hannan
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Ye Zhong
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Yifeng Wu
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | | | - Alice K Jacobs
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Gary Walford
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Ferdinand J Venditti
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Frederick S K Ling
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Jacqueline Tamis-Holland
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Spencer B King
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
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Panduranga P, Al-Rashidi M, Al-Hajri F. In-Hospital and One-Year Clinical Outcome of Percutaneous Coronary Intervention in a Tertiary Hospital in Oman: Oman PCI Registry. Oman Med J 2017; 32:54-61. [PMID: 28042404 DOI: 10.5001/omj.2017.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI) in a tertiary hospital in Oman. METHODS We conducted a retrospective, single-center, observational study looking at patients > 18 years old who underwent a PCI from 1 January to 31 December 2013. The primary end point was the occurrence of a major adverse cardiovascular event (MACE), defined as death, any myocardial infarction (MI), cerebrovascular accident (CVA), and target vessel revascularization (TVR) with either repeat PCI or coronary artery bypass surgery (CABG). Secondary end-points included procedural success rate, angina status, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. RESULTS A total of 1 045 consecutive patients were analyzed. The mean age of the cohort was 58.2±11.2 years. Hyperlipidemia (66.8%), hypertension (55.1%), and diabetes mellitus (45.9%) were the predominant risk factors. Stable angina, ST-elevation MI, non-ST-elevation MI, and post-acute coronary syndrome (ACS) were common indications (approximately 20.0% each). The angiographic and procedural success rate was 95.0%. Forty-six percent of patients had single-vessel disease, 34.4% had double vessel disease, and triple vessel disease was seen in 19.1% of patients. Ninety-eight percent had balloon angioplasty with stenting, and only 1.9% of patients had balloon angioplasty without stenting. The majority of patients had single-vessel stenting (81.3%). A drug-eluting stent was used in 88.4% of patients, and a bare-metal stent in 11.6%. In-hospital MACE was 3.6%. There were 19 in-hospital deaths (1.8%), and four patients (0.4%) had CVA/MI. Out of 1 026 patients discharged, 100 patients were lost to follow-up. Among the 926 patients followed-up, 673 patients (72.7%) were asymptomatic. One-year MACE was 17.0%, including 5.0% death and 6.0% MI. Repeat revascularization was performed in 53 patients (5.7%) for documented in-stent restenosis. Definite stent thrombosis was documented in 10 (1.1%) patients. At discharge, the majority of patients were on post-ACS evidence-based medications, aspirin (100%), clopidogrel (99.6%), statin (97.6%), beta-blocker (88.7%), and angiotensin-converting-enzyme inhibitors (83.9%). CONCLUSIONS Omani patients treated with PCI were much younger than Western patients with a high prevalence of risk factors. Successful PCI was achieved in a large percentage of patients with a low incidence of in-hospital complications and mortality. At one-year follow-up, the majority patients had a good clinical outcome.
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Koolen KHAJ, Mol KA, Rahel BM, Eerens F, Aydin S, Troquay RPT, Janssen L, Tonino WAL, Meeder JG. Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup. Neth Heart J 2016; 24:581-8. [PMID: 27595816 PMCID: PMC5039129 DOI: 10.1007/s12471-016-0872-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands. BACKGROUND Controversy remains about the safety and efficacy of PPCI in off-site PCI centres. METHODS We retrospectively analysed clinical and procedural data as well as 6‑month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven. RESULTS PPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4 % VieCuri vs. 12.3 % Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9 %) patients in the VieCuri group and 9 (8.1 %) in the Catharina Hospital group had a major adverse cardiac event. CONCLUSION Performing PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.
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Affiliation(s)
- K H A J Koolen
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands.
| | - K A Mol
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - B M Rahel
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - F Eerens
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - S Aydin
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - R P T Troquay
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - L Janssen
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - W A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - J G Meeder
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
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Cheng HY, Wang KT, Lin WH, Tsai JP, Chen YT. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease - A Single Hospital Experience without On-Site Cardiac Surgery. ACTA CARDIOLOGICA SINICA 2016; 31:267-79. [PMID: 27122882 DOI: 10.6515/acs20150119d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND To investigate the safety and outcome of percutaneous coronary intervention for left main coronary artery disease in hospital without on-site cardiac surgery. METHODS Between January 2007 and December 2010, all patients diagnosed with left main coronary artery disease and refused coronary artery bypass graft surgery in our hospital or a tertiary center, were enrolled. Data including clinical course, angiographic characteristics, and 1- and 3-years outcomes were recorded and analyzed. RESULTS Seventy patients (mean age 73.4 ± 10.2 years, 47 male, 23 females) were treated with a mean SYNTAX score of 34.8 ± 12.6 and EuroSCORE of 6.7 ± 3.3. Thirty-two (45.7%) patients had stable angina, 35 (50.0%) had unstable angina/non ST-elevation myocardial infarction, and 3 (4.3%) had ST-elevation Myocardial infarction. Forty-three (61.4%) patients received a single-stent, 26 (37.1%) received two-stents, and 1 (1.4%) received balloon angioplasty. No procedure-related mortalities were noted and no emergency coronary artery bypass graft surgery was required. In the 3-year follow-up period, 2 (2.9%) patients had non-fetal myocardial infarction, 11 (15.7%) had left main target lesion revascularization. The major adverse cardiac and cerebrovascular events rates were 24.3% at 1 year and 37.1% at 3-years. The all-cause mortality rate was 41.4% (29 patients), including 18 (25.7%) cases of septic shock, 7 (10.0%) of sudden cardiac death, 2 (2.8%) of hypovolemic shock due to upper gastrointestinal bleeding, 1 (1.4%) of terminal stage malignancy, and 1 (1.4%) of suffocation at 3 years. CONCLUSIONS Percutaneous coronary intervention for patients with left main coronary artery disease was found to be a safe and effective strategy in our hospital without on-site cardiac surgery. KEY WORDS Incomplete revascularization; Left main coronary artery (LM); No cardiac surgery; Percutaneous coronary intervention (PCI).
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Affiliation(s)
- Hsiao-Yang Cheng
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Kuang-Te Wang
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Wen-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Jui-Peng Tsai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung; ; Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yung-Tzi Chen
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
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Monteleone PP, Yeh RW. Management of Complications. Interv Cardiol Clin 2016; 5:201-209. [PMID: 28582204 DOI: 10.1016/j.iccl.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention (PCI) has matured rapidly to tackle increasingly complex coronary disease. Operators must be aware of the incidence of the basic risks involved with coronary angiography and PCI to appropriately inform patients and obtain procedural consent. Even before a wire enters a coronary artery, specific risks, including vascular access complications, renal injury, allergic reaction, and radiation injury, are constantly present. With initiation of PCI, new risks to the coronary circulation arise. A fundamental knowledge of the presentation of these complications and expert ability to emergently manage them are of the utmost importance to the successful completion of PCI.
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Affiliation(s)
- Peter P Monteleone
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Robert W Yeh
- Division of Cardiology, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
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Syed Z, Moscucci M, Share D, Gurm HS. Predicting emergency coronary artery bypass graft following PCI: application of a computational model to refer patients to hospitals with and without onsite surgical backup. Open Heart 2015; 2:e000243. [PMID: 26688738 PMCID: PMC4680582 DOI: 10.1136/openhrt-2015-000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 12/05/2022] Open
Abstract
Background Clinical tools to stratify patients for emergency coronary artery bypass graft (ECABG) after percutaneous coronary intervention (PCI) create the opportunity to selectively assign patients undergoing procedures to hospitals with and without onsite surgical facilities for dealing with potential complications while balancing load across providers. The goal of our study was to investigate the feasibility of a computational model directly optimised for cohort-level performance to predict ECABG in PCI patients for this application. Methods Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry data with 69 pre-procedural and angiographic risk variables from 68 022 PCI procedures in 2004–2007 were used to develop a support vector machine (SVM) model for ECABG. The SVM model was optimised for the area under the receiver operating characteristic curve (AUROC) at the level of the training cohort and validated on 42 310 PCI procedures performed in 2008–2009. Results There were 87 cases of ECABG (0.21%) in the validation cohort. The SVM model achieved an AUROC of 0.81 (95% CI 0.76 to 0.86). Patients in the predicted top decile were at a significantly increased risk relative to the remaining patients (OR 9.74, 95% CI 6.39 to 14.85, p<0.001) for ECABG. The SVM model optimised for the AUROC on the training cohort significantly improved discrimination, net reclassification and calibration over logistic regression and traditional SVM classification optimised for univariate performance. Conclusions Computational risk stratification directly optimising cohort-level performance holds the potential of high levels of discrimination for ECABG following PCI. This approach has value in selectively referring PCI patients to hospitals with and without onsite surgery.
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Affiliation(s)
- Zeeshan Syed
- Department of Electrical Engineering and Computer Science , University of Michigan , Ann Arbor, Michigan , USA
| | - Mauro Moscucci
- Miller School of Medicine, University of Miami , Miami, Florida , USA
| | - David Share
- Department of Family Medicine , University of Michigan , Ann Arbor, Michigan , USA
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine , University of Michigan , Ann Arbor, Michigan , USA
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Interventional cardiology. Nonprimary PCI at centres without onsite surgical backup. Nat Rev Cardiol 2015; 12:563-4. [PMID: 26346732 DOI: 10.1038/nrcardio.2015.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A new systematic review and meta-analysis by Lee and colleagues confirms the safety of nonprimary percutaneous coronary intervention (PCI) at centres without onsite surgical backup. In daily clinical practice at PCI centres without onsite surgical facilities, quality assurance and improvement programmes are important to ensure high-quality care.
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper. ACTA ACUST UNITED AC 2015; 68:976-995.e10. [PMID: 26315766 DOI: 10.1016/j.rec.2015.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.
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Affiliation(s)
- José López-Sendón
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - José Ramón González-Juanatey
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Fausto Pinto
- European Society of Cardiology; Department of Cardiology, University Hospital Santa Maria, Lisbon, Portugal
| | - José Cuenca Castillo
- Sociedad Española de Cirugía Torácica-Cardiovascular; Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lina Badimón
- Centro de Investigación Cardiovascular (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Regina Dalmau
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Esteban González Torrecilla
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Ramón López-Mínguez
- Unidad de Cardiología intervencionista, Servicio de Cardiología, Hospital Infanta Crsitina, Badajoz, Spain
| | - Alicia M Maceira
- Unidad de Imagen Cardiaca, Servicio de Cardiología, ERESA Medical Center, Valencia, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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14
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Lee JM, Hwang D, Park J, Kim KJ, Ahn C, Koo BK. Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup. Circulation 2015; 132:388-401. [DOI: 10.1161/circulationaha.115.016137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/03/2015] [Indexed: 01/16/2023]
Abstract
Background—
Emergency coronary artery bypass grafting for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and nonprimary PCI at centers with and without on-site surgical backup.
Methods and Results—
We performed an updated systematic review and meta-analysis by using mixed-effects models. We included 23 high-quality studies that compared clinical outcomes and complication rates of 1 101 123 patients after PCI at centers with or without on-site surgery. For primary PCI for ST-segment–elevation myocardial infarction (133 574 patients), all-cause mortality (without on-site surgery versus with on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence interval, 0.91–1.07;
P
=0.729;
I
2
=3.4%) or emergency coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR, 0.76; 95% confidence interval, 0.56–1.01;
P
=0.062;
I
2
=42.5%) did not differ by presence of on-site surgery. For nonprimary PCI (967 549 patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled OR, 1.15; 95% confidence interval, 0.94–1.41;
P
=0.172;
I
2
=67.5%) and emergency coronary artery bypass grafting rates (observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62–2.13;
P
=0.669;
I
2
=81.7%) were not significantly different. PCI complication rates (cardiogenic shock, stroke, aortic dissection, tamponade, recurrent infarction) also did not differ by on-site surgical capability. Cumulative meta-analysis of nonprimary PCI showed a temporal decrease of the effect size (OR) for all-cause mortality after 2007.
Conclusions—
Clinical outcomes and complication rates of PCI at centers without on-site surgery did not differ from those with on-site surgery, for both primary and nonprimary PCI. Temporal trends indicated improving clinical outcomes in nonprimary PCI at centers without on-site surgery.
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Affiliation(s)
- Joo Myung Lee
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Doyeon Hwang
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Jonghanne Park
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Kyung-Jin Kim
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Chul Ahn
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Bon-Kwon Koo
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
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15
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Pande AN, Jacobs AK. Percutaneous Coronary Intervention Without Onsite Cardiac Surgery: Ready for Take-Off? J Am Coll Cardiol 2015. [PMID: 26205594 DOI: 10.1016/j.jacc.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ashvin N Pande
- Department of Medicine, Section of Cardiology, Boston University Medical Center, Boston, Massachusetts
| | - Alice K Jacobs
- Department of Medicine, Section of Cardiology, Boston University Medical Center, Boston, Massachusetts.
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16
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Garg S, Anderson SG, Oldroyd K, Berry C, Emdin CA, Peters SA, West NE, Kelly D, Balachandran K, McDonald J, Singh R, Devadathan S, Redwood S, Ludman PF, Rahimi K, Woodward M. Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.05.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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17
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv 2015; 84:169-87. [PMID: 25045090 DOI: 10.1002/ccd.25371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Baylor Scott & White Health, Central Texas, Temple, TX. SCAI Writing Committee Member and Chair
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18
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Zhang Z, Kolm P, Grau-Sepulveda MV, Ponirakis A, O'Brien SM, Klein LW, Shaw RE, McKay C, Shahian DM, Grover FL, Mayer JE, Garratt KN, Hlatky M, Edwards FH, Weintraub WS. Cost-effectiveness of revascularization strategies: the ASCERT study. J Am Coll Cardiol 2015; 65:1-11. [PMID: 25572503 DOI: 10.1016/j.jacc.2014.09.078] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/29/2014] [Accepted: 09/03/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) over 4 to 5 years. OBJECTIVES This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease. METHODS The Society of Thoracic Surgeons and American College of Cardiology Foundation databases were linked to the Centers for Medicare and Medicaid Services claims data. Costs for the index and observation period (2004 to 2008) hospitalizations were assessed by diagnosis-related group Medicare reimbursement rates; costs beyond the observation period were estimated from average Medicare participant per capita expenditure. Effectiveness was measured via mortality and life-expectancy data. Cost and effectiveness comparisons were adjusted using propensity score matching with the incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year gained. RESULTS CABG patients (n = 86,244) and PCI patients (n = 103,549) were at least 65 years old with 2- or 3-vessel coronary artery disease. Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained. CONCLUSIONS Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.
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Affiliation(s)
- Zugui Zhang
- Value Institute, Christiana Care Health System, Newark, Delaware.
| | - Paul Kolm
- Value Institute, Christiana Care Health System, Newark, Delaware
| | - Maria V Grau-Sepulveda
- Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina
| | - Angelo Ponirakis
- Department of Research Study, American College of Cardiology, Washington, DC
| | - Sean M O'Brien
- Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina
| | - Lloyd W Klein
- Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Richard E Shaw
- Department of Clinical Informatics, California Pacific Medical Center, San Francisco, California
| | - Charles McKay
- Section of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - David M Shahian
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frederick L Grover
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Section of Cardiology, Denver Department of Veterans Affairs Medical Center, Denver, Colorado
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Kirk N Garratt
- Department of Interventional Cardiovascular Research, Lenox Hill Heart and Vascular Institute of New York, New York, New York
| | - Mark Hlatky
- Department of Health Research and Policy, Stanford University, Palo Alto, California
| | - Fred H Edwards
- Department of Surgery, University of Florida Shands Jacksonville, Jacksonville, Florida
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19
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Sara JDS, Holmes DR, Jaffe AS. Fundamental concepts of effective troponin use: important principles for internists. Am J Med 2015; 128:111-9. [PMID: 25232717 DOI: 10.1016/j.amjmed.2014.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/26/2022]
Abstract
Troponin testing is an essential component of our diagnostic approach to patients in acute medical care settings. With the advent of high-sensitivity troponin assays, its importance will extend to patients in chronic disease settings. Although elevated troponin levels provide diagnostic information, inform treatment decisions, and influence patient prognosis, proper interpretation of the values is essential. This requires an understanding of the operating characteristics of troponin testing; the likelihood ratios associated with a positive/negative test result and the pre- and post-test probabilities related to individual clinical settings. These principles will become more important as high-sensitivity assays become introduced over the coming years in the United States. This article reviews the important principles of troponin testing focusing in particular on acute settings and is aimed at internal medicine and hospital specialists.
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Affiliation(s)
- Jaskanwal D S Sara
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minn.
| | - David R Holmes
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minn
| | - Allan S Jaffe
- CCLS Division of Laboratory Medicine and Pathology, Mayo College of Medicine, Rochester, Minn
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20
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Percutaneous Coronary Intervention and the Various Coronary Artery Disease Syndromes. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Nippak PMD, Pritchard J, Horodyski R, Ikeda-Douglas CJ, Isaac WW. Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System. BMC Health Serv Res 2014; 14:449. [PMID: 25269747 PMCID: PMC4263118 DOI: 10.1186/1472-6963-14-449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. METHODS A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. RESULTS The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). CONCLUSIONS The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.
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Affiliation(s)
- Pria M D Nippak
- Health Services Management Department, Ryerson University, 350 Victoria St, Toronto, ON M2K 5B3, Canada.
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22
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Akasaka T, Hokimoto S, Oshima S, Nakao K, Fujimoto K, Miyao Y, Shimomura H, Tsunoda R, Hirose T, Kajiwara I, Matsumura T, Nakamura N, Yamamoto N, Koide S, Oka H, Morikami Y, Sakaino N, Kaikita K, Nakamura S, Matsui K, Ogawa H. Clinical outcomes of percutaneous coronary intervention (PCI) at hospital with or without onsite cardiac surgery backup. Int J Cardiol 2014; 176:1385-7. [PMID: 25156861 DOI: 10.1016/j.ijcard.2014.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shuichi Oshima
- Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan
| | - Koichi Nakao
- Cardiovascular Center, Kumamoto Saiseikai Hospital, Kumamoto, Japan
| | - Kazuteru Fujimoto
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yuji Miyao
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hideki Shimomura
- Division of Cardiology, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | | | - Toyoki Hirose
- Division of Cardiology, Minamata City Hospital and Medical Center, Minamata, Japan
| | | | | | | | - Nobuyasu Yamamoto
- Division of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Shunichi Koide
- Division of Cardiology, Health Insurance Yatsushiro General Hospital, Yatsushiro, Japan
| | - Hideki Oka
- Division of Cardiology, Health Insurance Hitoyoshi General Hospital, Hitoyoshi, Japan
| | | | - Naritsugu Sakaino
- Division of Cardiology, Amakusa Regional Medical Center, Amakusa, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Nakamura
- Cardiovascular Center, New Tokyo Hospital, Matsudo, Japan
| | - Kunihiko Matsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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23
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 update on percutaneous coronary intervention without on-site surgical backup. J Am Coll Cardiol 2014; 63:2624-2641. [PMID: 24651052 DOI: 10.1016/j.jacc.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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24
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Jacobs AK, Normand SLT, Mauri L. PCI at hospitals with or without on-site cardiac surgery. N Engl J Med 2013; 369:392. [PMID: 23883385 DOI: 10.1056/nejmc1306996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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26
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Li S, Chen A, Mead K. Racial disparities in the use of cardiac revascularization: does local hospital capacity matter? PLoS One 2013; 8:e69855. [PMID: 23875005 PMCID: PMC3713060 DOI: 10.1371/journal.pone.0069855] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/12/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity. DATA SOURCES Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006. STUDY DESIGN The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity. PRINCIPAL FINDINGS Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate. CONCLUSIONS County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.
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Affiliation(s)
- Suhui Li
- Department of Health Policy, George Washington University, Washington, District of Columbia, United States of America.
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27
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ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Simard T, Hibbert B, Pourdjabbar A, Ramirez FD, Wilson KR, Hawken S, O'Brien ER. Percutaneous coronary intervention with or without on-site coronary artery bypass surgery: A systematic review and meta-analysis. Int J Cardiol 2013; 167:197-204. [DOI: 10.1016/j.ijcard.2011.12.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 12/11/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
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29
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Maddox TM, Rumsfeld JS. Interventional cardiology. PCI without surgical backup--evidence-based, but wise? Nat Rev Cardiol 2013; 10:301-2. [PMID: 23648785 DOI: 10.1038/nrcardio.2013.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Thomas M Maddox
- VA Eastern Colorado Healthcare System and University of Colorado School of Medicine, 1055 Clermont Street, Denver, CO 80220, USA.
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30
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Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Jacobs AK, Normand SLT, Massaro JM, Cutlip DE, Carrozza JP, Marks AD, Murphy N, Romm IK, Biondolillo M, Mauri L. Nonemergency PCI at hospitals with or without on-site cardiac surgery. N Engl J Med 2013; 368:1498-508. [PMID: 23477625 DOI: 10.1056/nejmoa1300610] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain. METHODS We enrolled patients with indications for nonemergency PCI who presented at hospitals in Massachusetts without on-site cardiac surgery and randomly assigned these patients, in a 3:1 ratio, to undergo PCI at that hospital or at a partner hospital that had cardiac surgery services available. A total of 10 hospitals without on-site cardiac surgery and 7 with on-site cardiac surgery participated. The coprimary end points were the rates of major adverse cardiac events--a composite of death, myocardial infarction, repeat revascularization, or stroke--at 30 days (safety end point) and at 12 months (effectiveness end point). The primary end points were analyzed according to the intention-to-treat principle and were tested with the use of multiplicative noninferiority margins of 1.5 (for safety) and 1.3 (for effectiveness). RESULTS A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point. CONCLUSIONS Nonemergency PCI procedures performed at hospitals in Massachusetts without on-site surgical services were noninferior to procedures performed at hospitals with on-site surgical services with respect to the 30-day and 1-year rates of clinical events. (Funded by the participating hospitals without on-site cardiac surgery; MASS COM ClinicalTrials.gov number, NCT01116882.).
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Affiliation(s)
- Alice K Jacobs
- Boston University School of Medicine, Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Effect of volume of percutaneous coronary intervention on clinical outcomes in patients with acute myocardial infarctions in hospitals with and without onsite cardiac surgery backup. Int J Cardiol 2013; 163:216-7. [PMID: 22795707 DOI: 10.1016/j.ijcard.2012.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 11/20/2022]
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Oqueli E. Current state of the performance of percutaneous coronary intervention in centres without on-site cardiac surgery. Intern Med J 2012; 42 Suppl 5:58-67. [PMID: 23035684 DOI: 10.1111/j.1445-5994.2012.02898.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Before the routine use of coronary stents, potential complications of percutaneous coronary interventions required the presence of backup cardiac surgery on-site. Advances in pharmacotherapy and interventional techniques, particularly in the last decade, have significantly decreased the rates of complications requiring emergency cardiac surgery, from approximately 4% to 6% in the balloon angioplasty era to as low as 0.3% to 0.6% in the contemporary era of routine intracoronary stent implantation. An early invasive approach has been shown to improve outcomes among patients with non-ST elevation acute coronary syndromes (NSTEACS), particularly in those at the highest risk, emphasising the importance of early access to revascularisation premises in such patients. Patients with ST-segment elevation myocardial infarction require immediate and sustained recanalisation of the culprit vessel to obtain rapid reperfusion of the threatened myocardium, in order to reduce infarct size and improve outcomes. Primary percutaneous coronary intervention at hospitals without on-site cardiac surgery improves clinical outcomes and reduces length of stay when compared with fibrinolytic therapy. It also significantly reduces door-to-balloon times when compared with transfer for percutaneous coronary interventions at hospitals with on-site surgery. It has been published that risk-adjusted mortality rates for patients undergoing percutaneous coronary interventions in centres without on-site surgical backup are comparable with those of percutaneous coronary intervention facilities that have cardiac surgery on-site, regardless of whether percutaneous coronary intervention was performed as primary therapy for ST-segment elevation myocardial infarction or in a non-primary setting. To achieve these results however, an adequate percutaneous coronary intervention programme is required, including proper hospital infrastructure and appropriately trained interventional cardiologists.
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Affiliation(s)
- E Oqueli
- Ballarat Health Services, Ballarat, Victoria, Australia.
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Sakr TM, Moustapha ME, Motaleb MA. 99mTc-nebivolol as a novel heart imaging radiopharmaceutical for myocardial infarction assessment. J Radioanal Nucl Chem 2012. [DOI: 10.1007/s10967-012-2168-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery. METHODS We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months. RESULTS A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01). CONCLUSIONS We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).
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Shahian DM, Meyer GS, Yeh RW, Fifer MA, Torchiana DF. Percutaneous coronary interventions without on-site cardiac surgical backup. N Engl J Med 2012; 366:1814-23. [PMID: 22571203 DOI: 10.1056/nejmra1109616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David M Shahian
- Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kinlay S. The trials and tribulations of percutaneous coronary intervention in hospitals without on-site CABG surgery. JAMA 2011; 306:2507-9. [PMID: 22166613 PMCID: PMC4504239 DOI: 10.1001/jama.2011.1824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 902] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zia MI, Wijeysundera HC, Tu JV, Lee DS, Ko DT. Percutaneous Coronary Intervention With vs Without On-Site Cardiac Surgery Backup: A Systematic Review and Meta-analysis. Can J Cardiol 2011; 27:664.e9-16. [DOI: 10.1016/j.cjca.2010.12.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/07/2010] [Indexed: 11/29/2022] Open
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Bakal JA, Kaul P, Welsh RC, Johnstone D, Armstrong PW. Determining the Cost Economic “Tipping Point” for the Addition of a Regional Percutaneous Coronary Intervention Facility. Can J Cardiol 2011; 27:567-72. [DOI: 10.1016/j.cjca.2011.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 02/15/2011] [Indexed: 11/26/2022] Open
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Race and timeliness of transfer for revascularization in patients with acute myocardial infarction. Med Care 2011; 49:662-7. [PMID: 21677592 DOI: 10.1097/mlr.0b013e31821d98b2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability. We sought to determine whether the timeliness of hospital transfer and quality of destination hospitals differed between black and white patients. METHODS We evaluated all white and black Medicare beneficiaries admitted with AMI at nonrevascularization hospitals in 2006 who were transferred to a revascularization hospital. We compared hospital length of stay before transfer and the transfer destination's 30-day risk-standardized mortality rate for AMI between black and white patients. We used hierarchical regression to adjust for patient characteristics and examine within and across-hospital effects of race on 30-day mortality and length of stay before transfer. RESULTS A total of 25,947 (42%) white and 2345 (37%) black patients with AMI were transferred from 857 urban and 774 rural nonrevascularization hospitals to 928 revascularization hospitals. Median (interquartile range) length of stay before transfer was 1 day (1 to 3 d) for white patients and 2 days (1 to 4 d) for black patients (P<0.001). In adjusted models, black patients tended to be transferred more slowly than white patients, a finding because of both across and within-hospital effects. For example, within a given urban hospital, black patients were transferred an additional 0.24 days (95% confidence interval 0.03-0.44 d) later than white patients. In addition, the lengths of stay before transfer for all patients at urban hospitals increased by 0.37 days (95% confidence interval 0.28-0.47 d) for every 20% increase in the proportion of AMI patients who were black. These results were attenuated in rural hospitals. The risk-standardized mortality rate of the revascularization hospital to which patients were ultimately sent did not differ between black and white patients. CONCLUSIONS Black patients are transferred more slowly to revascularization hospitals after AMI than white patients, resulting from both less timely transfers within hospitals and admission to hospitals with greater delays in transfer; however, 30-day mortality of the revascularization hospital to which both groups were sent to appeared similar. Race-based delays in transfer may contribute to known racial disparities in outcomes of AMI.
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Agarwal S, Zaman T, Tuzcu EM, Shishehbor M, Lincoff AM, Whitlow PL, Bajzer C, Franco I, Nair R, Raymond R, Ellis SG, Kapadia SR. Comparison of outcomes of unprotected left main versus multivessel coronary artery interventions. Am J Cardiol 2011; 108:15-20. [PMID: 21529732 DOI: 10.1016/j.amjcard.2011.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/03/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
Abstract
Left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has emerged as an appealing alternative to bypass surgery for significant LMCA disease, especially in high-risk candidates. PCI for unprotected LMCA stenosis is currently designated a class IIb indication. Direct comparisons between unprotected LMCA PCI and multivessel PCI are lacking. We aimed to determine the incremental risk associated with unprotected LMCA PCI compared to multivessel PCI. We queried the Cleveland Clinic PCI database to identify patients who underwent unprotected LMCA PCI from 2003 through 2009 and compared these to patients undergoing multivessel PCI in the same period. Patients undergoing PCI for acute myocardial infarction were excluded. Mortality was derived using the Social Security Death Index. Short-term (≤30-day) mortality rates in the LMCA PCI group (n = 468, 1.9%) were similar to the death rate in the multivessel PCI group (n = 1,973, 1.3%, p = 0.3). There was no significant difference in adjusted mortality between the 2 study groups. Stratifying LMCA PCI by the number of concomitant vessel territories treated, there was no significant difference in mortality in any LMCA PCI category (LMCA only, LMCA + 1-vessel PCI, LMCA + multivessel PCI) compared to multivessel PCI. In conclusion, there was comparable short-term and long-term mortality in the LMCA PCI and multivessel PCI groups. LMCA stenting did not appear to incur incremental risk compared to multivessel PCI.
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Motaleb MA, Moustapha ME, Ibrahim IT. Synthesis and biological evaluation of 125I-nebivolol as a potential cardioselective agent for imaging β1-adrenoceptors. J Radioanal Nucl Chem 2011. [DOI: 10.1007/s10967-011-1069-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Outcomes of Nonemergent Percutaneous Coronary Intervention With and Without On-site Surgical Backup: A Meta-Analysis. Am J Ther 2011; 18:e22-8. [DOI: 10.1097/mjt.0b013e3181bc0f5a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Reed MC, Nallamothu BK. Optimizing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Interv Cardiol 2010. [DOI: 10.2217/ica.10.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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49
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Kereiakes DJ. Cultivating Prognosis Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2010; 55:1933-5. [DOI: 10.1016/j.jacc.2010.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 02/04/2010] [Accepted: 02/08/2010] [Indexed: 11/15/2022]
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Gharacholou SM, Alexander KP, Chen AY, Wang TY, Melloni C, Gibler WB, Pollack CV, Ohman EM, Peterson ED, Roe MT. Implications and reasons for the lack of use of reperfusion therapy in patients with ST-segment elevation myocardial infarction: findings from the CRUSADE initiative. Am Heart J 2010; 159:757-63. [PMID: 20435183 DOI: 10.1016/j.ahj.2010.02.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/08/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prompt reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is a class I guideline recommendation and has been shown to reduce mortality. However, many STEMI patients in contemporary practice still do not receive any form of reperfusion therapy. METHODS We evaluated 8,578 patients with STEMI from 226 US hospitals participating in the CRUSADE quality improvement initiative from September 2004 to December 2006 to determine the proportion of eligible patients who received an attempt at reperfusion therapy and factors associated with lack of reperfusion among patients without a contraindication to reperfusion. STEMI patients were classified into 3 groups: (1) patients eligible for reperfusion and for whom reperfusion was attempted; (2) patients eligible for reperfusion and for whom reperfusion was not attempted; and (3) patients who were ineligible for reperfusion because of identified contraindications. We compared patient characteristics, treatments, and outcomes among the groups and identified factors independently associated with lack of reperfusion use among eligible patients. RESULTS Of the 8,578 patients with STEMI, 881 patients (10.3%) had a documented contraindication to reperfusion, 7,080 (82.5%) received fibrinolysis or underwent an attempt at primary percutaneous coronary intervention, and 617 reperfusion-eligible patients (7.2%) had no attempt to administer reperfusion. Primary reasons for contraindications were identified as absence of an ischemic indication (n = 474; 53.8%), bleeding risk (n = 147; 16.7%), patient-related reasons (n = 223; 25.3%), and other (n = 37; 4.2%). The strongest factors associated with not attempting reperfusion among the reperfusion-eligible population were older age, heart failure at presentation, noncardiac surgical center, prior stroke, and female sex. Compared with patients receiving an attempt at reperfusion, adjusted in-hospital mortality rates were higher for patients with a documented reperfusion contraindication (adjusted odds ratio 1.77, 95% CI 1.28-2.45) and in eligible patients who did not receive reperfusion (adjusted odds ratio 1.64, 95% CI 1.07-2.50). CONCLUSIONS More than 7% of STEMI patients without a reperfusion contraindication did not have an attempt to administer reperfusion therapy, and this was associated with greater in-hospital mortality. Age, sex, and comorbidity were factors related to lack of attempting reperfusion among apparently eligible patients. Quality improvement efforts should focus on maximizing reperfusion use among all eligible STEMI patients and in addressing the processes by which contraindications are defined, clinically determined, and reported.
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