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Chowdhury MRK, Stub D, Dinh D, Karim MN, Siddiquea BN, Billah B. Preoperative Variables of 30-Day Mortality in Adults Undergoing Percutaneous Coronary Intervention: A Systematic Review. Heart Lung Circ 2024; 33:951-961. [PMID: 38570260 DOI: 10.1016/j.hlc.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIM Risk adjustment following percutaneous coronary intervention (PCI) is vital for clinical quality registries, performance monitoring, and clinical decision-making. There remains significant variation in the accuracy and nature of risk adjustment models utilised in international PCI registries/databases. Therefore, the current systematic review aims to summarise preoperative variables associated with 30-day mortality among patients undergoing PCI, and the other methodologies used in risk adjustments. METHOD The MEDLINE, EMBASE, CINAHL, and Web of Science databases until October 2022 without any language restriction were systematically searched to identify preoperative independent variables related to 30-day mortality following PCI. Information was systematically summarised in a descriptive manner following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The quality and risk of bias of all included articles were assessed using the Prediction Model Risk Of Bias Assessment Tool. Two independent investigators took part in screening and quality assessment. RESULTS The search yielded 2,941 studies, of which 42 articles were included in the final assessment. Logistic regression, Cox-proportional hazard model, and machine learning were utilised by 27 (64.3%), 14 (33.3%), and one (2.4%) article, respectively. A total of 74 independent preoperative variables were identified that were significantly associated with 30-day mortality following PCI. Variables that repeatedly used in various models were, but not limited to, age (n=36, 85.7%), renal disease (n=29, 69.0%), diabetes mellitus (n=17, 40.5%), cardiogenic shock (n=14, 33.3%), gender (n=14, 33.3%), ejection fraction (n=13, 30.9%), acute coronary syndrome (n=12, 28.6%), and heart failure (n=10, 23.8%). Nine (9; 21.4%) studies used missing values imputation, and 15 (35.7%) articles reported the model's performance (discrimination) with values ranging from 0.501 (95% confidence interval [CI] 0.472-0.530) to 0.928 (95% CI 0.900-0.956), and four studies (9.5%) validated the model on external/out-of-sample data. CONCLUSIONS Risk adjustment models need further improvement in their quality through the inclusion of a parsimonious set of clinically relevant variables, appropriately handling missing values and model validation, and utilising machine learning methods.
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Affiliation(s)
- Mohammad Rocky Khan Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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Urban L, Dragula M, John L, Kňazeje M. Percutaneous Coronary Intervention (PCI)-Related Coronary Artery Perforation Permanently Sealed by a Severed Inflated Balloon After Shaft Fracture: A Case Report. Cureus 2024; 16:e60295. [PMID: 38872636 PMCID: PMC11170306 DOI: 10.7759/cureus.60295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Percutaneous coronary intervention (PCI) is an essential modality for the treatment of coronary artery disease. However, rare complications, such as coronary artery perforation and equipment failure, pose significant challenges. This case report describes a unique case of PCI-related coronary artery perforation and a cascade of subsequent complications managed successfully by an unconventional approach. We present a case of an 86-year-old patient who underwent coronary angiography for unstable angina and was treated with implantation of two drug-eluting stents into his right coronary artery (RCA). Implantation of the second stent caused an Ellis grade III perforation. The attempt to seal the perforation with two covered stents failed, the leak persisted, and a balloon had to be reinflated in proximal RCA. However, the patient descending into obstructive shock abruptly flexed his upper extremities breaking off the inflated balloon in proximal RCA, effectively sealing the perforation. Successful pericardiocentesis with drainage of 250 ml of blood stabilized the patient's condition and he regained consciousness. Despite moderate-intensity chest pain and extensive consultation with members of the heart team, the patient refused cardiac surgery opting for a conservative approach. The patient was discharged on post-PCI day 7, eventually resumed a physically active lifestyle, and returned for frequent follow-up visits. This case highlights the challenges in managing rare PCI complications like coronary artery perforation and balloon shaft fracture. It emphasizes the importance of rapid recognition, discusses individual techniques for the management of these complications, and focuses on the value of shared decision-making.
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Affiliation(s)
- Lukáš Urban
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
| | - Milan Dragula
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
| | - Luboš John
- Cardiology, University Hospital Martin, Martin, SVK
- Genetics, Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, SVK
| | - Miloš Kňazeje
- Cardiology, University Hospital Martin, Martin, SVK
- Cardiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, SVK
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3
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Wakabayashi K, Higuchi S, Miyachi H, Minatsuki S, Ito R, Kondo S, Miyauchi K, Yamasaki M, Tanaka H, Yamashita J, Kishi M, Abe K, Mase T, Yahagi K, Asano T, Saji M, Iwata H, Mitsuhashi Y, Nagao K, Yamamoto T, Shinke T, Takayama M. Clinical features and predictors of non-cardiac death in patients hospitalised for acute myocardial infarction: Insights from the Tokyo CCU network multicentre registry. Int J Cardiol 2023; 378:1-7. [PMID: 36791966 DOI: 10.1016/j.ijcard.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) commonly have multiple comorbidities, and some die in hospitals due to causes other than cardiac complications. However, limited information is available on noncardiac death in patients hospitalised for AMI. Therefore, the present study was performed to determine the incidence, annual trend, clinical characteristics, and predictors of in-hospital non-cardiac death in patients with AMI using the Tokyo Cardiovascular Care Unit (CCU) network registry. METHODS The registry included 38,589 consecutive patients with AMI who were admitted to the CCU between 2010 and 2019. The primary endpoint was in-hospital noncardiac death. Further, predictors of cardiac and non-cardiac death were identified. RESULTS The incidence of all-cause in-hospital mortality was 7.0% (n = 2700), and the proportion of mortality was 15.6% (n = 420) and 84.4% (n = 2280) for noncardiac and cardiac causes, respectively. The proportion of noncardiac deaths did not change annually over the last decade (p = 0.66). After adjusting for all variables, age, Killip classification grade, peak creatine kinase, hemoglobin, serum creatinine, and C-reactive protein were common predictors of cardiac and non-cardiac deaths. Indicators of malnutrition, such as lower body mass index (kg/m2) [odds 0.94, 95%CI (0.90-0.97), p < 0.001] and serum low-density lipoprotein cholesterol level (per 10 mg/dl) [odds 0.92, 95%CI (0.89-0.96), p < 0.001] were the specific predictors for non-cardiac deaths. CONCLUSIONS The incidence of in-hospital noncardiac death was significant in patients with AMI, accounting for 15.6% of all in-hospital mortalities. Thus, prevention and management of non-cardiac complications are vital to improve acute-phase outcomes, especially those with predictors of non-cardiac death.
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Affiliation(s)
- Kohei Wakabayashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
| | | | | | | | - Ryosuke Ito
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Seita Kondo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Jun Yamashita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mikio Kishi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Kaito Abe
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takaaki Mase
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Taku Asano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mike Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroshi Iwata
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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4
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Tung ML, Nathan AS, Hirshfeld JW. Short-Term Mortality After Percutaneous Coronary Intervention-It Ain't Over When It's Over. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100573. [PMID: 39129809 PMCID: PMC11308001 DOI: 10.1016/j.jscai.2022.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 08/13/2024]
Affiliation(s)
- Monica L. Tung
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John W. Hirshfeld
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Falcetta A, Bonfanti E, Rossini R, Lauria G. A case of shock after STEMI: Think beyond the cardiogenic one. Clin Case Rep 2023; 11:e6792. [PMID: 36644612 PMCID: PMC9834149 DOI: 10.1002/ccr3.6792] [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: 02/16/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Acute ST-segment elevation myocardial infarction (STEMI) can typically complicate with the development of cardiogenic shock; nevertheless, other less frequent types of shock may occur, including adrenal crisis (AC). We describe a case of STEMI complicated by AC and, for the first time, AC-induced focal takotsubo syndrome.
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Affiliation(s)
- Andrea Falcetta
- Emergency Medicine DepartmentSanta Croce e Carle HospitalCuneoItaly
| | - Eleonora Bonfanti
- Internal Medicine DepartmentCittà della Salute e della ScienzaTorinoItaly,University of TurinMedical Science DivisionTorinoItaly
| | - Roberta Rossini
- Cardiology and Intensive Coronary Care Unit DepartmentSanta Croce e Carle HospitalCuneoItaly
| | - Giuseppe Lauria
- Emergency Medicine DepartmentSanta Croce e Carle HospitalCuneoItaly
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6
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Verghese D, Harsha Patlolla S, Cheungpasitporn W, Doshi R, Miller VM, Jentzer JC, Jaffe AS, Holmes DR, Vallabhajosyula S. Sex Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction in the United States. Resuscitation 2022; 172:92-100. [DOI: 10.1016/j.resuscitation.2022.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 02/08/2023]
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7
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Tummala R, Shah SD, Rawal E, Sandhu RK, Kavuri SP, Kaur G, Khan AT, Mathialagan K, Ajibawo T. In-Hospital Mortality Risk Factor Analysis in Multivessel Percutaneous Coronary Intervention Inpatient Recipients in the United States. Cureus 2021; 13:e17520. [PMID: 34603890 PMCID: PMC8476197 DOI: 10.7759/cureus.17520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The primary goal of our study is to evaluate the mortality rate in inpatient recipients of multivessel percutaneous coronary intervention (MVPCI) and to evaluate the demographic risk factors and medical complications that increase the risk of in-hospital mortality. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2016) and included 127,145 inpatients who received MVPCI as a primary procedure in United States' hospitals. We used a multivariable logistic regression model adjusted for demographic confounders to measure the odds ratio (OR) of association of medical complications and in-hospital mortality risk in MVPCI recipients. Results The in-hospital mortality rate was 2% in MVPCI recipients and was seen majorly in older-age adults (>64 years, 74%) and males (61%). Even though the prevalence of mortality among females was comparatively low, yet in the regression model, they were at a higher risk for in-hospital mortality than males (OR 1.2; 95% CI 1.13-1.37). While comparing ethnicities, in-hospital mortality was prevalent in whites (79%) followed by blacks (9%) and Hispanics (7.5%). Patients who developed cardiogenic shock were at higher odds of in-hospital mortality (OR 9.2; 95% CI 8.27-10.24) followed by respiratory failure (OR 5.9; 95% CI 5.39-6.64) and ventricular fibrillation (OR 3.5; 95% CI 3.18-3.92). Conclusion Accelerated use of MVPCI made it important to study in-hospital mortality risk factors allowing us to devise strategies to improve the utilization and improve the quality of life of these at-risk patients. Despite its effectiveness and comparatively lower mortality profile, aggressive usage of MVPCI is restricted due to the periprocedural complications and morbidity profile of the patients.
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Affiliation(s)
- Ravi Tummala
- Internal Medicine, Narayana Medical College, Nellore, IND
| | - Suchi D Shah
- Internal Medicine, Ahmedabad Municipal Corporation's Medical Education Trust Medical College, Ahmedabad, IND
| | - Era Rawal
- Cardiology, Norvic International Hospital, Kathmandu, NPL
| | - Ramneek K Sandhu
- Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Swathi P Kavuri
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Gagan Kaur
- Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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8
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Wang L, Su W, Xue J, Gong X, Dai Y, Chen J, Xue L, He P, Liu Y, Tan N. Association of thrombocytopenia and infection in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21:404. [PMID: 34418967 PMCID: PMC8379583 DOI: 10.1186/s12872-021-02210-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood. Aims To evaluate the association between thrombocytopenia and infection in patients with STEMI. Methods Patients diagnosed with STEMI were identified from January 2010 to June 2016. The primary endpoint was in-hospital infection, and major adverse clinical events (MACE) and all-cause death were considered as secondary endpoints. Results A total of 1401 STEMI patients were enrolled and divided into two groups according to the presence (n = 186) or absence (n = 1215) of thrombocytopenia. The prevalence of in-hospital infection was significantly higher in the thrombocytopenic group (30.6% (57/186) vs. 16.2% (197/1215), p < 0.001). Prevalence of in-hospital MACE (30.1% (56/186) vs. 16.4% (199/1215), p < 0.001) and all-cause death (8.1% (15/186) vs. 3.8% (46/1215), p = 0.008) revealed an increasing trend. Multivariate analysis indicated that thrombocytopenia was independently associated with increased in-hospital infection (OR, 2.09; 95%CI 1.32–3.27; p = 0.001) and MACE (1.92; 1.27–2.87; p = 0.002), but not all-cause death (1.87; 0.88–3.78; p = 0.091). After a median follow-up of 2.85 years, thrombocytopenia was not associated with all-cause death at multivariable analysis (adjusted hazard ratio, 1.19; 95%CI 0.80–1.77; p = 0.383). Conclusions Thrombocytopenia is significantly correlated with in-hospital infection and MACE, and might be used as a prognostic tool in patients with STEMI. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02210-3.
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Affiliation(s)
- Litao Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China
| | - Weijiang Su
- Department of Cardiology, The People's Hospital of Dianbai District, Maoming, 525400, China
| | - Jinhua Xue
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, 341000, China
| | - Xiao Gong
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yining Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Ling Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China.
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, China. .,Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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9
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Gaudino M, Hameed I, Farkouh ME, Rahouma M, Naik A, Robinson NB, Ruan Y, Demetres M, Biondi-Zoccai G, Angiolillo DJ, Bagiella E, Charlson ME, Benedetto U, Ruel M, Taggart DP, Girardi LN, Bhatt DL, Fremes SE. Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery: A Meta-analysis. JAMA Intern Med 2020; 180:1638-1646. [PMID: 33044497 PMCID: PMC7551235 DOI: 10.1001/jamainternmed.2020.4748] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Mortality is a common outcome in trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG). Controversy exists regarding whether all-cause mortality or cardiac mortality is preferred as a study end point, because noncardiac mortality should be unrelated to the treatment. OBJECTIVE To evaluate the difference in all-cause and cause-specific mortality in randomized clinical trials (RCTs) comparing PCI with CABG for the treatment of patients with coronary artery disease. DATA SOURCES MEDLINE (1946 to the present), Embase (1974 to the present), and the Cochrane Library (1992 to the present) databases were searched on November 24, 2019. Reference lists of included articles were also searched, and additional studies were included if appropriate. STUDY SELECTION Articles were considered for inclusion if they were in English, were RCTs comparing PCI with drug-eluting or bare-metal stents and CABG for the treatment of coronary artery disease, and reported mortality and/or cause-specific mortality. Trials of PCI involving angioplasty without stenting were excluded. For each included trial, the publication with the longest follow-up duration for each outcome was selected. DATA EXTRACTION AND SYNTHESIS For data extraction, all studies were reviewed by 2 independent investigators, and disagreements were resolved by a third investigator in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Data were pooled using fixed- and random-effects models. MAIN OUTCOMES AND MEASURES The primary outcomes were all-cause and cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were performed for PCI trials using drug-eluting vs bare-metal stents and for trials involving patients with left main disease. RESULTS Twenty-three unique trials were included involving 13 620 unique patients (6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study populations; mean age range, 60.0-71.0 years). The weighted mean (SD) follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29) and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41). CONCLUSIONS AND RELEVANCE Percutaneous coronary intervention was associated with higher all-cause, cardiac, and noncardiac mortality compared with CABG at 5 years. The significantly higher noncardiac mortality associated with PCI suggests that even noncardiac deaths after PCI may be procedure related and supports the use of all-cause mortality as the end point for myocardial revascularization trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.,Section of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Yongle Ruan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Michelle Demetres
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary E Charlson
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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10
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Mikaeilvand A, Firuozi A, Basiri H, Varghaei A, Izadpanah P, Kojuri J, Abdi-Ardekani A, Attar A. Association of coronary artery dominance and mortality rate and complications in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:107. [PMID: 33824672 PMCID: PMC8019104 DOI: 10.4103/jrms.jrms_414_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/29/2020] [Accepted: 07/13/2020] [Indexed: 11/04/2022]
Abstract
Background Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI. Materials and Methods In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups. Results Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different (P > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 (P = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, P = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate (P > 0.05). Conclusion Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.
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Affiliation(s)
- Amir Mikaeilvand
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Ata Firuozi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hosseinali Basiri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Peyman Izadpanah
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Abdi-Ardekani
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Menon V. Targeting Mean Arterial Pressure to Limit Myocardial Injury: Novel Finding or Wild Goose Chase? J Am Coll Cardiol 2020; 76:825-827. [PMID: 32792080 DOI: 10.1016/j.jacc.2020.06.054] [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] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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12
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In-Hospital Mortality in Patients Receiving Percutaneous Coronary Intervention According to Nurse Staffing Level: An Analysis of National Administrative Health Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113799. [PMID: 32471103 PMCID: PMC7313060 DOI: 10.3390/ijerph17113799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
Abstract
The increasing incidence of ischemic heart disease is concomitantly increasing percutaneous coronary intervention (PCI) treatments. Adequate nurse staffing has enhanced quality of care and this study was conducted to determine the relationship between survival-related PCI treatment and the level of nursing staff who care for patients admitted to receive PCI. National Health Insurance claims data from 2014 to 2015 for 67,927 patients who underwent PCI in 43 tertiary hospitals were analyzed. The relationships of nurse staffing in intensive care units (ICUs) and general wards with survival after PCI were investigated using logistic regression analyses with a generalized estimation model. The in-hospital mortality rate in ICUs was lower in hospitals with first-grade nurse staffing {odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.23–0.48}, second-grade nurse staffing (OR = 0.55, 95% CI = 0.40–0.77), or third-grade nurse staffing (OR = 0.71, 95% CI = 0.53–0.95) than in hospitals with fifth-grade nurse staffing. Nurse staffing in general wards was not related to in-hospital mortality due to PCI treatment. This study found that nurse staffing in PCI patients requiring short-term intensive care significantly affected patient survival. An understanding of the importance of managing the ICU nursing workforce for PCI treatment is required.
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13
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Mancone M, Cavalcante R, Modolo R, Falcone M, Biondi-Zoccai G, Frati G, Spitzer E, Benedetto U, Blackstone EH, Onuma Y, van Geuns RJM, Diletti R, Serruys PW. Major infections after bypass surgery and stenting for multivessel coronary disease in the randomised SYNTAX trial. EUROINTERVENTION 2020; 15:1520-1526. [PMID: 31289019 DOI: 10.4244/eij-d-19-00208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
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14
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McCracken C, Spector LG, Menk JS, Knight JH, Vinocur JM, Thomas AS, Oster ME, St Louis JD, Moller JH, Kochilas L. Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index. J Am Heart Assoc 2019; 7:e010624. [PMID: 30571499 PMCID: PMC6404427 DOI: 10.1161/jaha.118.010624] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery. Methods and Results This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58); P=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9). Conclusions Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.
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Affiliation(s)
| | - Logan G Spector
- 3 Department of Pediatrics University of Minnesota Minneapolis MN
| | - Jeremiah S Menk
- 5 Biostatistical Design and Analysis Center University of Minnesota Minneapolis MN
| | - Jessica H Knight
- 6 Department of Epidemiology and Biostatistics University of Georgia School of Public Health Athens GA
| | - Jeffrey M Vinocur
- 7 Department of Pediatrics School of Medicine and Dentistry University of Rochester NY
| | - Amanda S Thomas
- 1 Department of Pediatrics Emory University School of Medicine Atlanta GA
| | | | - James D St Louis
- 8 Department of Pediatric Surgery University of Missouri-Kansas City School of Medicine Kansas City MO
| | - James H Moller
- 4 Department of Internal Medicine University of Minnesota Minneapolis MN
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15
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Jones DA, Rathod KS, Koganti S, Lim P, Firoozi S, Bogle R, Jain AK, MacCarthy PA, Dalby MC, Malik IS, Mathur A, DeSilva R, Rakhit R, Kalra SS, Redwood S, Ludman P, Wragg A. The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) Registry using an interrupted time series analysis. Eur Heart J 2019; 40:2620-2629. [PMID: 31220238 DOI: 10.1093/eurheartj/ehz152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/17/2019] [Accepted: 03/03/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS The public reporting of healthcare outcomes has a number of potential benefits; however, unintended consequences may limit its effectiveness as a quality improvement process. We aimed to assess whether the introduction of individual operator specific outcome reporting after percutaneous coronary intervention (PCI) in the UK was associated with a change in patient risk factor profiles, procedural management, or 30-day mortality outcomes in a large cohort of consecutive patients. METHODS AND RESULTS This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry, from January 2005 to December 2015. Outcomes were compared pre- (2005-11) and post- (2011-15) public reporting including the use of an interrupted time series analysis. Patients treated after public reporting was introduced were older and had more complex medical problems. Despite this, reported in-hospital major adverse cardiovascular and cerebrovascular events rates were significantly lower after the introduction of public reporting (2.3 vs. 2.7%, P < 0.0001). Interrupted time series analysis demonstrated evidence of a reduction in 30-day mortality rates after the introduction of public reporting, which was over and above the existing trend in mortality before the introduction of public outcome reporting (35% decrease relative risk 0.64, 95% confidence interval 0.55-0.77; P < 0.0001). CONCLUSION The introduction of public reporting has been associated with an improvement in outcomes after PCI in this data set, without evidence of risk-averse behaviour. However, the lower reported complication rates might suggest a change in operator behaviour and decision-making confirming the need for continued surveillance of the impact of public reporting on outcomes and operator behaviour.
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Affiliation(s)
- Daniel A Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sudheer Koganti
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Pitt Lim
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Sam Firoozi
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Richard Bogle
- Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, Blackshaw Road, Tooting, London, UK
| | - Ajay K Jain
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Philip A MacCarthy
- Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, 10 Cutcombe Road, London, UK
| | - Miles C Dalby
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, UK
| | - Iqbal S Malik
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Ranil DeSilva
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, UK
| | - Sundeep Singh Kalra
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, UK
| | - Simon Redwood
- Department of Cardiology, St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London, UK
| | - Peter Ludman
- Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Andrew Wragg
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
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16
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Tripathi B, Khan S, Arora S, Kumar V, Naraparaju V, Lahewala S, Sharma P, Atti V, Jain V, Shah M, Patel B, Ram P, Deshmukh A. Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization. J Arrhythm 2019; 35:612-625. [PMID: 31410232 PMCID: PMC6686349 DOI: 10.1002/joa3.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/25/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) accounts for significant morbidity and mortality worldwide. Arrhythmias are considered the main cause of mortality, however, there is paucity of data relating to trends of arrhythmia and associated outcomes in HCM patients. METHODS Nationwide Inpatient Sample from 2003 to 2014 was analyzed. HCM related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) code 425.1 and 425.11 in all diagnosis fields. RESULTS Overall, there was an increase in number of hospitalizations related to arrhythmias among HCM patients from 7784 in 2003 to 8380 in 2014 (relative increase 10.5%, P < 0.001). The increase was most significant in patients ≥ 80 years and those with higher comorbidity burden. Atrial fibrillation (AF) was the most frequently occurring arrhythmia however atrial flutter (AFL) witnessed the highest rise during the study period. In general, there was a down trend in mortality with the greatest reduction occurring in patients with ventricular fibrillation/flutter (VF/VFL). The mean length of stay was higher if patients had arrhythmia, which led to increased cost of care from $16105 in 2003 to $19310 in 2014 (relative increase 22.9%, P < 0.001). CONCLUSION There is overall decline in HCM related hospitalizations but rise in hospitalization among HCM patients with arrhythmias. HCM with arrhythmia accounts for significant inpatient mortality coupled with prolonged hospital stay and increased cost of care. However, there is an encouraging downtrend in the mortality most likely because of improved clinical practice, cardiac screening and primary and secondary prevention strategies.
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Affiliation(s)
| | - Safi Khan
- Guthrie Robert Packer HospitalSayrePennsylvania
| | | | - Varun Kumar
- Guthrie Robert Packer HospitalSayrePennsylvania
| | | | | | | | | | - Varun Jain
- St. Francis Medical CenterHartfordConnecticut
| | - Mahek Shah
- Lehigh Valley HospitalAllentownPennsylvania
| | | | - Pradhum Ram
- Einstein Medical CenterPhiladelphiaPennsylvania
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17
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Raphael CE, Singh M, Bell M, Crusan D, Lennon RJ, Lerman A, Prasad A, Rihal CS, Gersh BJ, Gulati R. Sex Differences in Long-Term Cause-Specific Mortality After Percutaneous Coronary Intervention: Temporal Trends and Mechanisms. Circ Cardiovasc Interv 2019. [PMID: 29540493 DOI: 10.1161/circinterventions.117.006062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. METHODS AND RESULTS We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991-1997, 1998-2005, and 2006-2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%). CONCLUSIONS The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design.
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Affiliation(s)
- Claire E Raphael
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Daniel Crusan
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Amir Lerman
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Abhiram Prasad
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Charanjit S Rihal
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- From the Department of Cardiovascular Diseases (C.E.R., M.S., M.B., A.L., A.P., C.S.R., B.J.G., R.G.) and Division of Biomedical Statistics and Informatics (D.C., R.J.L.), Mayo Clinic, Rochester, MN.
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18
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Tran DT, Barake W, Galbraith D, Norris C, Knudtson ML, Kaul P, McAlister FA, Sandhu RK. Total and Cause-Specific Mortality After Percutaneous Coronary Intervention: Observations From the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease Registry. CJC Open 2019; 1:182-189. [PMID: 32159105 PMCID: PMC7063620 DOI: 10.1016/j.cjco.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022] Open
Abstract
Background Patients undergoing percutaneous coronary intervention (PCI) are increasingly older and have a higher comorbidity burden. This study evaluated trends in 30-day, 1-year, and 2-year total and cause-specific mortality using a large, contemporary cohort of patients who underwent PCI in Alberta, Canada. Methods We used the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry to identify patients aged ≥ 20 years who underwent PCI between 2005 and 2013. All patients were followed until death or being censored by August 2016. Cause of death was from the Vital Statistics database and classified as cardiac or noncardiac. Multivariable logistic regression was used to calculate predicted mortality at 30 days, 1 year, and 2 years post-PCI. Results Of the 35,602 patients who underwent PCI, 5284 (14.8%) had died. Mean (standard deviation) follow-up was 74.9 (35.1) months. Over the study period, patients were older and more likely to undergo PCI for an acute coronary syndrome indication. Thirty-day (2005: 1.3%; 2013: 3.2%; P < 0.001), 1-year (2005: 2.7%; 2013: 5.7%; P < 0.001), and 2-year (2005: 4.5%; 2013: 7.5%; P < 0.001) predicted mortality after PCI increased over the study period. Cardiac cause of death dominated in the short-term, but the proportion of noncardiac deaths increased as time from PCI to death increased (30 days = 11.5%, 1 year = 31.5%, 2 years = 39.6%; P < 0.001). Conclusions In this population-based study, we found all-cause mortality at 30 days, 1 year, and 2 years after PCI increased over time. Cardiac causes of death dominate in the short-term after PCI; however, noncardiac cause becomes a major driver of mortality in the long-term.
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Affiliation(s)
- Dat T Tran
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Walid Barake
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Galbraith
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Colleen Norris
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Merril L Knudtson
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K Sandhu
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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19
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Burton BN, Abudu B, Danforth DJ, Patell S, Wilkins Y Martinez L, Fergerson B, Elsharydah A, Gabriel RA. Prediction Model for Extended Hospital Stay Among Medicare Beneficiaries After Percutaneous Coronary Intervention. J Cardiothorac Vasc Anesth 2019; 33:3035-3041. [PMID: 31122844 DOI: 10.1053/j.jvca.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The authors conducted a retrospective analysis to develop a predictive model consisting of factors associated with extended hospital stay among Medicare beneficiaries undergoing percutaneous coronary intervention (PCI). DESIGN Retrospective cohort study. SETTING Multi-institutional. PARTICIPANTS Data were obtained from the National (Nationwide) Inpatient Sample registry from 2013 to 2014 over a 2-year period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was extended hospital stay, which was defined as an inpatient stay greater than 75th percentile for the cohort (≥5 d), among Medicare beneficiaries (fee-for-service and managed care) undergoing PCI. A multivariable logistic regression analysis was built on a training set to develop the predictive model. The authors evaluated model performance with area under the receiver operating characteristic curve (AUC) and performed k-folds cross-validation to calculate the average AUC. The final analysis included 91,880 patients. Inpatient hospital length of stay ranged from 0 to 247 days, with 3 and 5 days as the median and 3rd quartile hospital stay, respectively. The final multivariable analysis suggested that sociodemographic variables, hospital-related factors, and comorbidities were associated with a greater odds of extended hospital stay (all p < 0.05). The use of PCI with drug-eluting stent was associated with a 31% decrease in extended hospital stay (odds ratio 0.69, 95% confidence interval 0.66-0.72; p < 0.001). Model discrimination was deemed excellent with an AUC (95% confidence interval) of 0.814 (0.811-0.817) and 0.809 (0.799-0.819) for the training and testing sets, respectively. CONCLUSION The authors' predictive model identified risk factors that have a higher probability of extended hospital stay. This model can be used to improve periprocedural optimization and improved discharge planning, which may help to decrease costs associated with PCIs. Management of Medicare beneficiaries after PCI calls for a multidisciplinary approach among healthcare teams and hospital administrators.
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Affiliation(s)
- Brittany N Burton
- School of Medicine, University of California San Diego, San Diego, CA
| | - Boya Abudu
- School of Medicine, University of California San Diego, San Diego, CA
| | - Dennis J Danforth
- Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Saatchi Patell
- School of Medicine, University of California San Diego, San Diego, CA
| | | | - Byron Fergerson
- Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, San Diego, CA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego, CA.
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20
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Bricker RS, Valle JA, Plomondon ME, Armstrong EJ, Waldo SW. Causes of Mortality After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2019; 12:e005355. [DOI: 10.1161/circoutcomes.118.005355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rory S. Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Javier A. Valle
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Mary E. Plomondon
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Ehrin J. Armstrong
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Stephen W. Waldo
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
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21
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Tsujimoto T, Kajio H. Thrombotic/Thrombolytic Balance as a Cardiac Treatment Determinant in Patients With Diabetes Mellitus and Coronary Artery Disease. J Am Heart Assoc 2019; 8:e011207. [PMID: 30646801 PMCID: PMC6497335 DOI: 10.1161/jaha.118.011207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study aimed to assess whether the plasminogen activator inhibitor‐1/tissue plasminogen activator (PAI‐1/tPA) ratio as a prothrombotic state is useful for optimizing cardiac treatment strategy. Methods and Results Using BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial data, we used a Cox proportional hazard model to calculate hazard ratios with 95% CIs for cardiac events in patients receiving early revascularization (percutaneous coronary intervention or coronary artery bypass grafting) or medical therapy, separately in patients with low (n=1276) and high (n=894) PAI‐1/tPA ratios. The primary outcome was major cardiac events, which was a composite end point including cardiac death and nonfatal myocardial infarction. The mean±SD follow‐up period was 4.1±1.7 years. The risk of major cardiac events in patients with high PAI‐1/tPA ratio was significantly higher when receiving percutaneous coronary intervention (hazard ratio, 1.84; 95% CI, 1.16–2.93; P=0.01) than when receiving medical therapy, whereas that in patients with low PAI‐1/tPA ratio did not differ significantly between the groups (hazard ratio, 0.95; 95% CI, 0.66–1.36; P=0.77); the interaction between the cardiac treatment strategy and PAI‐1/tPA ratio was significant (P=0.02). However, regardless of the PAI‐1/tPA ratio, major cardiac event risk seemed to be lower in patients receiving coronary artery bypass grafting than in those receiving medical therapy. Conclusions In patients with type 2 diabetes mellitus and coronary artery disease, this study demonstrated that those with high PAI‐1/tPA ratio were at higher risks of major cardiac events when treated with percutaneous coronary intervention than when treated with intensive medical therapy.
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Affiliation(s)
- Tetsuro Tsujimoto
- 1 Department of Diabetes, Endocrinology, and Metabolism Center Hospital National Center for Global Health and Medicine Tokyo Japan
| | - Hiroshi Kajio
- 1 Department of Diabetes, Endocrinology, and Metabolism Center Hospital National Center for Global Health and Medicine Tokyo Japan
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Harhash A, Rao P, Kern KB. The Role of Cardiac Catheterization after Cardiac Arrest. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Capodanno D, Buccheri S, Romano S, Capranzano P, Francaviglia B, Tamburino C. Decision Analytic Markov Model Weighting Expected Benefits and Current Limitations of First-Generation Bioresorbable Vascular Scaffolds: Implications for Manufacturers and Next Device Iterations. Circ Cardiovasc Interv 2018; 11:e005768. [PMID: 29326152 DOI: 10.1161/circinterventions.117.005768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relative benefits of bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents (EES) are expected to accrue after complete bioresorption. METHODS AND RESULTS We built a decision analytic Markov model comparing BVS and EES for a contemporary percutaneous coronary intervention population. Procedure-related morbidity and outcome data from the available literature were used to derive model probabilities. The net benefit of BVS and EES was estimated in terms of quality-adjusted life expectancy. Under the assumption of no risk for device thrombosis and target lesion revascularization with BVS beyond 3 years, the equipoise in quality-adjusted life expectancy (12.86) between BVS and EES was achieved 19 years after implantation. The maximum tolerable excess risk of 3-year BVS thrombosis equalizing the model-predicted quality-adjusted life expectancy of BVS and EES at 10 years was 1.40, corresponding to an absolute tolerable rate of 1.45%. CONCLUSIONS At the currently observed relative increase in device thrombosis and under the extreme hypothesis of no scaffold thrombosis and target lesion revascularization beyond 3 years, the incremental benefit of BVS over EES becomes apparent only after 19 years. This simulation suggests that there is a small degree of benefit that clinicians and decision-makers may expect from the first-generation BVS at the current risk of device thrombosis. Manufacturers should target scaffold thrombosis rates <1.45% at 3 years to make their technologies attractive during a 10-year horizon.
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Affiliation(s)
- Davide Capodanno
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.).
| | - Sergio Buccheri
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.)
| | - Sara Romano
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.)
| | - Piera Capranzano
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.)
| | - Bruno Francaviglia
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.)
| | - Corrado Tamburino
- From the Cardiac-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Presidio Ferrarotto, Catania, Italy (D.C., S.B., S.R., P.C., B.F., C.T.); and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy (D.C., P.C., C.T.)
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Wakabayashi K, Ikeda N, Kajimoto K, Minami Y, Keida T, Asai K, Munakata R, Murai K, Sakata Y, Suzuki H, Takano T, Sato N. Trends and predictors of non-cardiovascular death in patients hospitalized for acute heart failure. Int J Cardiol 2018; 250:164-170. [DOI: 10.1016/j.ijcard.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/17/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
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25
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Lam DH, Glassmoyer LM, Strom JB, Davis RB, McCabe JM, Cutlip DE, Donnino MW, Cocchi MN, Pinto DS. Factors associated with performing urgent coronary angiography in out-of-hospital cardiac arrest patients. Catheter Cardiovasc Interv 2017; 91:832-839. [PMID: 28766924 DOI: 10.1002/ccd.27199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Factors associated with performing urgent coronary angiography (UCA) in patients with out-of-hospital cardiac arrest (OHCA) were identified. BACKGROUND Current guidelines for resuscitated OHCA patients recommend UCA if there is ST-elevation on post-arrest electrocardiogram or high suspicion of acute myocardial infarction. Some have advocated for UCA in all OHCA regardless of suspected etiology. The reasons for variations in performing UCA are not well understood. METHODS A retrospective analysis of subjects presenting with resuscitated OHCA to a single academic medical center from 12/15/2007 to 8/31/2014 was conducted. Demographic and clinical characteristics of patients undergoing UCA, defined as angiography within 6 hr of presentation, were compared with those not undergoing UCA. Logistic regression was used to determine predictors of UCA. RESULTS A total of 323 resuscitated OHCA patients (mean age, 64 years; women, 35%) were included in the analysis; 107 (33.1%) underwent coronary angiography during their hospitalization and 66 (20.4%) underwent UCA. Multivariable adjusted factors associated with UCA were ST-elevation [odds ratio (OR) 14.66, 95% confidence interval (CI) 6.28-34.24, P < 0.001], initial shockable rhythm (OR 3.69, 95% CI 1.52-8.97, P = 0.004), and history of coronary artery disease (CAD) (OR 3.37, 95% CI 1.43-7.95, P = 0.005). Higher age (OR 0.71 per decade, 95% CI 0.55-0.92, P = 0.01) and obvious non-cardiac cause of arrest (OR 0.08, 95% CI 0.02-0.38, P = 0.001) were negatively associated with UCA. CONCLUSIONS In resuscitated out-of-hospital cardiac arrest patients, ST-elevation, shockable rhythm, and history of CAD were associated with performing urgent coronary angiography; older patients and those with obvious non-cardiac causes of arrest were negatively associated.
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Affiliation(s)
- David H Lam
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Lauren M Glassmoyer
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California
| | - Jordan B Strom
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James M McCabe
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Donald E Cutlip
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of Pulmonary Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael N Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Divison of Critical Care, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Duane S Pinto
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
Public reporting provides transparency and improved quality of care. However, methods in estimating risk adjusted mortality in ST-segment myocardial infarction, particularly in cardiogenic shock and cardiac arrest are contentious. There are concerns that this has resulted in risk-averse behavior in publicly reporting states, resulting in suboptimal care in these patients.
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Doll JA, Dai D, Roe MT, Messenger JC, Sherwood MW, Prasad A, Mahmud E, Rumsfeld JS, Wang TY, Peterson ED, Rao SV. Assessment of Operator Variability in Risk-Standardized Mortality Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2017; 10:672-682. [DOI: 10.1016/j.jcin.2016.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022]
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Klein LW, Harjai KJ, Resnic F, Weintraub WS, Vernon Anderson H, Yeh RW, Feldman DN, Gigliotti OS, Rosenfeld K, Duffy P. 2016 Revision of the SCAI position statement on public reporting. Catheter Cardiovasc Interv 2016; 89:269-279. [PMID: 27755653 DOI: 10.1002/ccd.26818] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/08/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Fred Resnic
- Lahey Hospital and Medical Center, Burlington, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | | | - H Vernon Anderson
- University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas
| | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dmitriy N Feldman
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | - Kenneth Rosenfeld
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lee PT, Chao TH, Huang YL, Lin SH, Wang WM, Lee WH, Huang CW, Lee CH, Chen JY, Lin CC, Liu PY, Chan SH, Liu YW, Tsai WC, Lin LJ, Tsai LM, Li YH. Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014. Int Heart J 2016; 57:541-6. [PMID: 27581671 DOI: 10.1536/ihj.15-454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.
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Affiliation(s)
- Po-Tseng Lee
- Department of Internal Medicine, Institute of Clinical Medicine and Biostatistics Consulting Center, National Cheng Kung University Hospital and College of Medicine
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30
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Abstract
Since the 1980s, the evolution of public reporting of provider-specific and institution-specific clinical outcomes has historically been rooted in the field of cardiology. Although public reporting is not a novel concept, how we collect, analyze, report, and interpret outcome data remains a critical element in quality improvement and in the quest toward providing truly high-value care. In this review, we explore the emergence of public reporting within the scope of cardiovascular medicine, specifically as it relates to surgical and percutaneous coronary revascularization. We highlight both the advantages and the disadvantages of public reporting from the perspective of the patient, the practicing physician, the hospital, and the healthcare system. A discussion on the limitations of public reporting and specific strategies by which it can be improved is presented.
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31
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Maximus S, Milliken JC, Danielsen B, Khan J, Shemin R, Carey JS. Defining operative mortality: Impact on outcome reporting. J Thorac Cardiovasc Surg 2016; 151:1101-7. [DOI: 10.1016/j.jtcvs.2015.10.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/15/2015] [Accepted: 10/01/2015] [Indexed: 11/26/2022]
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32
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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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Edward KL, Stephenson J, Giandinoto JA, Wilson A, Whitbourn R, Gutman J, Newcomb A. An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention. BMC Cardiovasc Disord 2016; 16:31. [PMID: 26841927 PMCID: PMC4739379 DOI: 10.1186/s12872-016-0203-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted.
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Affiliation(s)
- Karen-Leigh Edward
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia. .,University of Huddersfield, Huddersfield, United Kingdom.
| | - John Stephenson
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia. .,University of Huddersfield, Huddersfield, United Kingdom.
| | - Jo-Ann Giandinoto
- Australian Catholic University and St Vincent's Private Hospital Melbourne Ltd, Locked Bag 4115 MDC, Fitzroy, 3065, Australia.
| | - Andrew Wilson
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Robert Whitbourn
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Jack Gutman
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Andrew Newcomb
- University of Melbourne and St Vincent's Hospital Melbourne, Melbourne, Australia.
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Lee JS, Kim HL, Seo JB, Lim WH, Kang EG, Chung WY, Kim SH, Jo ZH, Kim MA. Re-mobilization of Lost Coronary Stent From the Axillary Artery to the Femoral Artery. J Lipid Atheroscler 2016. [DOI: 10.12997/jla.2016.5.1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jeong Seok Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Gyu Kang
- Department of Internal Medicine, Hongik Hospital, Seoul, Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Zoo-Hee Jo
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-A Kim
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Background—
Current risk models for predicting long-term mortality after percutaneous coronary intervention are restricted to all-cause mortality. We sought to develop novel risk models for the prediction of cardiac and noncardiac mortality after percutaneous coronary intervention.
Methods and Results—
We retrospectively evaluated patients who underwent index percutaneous coronary intervention at Mayo Clinic from 2003 to 2008. Long-term deaths were ascertained through scheduled prospective surveillance. Cause of death was determined via telephone interviews, medical records, and autopsy reports. Fine and Gray extension of Cox proportional hazards models was used to model cause-specific cumulative incidence. Candidate variables and interactions were chosen a priori, without variable selection methods. Resulting models were mapped to an integer-based risk score. The study comprised 6636 patients followed up over a median of 62 months (25th, 75th percentiles: 45, 77 months). There were 1488 deaths, 518 (35%) cardiac, 938 (63%) noncardiac, and 32 (2%) unknown. The 5-year predicted cardiac mortality ranged from 0.6% to 97%, with a corrected
c
-statistic of 0.82. Risk factors for cardiac death included age, body mass index, ejection fraction, and history of congestive heart failure. The integer score for noncardiac death included age, medicine index, body mass index, current smoker, noncardiac Charlson index and cardiac Charlson index, and accommodated significant age-based interactions for smoking and the 2 Charlson indices. Predicted noncardiac mortality at 5 years ranged from 0.2% to 81%, with a corrected
c
-statistic of 0.77.
Conclusions—
We report novel risk models to predict cardiac and noncardiac long-term mortality after percutaneous coronary intervention.
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Arora S, Panaich SS, Patel NJ, Patel N, Solanki S, Deshmukh A, Singh V, Lahewala S, Savani C, Thakkar B, Dave A, Patel A, Bhatt P, Sonani R, Patel A, Cleman M, Forrest JK, Schreiber T, Badheka AO, Grines C. Multivessel Percutaneous Coronary Interventions in the United States. Angiology 2015; 67:326-35. [DOI: 10.1177/0003319715593853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Multivessel coronary artery disease carries significant mortality risk. Comprehensive data on inhospital outcomes following multivessel percutaneous coronary intervention (MVPCI) are sparse. Methods: We queried the Healthcare Cost and Utilization Project’s nationwide inpatient sample (NIS) between 2006 and 2011 using different International Classification of Diseases, 9th Revision, Clinical Modification procedure codes. The primary outcome was inhospital all-cause mortality, and the secondary outcome was a composite of inhospital mortality and periprocedural complications. Results: The overall mortality was low at 0.73% following MVPCI. Multivariate analysis revealed that (odds ratio, 95% confidence interval, P value) age (1.63, 1.48-1.79; <.001), female sex (1.19, 1.00-1.42; P = .05), acute myocardial infarction (AMI; 2.97, 2.35-3.74; <.001), shock (17.24, 13.61-21.85; <.001), a higher burden of comorbidities (2.09, 1.32-3.29; .002), and emergent/urgent procedure status (1.67, 1.30-2.16; <.001) are important predictors of primary and secondary outcomes. MVPCI was associated with higher mortality, length of stay (LOS), and cost of care as compared to single vessel single stent PCI. Conclusion: MVPCI is associated with higher inhospital mortality, LOS, and hospitalization costs compared to single vessel, single stent PCI. Higher volume hospitals had lower overall postprocedural mortality rate along with shorter LOS and lower hospitalization costs following MVPCI.
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Affiliation(s)
- Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St Luke’s Roosevelt Hospital, New York, NY, USA
| | | | - Nileshkumar J. Patel
- Internal Medicine Department, Staten Island University Hospital, Staten Island, NY, USA
| | - Nilay Patel
- Internal Medicine Department, Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - Shantanu Solanki
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vikas Singh
- Cardiology Department, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sopan Lahewala
- Internal Medicine Department, Mount Sinai Hospital Center, New York, NY, USA
| | - Chirag Savani
- Internal Medicine Department, New York Medical College, Valhalla, NY, USA
| | - Badal Thakkar
- Internal Medicine Department, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Abhishek Dave
- Internal Medicine Department, Texas A&M University, College Station, TX, USA
| | - Achint Patel
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Bhatt
- Internal Medicine Department, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Rajesh Sonani
- Internal Medicine Department, Emory University School of Medicine, Atlanta, GA, USA
| | - Aashay Patel
- Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Michael Cleman
- Cardiology Department, Yale School of Medicine, New Haven, CT, USA
| | - John K. Forrest
- Cardiology Department, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Cindy Grines
- Cardiovascular Department, Detroit Medical Center, Detroit, MI, USA
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Wakabayashi K, Sato N, Kajimoto K, Minami Y, Mizuno M, Keida T, Asai K, Munakata R, Murai K, Sakata Y, Suzuki H, Takano T. Incidence and predictors of in-hospital non-cardiac death in patients with acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:441-449. [PMID: 26139590 DOI: 10.1177/2048872615593388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with acute heart failure (AHF) commonly have multiple co-morbidities, and some of these patients die in the hospital from causes other than aggravated heart failure. However, limited information is available on the mode of death in patients with AHF. Therefore, the present study was performed to determine the incidence and predictors of in-hospital non-cardiac death in patients with AHF, using the Acute Decompensated Heart Failure Syndromes (ATTEND) registry Methods: The ATTEND registry included 4842 consecutive patients with AHF admitted between April 2007-September 2011. The primary endpoint of the present study was in-hospital non-cardiac death. A stepwise regression model was used to identify the predictors of in-hospital non-cardiac death. RESULTS The incidence of all-cause in-hospital mortality was 6.4% ( n=312), and the incidence was 1.9% ( n=93) and 4.5% ( n=219) for non-cardiac and cardiac causes, respectively. Old age was associated with in-hospital non-cardiac death, with a 42% increase in the risk per decade (odds 1.42, p=0.004). Additionally, co-morbidities including chronic obstructive pulmonary disease (odds 1.98, p=0.034) and anaemia (odds 1.17 (per 1.0 g/dl decrease), p=0.006) were strongly associated with in-hospital non-cardiac death. Moreover, other predictors included low serum sodium levels (odds 1.05 (per 1.0 mEq/l decrease), p=0.045), high C-reactive protein levels (odds 1.07, p<0.001) and no statin use (odds 0.40, p=0.024). CONCLUSIONS The incidence of in-hospital non-cardiac death was markedly high in patients with AHF, accounting for 30% of all in-hospital deaths in the ATTEND registry. Thus, the prevention and management of non-cardiac complications are vital to prevent acute-phase mortality in patients with AHF, especially those with predictors of in-hospital non-cardiac death.
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Affiliation(s)
- Kohei Wakabayashi
- 1 Division of Cardiology, Showa University Fujigaoka Hospital, Japan
| | - Naoki Sato
- 2 Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Japan
| | | | - Yuichiro Minami
- 4 Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Masayuki Mizuno
- 4 Department of Cardiology, Tokyo Women's Medical University, Japan
| | | | - Kuniya Asai
- 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Ryo Munakata
- 7 Intensive and Cardiac Care Unit, Nippon Medical School, Japan
| | - Koji Murai
- 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Yasushi Sakata
- 8 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan
| | - Hiroshi Suzuki
- 1 Division of Cardiology, Showa University Fujigaoka Hospital, Japan
| | - Teruo Takano
- 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan
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Badheka AO, Singh V, Patel NJ, Arora S, Patel N, Thakkar B, Jhamnani S, Pant S, Chothani A, Macon C, Panaich SS, Patel J, Manvar S, Savani C, Bhatt P, Panchal V, Patel N, Patel A, Patel D, Lahewala S, Deshmukh A, Mohamad T, Mangi AA, Cleman M, Forrest JK. Trends of Hospitalizations in the United States from 2000 to 2012 of Patients >60 Years With Aortic Valve Disease. Am J Cardiol 2015; 116:132-41. [PMID: 25983278 DOI: 10.1016/j.amjcard.2015.03.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Abstract
In recent years, there has been an increased emphasis on the diagnosis and treatment of valvular heart disease and, in particular, aortic stenosis. This has been driven in part by the development of innovative therapeutic options and by an aging patient population. We hypothesized an increase in the number of hospitalizations and the economic burden associated with aortic valve disease (AVD). Using Nationwide Inpatient Sample from 2000 to 2012, AVD-related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 424.1, as the principal discharge diagnosis. Overall AVD hospitalizations increased by 59% from 2000 to 2012. This increase was most significant in patients >80 years and those with higher burden of co-morbidities. The most frequent coexisting conditions were hypertension, heart failure, renal failure, anemia, and diabetes. Overall inhospital mortality of patients hospitalized for AVD was 3.8%, which significantly decreased from 4.5% in 2000 to 3.5% in 2012 (p <0.001). The largest decrease in mortality was seen in the subgroup of patients who had heart failure (62% reduction), higher burden of co-morbidities (58% reduction), and who were >80 years (53% reduction). There was a substantial increase in the cost of hospitalization in the last decade from $31,909 to $38,172 (p <0.001). The total annual cost for AVD hospitalization in the United States increased from $1.3 billion in 2001 to $2.1 billion in 2011 and is expected to increase to nearly 3 billion by 2020. The last decade has witnessed a significant increase in hospitalizations for AVD in the United States. The associated decrease in inhospital mortality and increase in the cost of hospitalization have considerably increased the economic burden on the public health system.
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Affiliation(s)
- Apurva O Badheka
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Vikas Singh
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Nileshkumar J Patel
- Cardiovascular Division, Staten Island University Hospital, Staten Island, New York
| | - Shilpkumar Arora
- Cardiovascular Division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York
| | - Nilay Patel
- Cardiovascular Division, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Badal Thakkar
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Sunny Jhamnani
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Sadip Pant
- Cardiovascular Division, Icahn School of Public Health at Mount Sinai, New York, New York
| | - Ankit Chothani
- Cardiovascular Division, University of Louisville, Louisville, Kentucky
| | - Conrad Macon
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Sidakpal S Panaich
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jay Patel
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sohilkumar Manvar
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Chirag Savani
- Cardiovascular Division, Detroit Medical Center, Detroit, Michigan
| | - Parth Bhatt
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Vinaykumar Panchal
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Neil Patel
- Cardiovascular Division, Jersey City Medical Center, Jersey City, New Jersey
| | - Achint Patel
- Cardiovascular Division, Jersey City Medical Center, Jersey City, New Jersey
| | - Darshan Patel
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sopan Lahewala
- Cardiovascular Division, Mayo Clinic, Rochester, Minnesota
| | | | - Tamam Mohamad
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Abeel A Mangi
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Michael Cleman
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut.
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Kwok CS, Kontopantelis E, Myint PK, Zaman A, Berry C, Keavney B, Nolan J, Ludman PF, de Belder MA, Buchan I, Mamas MA. Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007–12. Eur Heart J 2015; 36:1618-1628. [DOI: 10.1093/eurheartj/ehv113] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Eleid MF, Michelena HI, Nkomo VT, Nishimura RA, Malouf JF, Scott CG, Pellikka PA. Causes of death and predictors of survival after aortic valve replacement in low flow vs. normal flow severe aortic stenosis with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2015; 16:1270-5. [PMID: 25896358 DOI: 10.1093/ehjci/jev091] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/21/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown. We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. METHODS AND RESULTS Among 1120 consecutive patients with severe AS (aortic valve area <1.0 cm(2)) and preserved EF (≥50%) using 2-D and Doppler echocardiography who had AVR, 61 (5%) patients had reduced SVI [<35 mL/m(2) (low flow, LF)] and 1059 (95%) had normal SVI [≥35 mL/m(2) (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76% (95% CI 70-82) vs. 89% (95% CI 88-90%), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13% (95% CI 8-18%) in LF vs. 5% (95% CI 5-7%) in NF, P = 0.02]. Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57% of post-AVR cardiac deaths) and was a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2%, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. CONCLUSION Reduced SVI is associated with higher cardiac mortality after AVR. CHF is the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.
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Affiliation(s)
- Mackram F Eleid
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Rick A Nishimura
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Joseph F Malouf
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Christopher G Scott
- Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Herrmann J, Lennon RJ, Jaffe AS, Holmes DR, Rihal CS, Prasad A. Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2014; 7:533-42. [DOI: 10.1161/circinterventions.113.000544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joerg Herrmann
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Ryan J. Lennon
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Allan S. Jaffe
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - David R. Holmes
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Charanjit S. Rihal
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Abhiram Prasad
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
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Yoshizaki T, Ishida M, Takagi T, Matsukura G, Yamashita S, Hosoya N, Kageyama S, Watanabe Y, Takeuchi R, Murata K, Nawada R, Onodera T, Nakai M. A case of ventricular septal rupture associated with major septal branch occlusion after percutaneous coronary intervention. J Cardiol Cases 2014; 10:140-143. [PMID: 30534226 DOI: 10.1016/j.jccase.2014.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/16/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022] Open
Abstract
A 67-year-old man underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery. The major septal branch became occluded during coronary stenting. The patient developed dyspnea 19 days later. Chest radiography revealed lung congestion and a pleural effusion. Transthoracic echocardiography revealed a basal ventricular septal rupture. Emergency coronary angiography did not reveal any in-stent restenosis, and the major septal branch remained occluded. Therefore, the patient underwent closure of the ventricular septal rupture. The postoperative period was uneventful, and he was discharged 29 days after the operation. Septal branch occlusion due to coronary stenting occasionally occurs during routine PCI for which recanalization is sometimes not attempted. However, this case demonstrates that occluded septal branches, although rare, may cause serious complications. <Learning objective: Rupture of the ventricular septum, a complication of acute myocardial infarction, is usually observed in the setting of acute myocardial infarction associated with major coronary artery occlusion. However, ventricular septal rupture associated with side branch occlusion due to coronary stenting for stable angina pectoris is uncommon. Awareness of this rare complication is useful during routine percutaneous coronary intervention.>.
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Affiliation(s)
- Toru Yoshizaki
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Marina Ishida
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tamotsu Takagi
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Gaku Matsukura
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Satoshi Yamashita
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Natsuko Hosoya
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Shigetaka Kageyama
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yuzo Watanabe
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Ryosuke Takeuchi
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Ryuzo Nawada
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tomoya Onodera
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masanao Nakai
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
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43
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Deliverability of the Resolute Integrity stent and a post hoc comparison of radial and femoral access: The DELIVER study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:289-94. [DOI: 10.1016/j.carrev.2014.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022]
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45
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Singh M, Lennon RJ, Gulati R, Holmes DR. Risk scores for 30-day mortality after percutaneous coronary intervention: new insights into causes and risk of death. Mayo Clin Proc 2014; 89:631-7. [PMID: 24797644 DOI: 10.1016/j.mayocp.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/28/2014] [Accepted: 03/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the causes and risk of death after percutaneous coronary interventions (PCIs) and to compare the discriminatory ability of the New York State Risk Score (NYSRS) with the Mayo Clinic Risk Score (MCRS). PATIENTS AND METHODS We studied in-hospital and 30-day mortality after PCI in 4898 patients treated at Mayo Clinic in Rochester, Minnesota, from January 1, 2007, through December 31, 2010, to validate the NYSRS equation with recalibrated predicted probabilities of death. RESULTS Of the 4898 patients studied, 93 (1.9%) died during the index hospitalization, and 36 (0.7%) died within 30 days after discharge. For the in-hospital and 30-day mortality, respectively, the area under the receiver operating characteristic curve was 0.92 and 0.88 for the NYSRS and 0.93 and 0.90 for the MCRS, indicating excellent discrimination. The NYSRS model underpredicted event rates when applied in Mayo Clinic data (2.6% observed [127 of 4898 patients] vs 2.3% predicted [114 of 4898 patients]), even after recalibration. The instantaneous hazard over time revealed the highest risk of death in the first 3 days after PCI (daily probability, >0.2%), declined to 0.1% until about day 12, and then decreased below 0.1%. Cardiac causes (mainly myocardial infarction) dominated in the first week (83 of 85 deaths [97.6%]) and then decreased to 59.5% (25 of 42 deaths) between 8 and 30 days after PCI. CONCLUSION The discriminatory ability of the NYSRS and the MCRS for in-hospital and 30-day mortality after PCI is roughly interchangeable. The risk of death is highest during the first 2 weeks and is dominated by cardiac causes of death.
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Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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DeMaria AN, Adler ED, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall JL, Hlatky MA, Lew WYW, Lima JAC, Mahmud E, Maisel AS, Narayan SM, Nissen SE, Sahn DJ, Tsimikas S. Highlights of the year in JACC 2013. J Am Coll Cardiol 2014; 63:570-602. [PMID: 24524815 DOI: 10.1016/j.jacc.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Eric D Adler
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gregory K Feld
- Cardiology Division, UCSD Medical Center, San Diego, California
| | | | | | | | | | | | - Ehtisham Mahmud
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Alan S Maisel
- Veterans Affairs Medical Center, San Diego, California
| | | | | | - David J Sahn
- Department of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon
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Dehmer GJ, Drozda JP, Brindis RG, Masoudi FA, Rumsfeld JS, Slattery LE, Oetgen WJ. Public Reporting of Clinical Quality Data. J Am Coll Cardiol 2014; 63:1239-1245. [DOI: 10.1016/j.jacc.2013.11.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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Spoon DB, Psaltis PJ, Singh M, Holmes DR, Gersh BJ, Rihal CS, Lennon RJ, Moussa ID, Simari RD, Gulati R. Trends in cause of death after percutaneous coronary intervention. Circulation 2014; 129:1286-94. [PMID: 24515993 DOI: 10.1161/circulationaha.113.006518] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The impact of changing demographics on causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined. METHODS AND RESULTS We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991 to 2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports, and death certificates. Competing-risks analysis of cause-specific mortality was performed using 3 time periods of PCI (1991-1996, 1997-2002, and 2003-2008). Final follow-up was December 31, 2012. A total of 19 077 patients survived index PCI hospitalization, of whom 6988 subsequently died (37%, 4.48 per 100 person-years). Cause was determined in 6857 (98.1%). Across 3 time periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence: 9.8%, 7.4%, and 6.6%) but a 57% increase in noncardiac deaths (7.1%, 8.5%, and 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease, or PCI indication. After adjustment for baseline variables, there was a 50% temporal decline in cardiac mortality but no change in noncardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (P<0.001) but not heart failure (P=0.85). The increase in noncardiac mortality was primarily attributable to cancer and chronic diseases (P<0.001). CONCLUSIONS This study found a marked temporal switch from predominantly cardiac to predominantly noncardiac causes of death after PCI over 2 decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design.
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Affiliation(s)
- Daniel B Spoon
- Divisions of Cardiovascular Diseases (D.B.S., P.J.P., M.S., D.R.H., B.J.G., C.S.R., R.D.S., R.G.) and Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Diseases (I.D.M.), Mayo Clinic, Jacksonville, FL
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Paved With Good Intentions and Marred by Half-Truths. J Am Coll Cardiol 2013; 62:416-7. [DOI: 10.1016/j.jacc.2013.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 11/24/2022]
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