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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 593] [Impact Index Per Article: 593.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Cassan S, Rata M, Vallenet C, Fromage P, Champly F, Broin P, Peribois G, Sierra V, Lutz C, Mangin L, Savary D, Ageron FX, Belle L. Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network. BMC Emerg Med 2019; 19:60. [PMID: 31660873 PMCID: PMC6819338 DOI: 10.1186/s12873-019-0280-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Background In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI. Methods In the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI). Results Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up. Conclusions Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.
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Affiliation(s)
- Sebastien Cassan
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Mihaela Rata
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Claire Vallenet
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Philippe Fromage
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Frederic Champly
- Department of Cardiology and Emergency Department, Centre Hospitalier de Sallanches, Sallanches, France
| | - Patrick Broin
- Department of Cardiology and Emergency Department, Centre Hospitalier de Sallanches, Sallanches, France
| | - Guillaume Peribois
- Department of Cardiology and Emergency Department, Centre Hospitalier de Thonon, Thonon, France
| | - Valerie Sierra
- Department of Cardiology and Emergency Department, Centre Hospitalier de Thonon, Thonon, France
| | - Cedric Lutz
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Lionel Mangin
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Dominique Savary
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - François-Xavier Ageron
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Loic Belle
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France.
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Gallego-Delgado M, Villacorta E, Valenzuela-Vicente MC, Walias-Sánchez Á, Ávila C, Velasco-Cañedo MJ, Cano-Mozo MT, Martín-García A, García-Sánchez MJ, Sánchez A, Cascón M, Sánchez PL. Puesta en marcha de un hospital de día del área del corazón: análisis de actividad, calidad y coste-efectividad en el primer año de funcionamiento. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gallego-Delgado M, Villacorta E, Valenzuela-Vicente MC, Walias-Sánchez Á, Ávila C, Velasco-Cañedo MJ, Cano-Mozo MT, Martín-García A, García-Sánchez MJ, Sánchez A, Cascón M, Sánchez PL. Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation. ACTA ACUST UNITED AC 2018; 72:130-137. [PMID: 29793830 DOI: 10.1016/j.rec.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH. METHODS An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays. RESULTS A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation. CONCLUSIONS In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions.
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Affiliation(s)
- María Gallego-Delgado
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain.
| | - Eduardo Villacorta
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - M Carmen Valenzuela-Vicente
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Ángela Walias-Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Carmen Ávila
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - M Jesús Velasco-Cañedo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - M Teresa Cano-Mozo
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Agustín Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - María Jesús García-Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Argelina Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Manuel Cascón
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca y Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
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Íñiguez Romo A, Bertomeu Martínez V, Rodríguez Padial L, Anguita Sánchez M, Ruiz Mateas F, Hidalgo Urbano R, Bernal Sobrino JL, Fernández Pérez C, Macaya de Miguel C, Elola Somoza FJ. Proyecto RECALCAR. La atención al paciente en las unidades de cardiología del Sistema Nacional de Salud, 2011-2014. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.12.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Íñiguez Romo A, Bertomeu Martínez V, Rodríguez Padial L, Anguita Sánchez M, Ruiz Mateas F, Hidalgo Urbano R, Bernal Sobrino JL, Fernández Pérez C, Macaya de Miguel C, Elola Somoza FJ. The RECALCAR Project. Healthcare in the Cardiology Units of the Spanish National Health System, 2011 to 2014. ACTA ACUST UNITED AC 2017; 70:567-575. [PMID: 28457812 DOI: 10.1016/j.rec.2017.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 12/15/2022]
Abstract
The RECALCAR project (Spanish acronym for Resources and Quality in Cardiology Units) uses 2 data sources: a survey of cardiology units and an analysis of the Minimum Basic Data set of all hospital discharges of the Spanish National Health System. From 2011 to 2014, there was marked stability in all indicators of the availability, utilization, and productivity of cardiology units. There was significant variability between units and between the health services of the autonomous communities. There was poor implementation of process management (only 14% of the units) and scarce development of health care networks (17%). Structured cardiology units tended to have better results, in terms of both quality and efficiency. No significant differences were found between the different types of unit in the mean length of stay (5.5±1.1 days) or the ratio between successive and first consultations (2:1). The mean discharge rate was 5/1000 inhabitants/y and the mean rate of initial consultations was 16±4/1000 inhabitants/y. No duty or on-call cardiologist was available in 30% of cardiology units with 24 or more beds; of these, no critical care beds were available in 45%. Our findings support the recommendation to regionalize cardiology care and to promote the development of cardiology unit networks.
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Affiliation(s)
- Andrés Íñiguez Romo
- Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | | | | | | | - Rafael Hidalgo Urbano
- Unidad de Gestión Clínica de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Cristina Fernández Pérez
- Unidad Transversal de Apoyo a la Investigación, Hospital Clínico Universitario San Carlos, Madrid, Spain
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impacto en la mortalidad de diferentes sistemas de asistencia en red para el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia de España. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cequier Á, Ariza-Solé A, Elola FJ, Fernández-Pérez C, Bernal JL, Segura JV, Iñiguez A, Bertomeu V. Impact on Mortality of Different Network Systems in the Treatment of ST-segment Elevation Acute Myocardial Infarction. The Spanish Experience. ACTA ACUST UNITED AC 2016; 70:155-161. [PMID: 27600863 DOI: 10.1016/j.rec.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the association between the development of network systems of care for ST-segment elevation myocardial infarction (STEMI) in the autonomous communities (AC) of Spain and the regional rate of percutaneous coronary intervention (PCI) and in-hospital mortality. METHODS From 2003 to 2012, data from the minimum basic data set of the Spanish taxpayer-funded health system were analyzed, including admissions from general hospitals. Diagnoses of STEMI and related procedures were codified by the International Diseases Classification. Discharge episodes (n = 302 471) were distributed in 3 groups: PCI (n = 116 621), thrombolysis (n = 46 720), or no reperfusion (n = 139 130). RESULTS Crude mortality throughout the evaluation period was higher for the no-PCI or thrombolysis group (17.3%) than for PCI (4.8%) and thrombolysis (8.6%) (P < .001). For the aggregate of all communities, the PCI rate increased (21.6% in 2003 vs 54.5% in 2012; P < .001) with a decrease in risk-standardized mortality rates (10.2% in 2003; 6.8% in 2012; P < .001). Significant differences were observed in the PCI rate across the AC. The development of network systems was associated with a 50% increase in the PCI rate (P < .001) and a 14% decrease in risk-standardized mortality rates (P < .001). CONCLUSIONS From 2003 to 2012, the PCI rate in STEMI substantially increased in Spain. The development of network systems was associated with an increase in the PCI rate and a decrease in in-hospital mortality.
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Affiliation(s)
- Ángel Cequier
- Sociedad Española de Cardiología, Madrid, Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Albert Ariza-Solé
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco J Elola
- Sociedad Española de Cardiología, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | | | - José L Bernal
- Servicio de Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
| | - José V Segura
- Centro de Investigación Operativa, Instituto Universitario de Investigación (IUI), Universidad Miguel Hernández, Alicante, Spain
| | - Andrés Iñiguez
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Álvaro Cunquerio, Vigo, Pontevedra, Spain
| | - Vicente Bertomeu
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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Andersen JG, Grepperud S, Kløw NE, Johansen O. Effects on length of stay and costs with same-day retransfer to the referring hospitals for patients with acute coronary syndrome after angiography and/or percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:375-80. [PMID: 26139591 DOI: 10.1177/2048872615593386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fast track interventions may generate benefits for patients and hospitals by representing a potential for shorter hospital stay. The aim of this study was to investigate how same-day retransfers to the referring hospital after angiographic examination and/or percutaneous coronary intervention (PCI) at the PCI centre affected length of stay and hospital treatment costs for patients with acute coronary syndrome. METHODS AND RESULTS Three hundred and ninety-nine consecutive admitted patients were prospectively randomized to ordinary care with overnight stay or fast track with same-day retransfer. Length of stay at both the PCI centre and the referring hospital after the stay at the PCI centre were recorded. Costs at the PCI centre related to examinations and treatments were also collected. The ordinary care group included 206 patients and the fast track group 193 patients. Forty-six per cent underwent PCI and 10% coronary artery bypass graft (CABG) in the ordinary care group. In the fast track group 40% had PCI and 6% CABG. Length of stay was reduced at the PCI centre from a median 1.25 days for the ordinary care group to median 0.24 days for the FT group (p<0.001). Length of stay at the PCI centre was significantly reduced after selective coronary angiography and PCI but not for patients undergoing CABG. No significant difference was identified in length of stay for the referring hospitals. Total median treatment costs were reduced from NOK23,657 (US$3838) for the ordinary care group to NOK15,730 (US$2552) for the fast track group (p<0.001). The main contributor to this reduction was shorter length of stay and the corresponding reduction in ward costs at the PCI centre. CONCLUSIONS We conclude that fast-track intervention with same-day retransfer for patients with acute coronary syndrome to the referring hospital reduced length of stay and the hospital treatment costs for patients undergoing selective coronary angiography and PCI.
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Affiliation(s)
| | - Sverre Grepperud
- Oslo University, Institute of Health and Society, Faculty of Medicine, Norway
| | - Nils-Einar Kløw
- Oslo University Hospital Ulleval, X-Ray Department, The University of Oslo, Norway
| | - Odd Johansen
- The Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
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Abstract
OBJECTIVE Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care. DATA SOURCE Narrative review of medical and organizational literature. SUMMARY Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by organizational routines or non-patient-centered organizational priorities. Accomplishing a transfer is often quite difficult for sending hospitals. But once a transfer destination is successfully found, the mechanics of interhospital transfer now appear quite safe. CONCLUSION Important technological advances now make it possible to identify nearby hospitals best able to help critically ill patients, and to successfully transfer patients to those hospitals. However, organizational structures have not yet developed to insure that patients are optimally routed, resulting in potentially significant excess mortality.
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Barge-Caballero E, Vázquez-Rodríguez JM, Estévez-Loureiro R, Calviño-Santos R, Salgado-Fernández J, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Campo-Pérez R, Rodríguez-Fernández JÁ, Lombán-Villanueva JA, Mesías-Prego A, Gutiérrez-Cortés JM, González-Juanatey C, Portela C, Iglesias-Vázquez A, Varela-Portas Mariño J, Vázquez-González N, Castro-Beiras A. Angioplastia primaria en el Área Norte de Galicia: cambios asistenciales y resultados tras la implantación del programa PROGALIAM. Rev Esp Cardiol 2012; 65:341-9. [DOI: 10.1016/j.recesp.2011.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
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Prada-Delgado O, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, Castro-Beiras A. Renal insufficiency and vascular complications after primary angioplasty via femoral route. Impact of vascular closure devices use. Rev Esp Cardiol 2012; 65:258-64. [PMID: 22305819 DOI: 10.1016/j.recesp.2011.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 10/28/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES We sought to determine the incidence of vascular complications in patients with chronic kidney disease undergoing primary angioplasty via the femoral route; we also evaluated the safety and efficacy of the use of vascular closure devices in this setting. METHODS Registry of 527 patients undergoing primary angioplasty via the femoral route from January 2003 to December 2008. Chronic kidney disease was defined as creatinine clearance less than 60 mL/min. The primary endpoint was the presence of major vascular complications. RESULTS Baseline chronic kidney disease was observed in 166 (31.5%) patients. Patients with chronic kidney disease experienced higher rates of major vascular complications compared to those without worsening of renal function (8.4% vs 4.2%; P=.045), especially those requiring transfusion (6.6% vs 1.9%; P=.006). Among patients with chronic kidney disease, 129 (77.7%) received a vascular closure device and manual compression was used in 37 patients (22.3%). The risk of major vascular complications was significantly lower with vascular closure device use compared to manual compression (4.7% vs 21.6%; P=.003). Multivariable logistic regression analysis showed that the use of a vascular closure device was independently associated with a decreased risk of major vascular complications in patients with chronic kidney disease undergoing primary angioplasty (odds ratio=0.11; 95% confidence interval, 0.03-0.41; P=.001). CONCLUSIONS Patients with chronic kidney disease undergoing primary angioplasty via the femoral route experience higher rates of major vascular complications. The use of vascular closure devices in this group of patients is safe and is associated with lower rates of major vascular complications compared to manual compression.
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Affiliation(s)
- Oscar Prada-Delgado
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
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[Reduction in 28 days and 6 months of acute myocardial infarction mortality from 1995 to 2005. Data from PRIAMHO I, II and MASCARA registries]. Rev Esp Cardiol 2011; 64:972-80. [PMID: 21803474 DOI: 10.1016/j.recesp.2011.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 05/03/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine whether mortality from acute myocardial infarction has reduced in Spain and the possibly related therapeutic factors. METHODS Nine thousand, nine hundred and forty-nine patients with ST-segment elevation myocardial infarction admitted to the Coronary Care Unit were identified from PRIAMHO I, II and MASCARA registries performed in 1995, 2000 and 2005, with a 6 month follow-up. RESULTS From 1995 to 2005 patients were increasingly more likely to have hypertension, hyperlipidemia and anterior infarction, but age of onset and the proportion of females did not increase. Twenty-eight-day mortality rates were 12.6%, 12.3% and 6% in 1995, 2000 and 2005 respectively, and 15.3%, 14.6% and 9.4% at 6 months (both P-trend <.001). Multivariate analysis was performed and the adjusted odds ratio for 28-day mortality for an infarction occuring in 2005 (compared with 1995) was 0.62 (95% confidence interval: 0.44-0.88) whereas the adjusted hazard ratio for mortality at 6 months was 0.40 (95% confidence interval: 0.24-0.67). Other variables independently associated with lower mortality at 28 days were: reperfusion therapy, and the use of anti-thrombotic treatment, beta-blockers and angiotensin-converting enzyme inhibitors. The 28-day-6-month period had an independent protective effect on the following therapies: coronary reperfusion, and prescription of antiplatelet agents, beta-blockers and lipid lowering drugs upon discharge. CONCLUSIONS Twenty-eight-day and six-month mortality rates fell among patients with ST-elevation myocardial infarction in Spain from 1995 to 2005. The possibly related therapeutic factors were the following: more frequent reperfusion therapy and increased use of anti-thrombotic drugs, beta-blockers, angiotensin-converting enzyme inhibitors and lipid lowering drugs.
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Prada-Delgado Ó, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, Castro-Beiras A. Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2011; 161:1207-13. [PMID: 21641370 DOI: 10.1016/j.ahj.2011.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI. METHODS A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion. RESULTS Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91). CONCLUSIONS The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.
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Affiliation(s)
- Óscar Prada-Delgado
- Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Barrabés JA, Bodí V, Jiménez-Candil J, Fernández-Ortiz A. Actualización en cardiopatía isquémica. Rev Esp Cardiol 2011; 64 Suppl 1:50-8. [DOI: 10.1016/s0300-8932(11)70007-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Returning patients after primary percutaneous coronary angioplasty: the (re) TRANSFER AMI. Rev Esp Cardiol 2009; 62:1350-2. [PMID: 20038399 DOI: 10.1016/s1885-5857(09)73527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Margheri M, Aquilina M. Retorno de pacientes al centro de origen tras la angioplastia coronaria percutánea primaria: el estudio (re)-TRANSFER AMI. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73118-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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