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Simeone S, Vellone E, Pucciarelli G, Alvaro R. Emergency percutaneous coronary intervention and stent implantation: Patients' lived experiences. Nurs Crit Care 2021; 27:148-156. [PMID: 33780092 DOI: 10.1111/nicc.12623] [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: 08/29/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given that emergency procedures must be performed immediately and without the possibility of sufficiently informing and preparing a patient, the lived experiences of patients who undergo emergency procedures and those who undergo elective procedures may well differ. Elucidating the lived experiences of patients who underwent percutaneous coronary intervention (PCI) with stent implantation in an emergency situation is crucial because such knowledge might prove helpful in tailoring post-procedure interventions intended to improve the lives of PCI patients. AIM To describe the experiences of patients 1 month after they underwent emergency PCI with coronary stent implantation. METHODS Cohen's phenomenology was applied in this study. This method combines the characteristics of descriptive (Husserlian) phenomenology with those of interpretative (Gadmerian) phenomenology, and it is by nature an inductive approach. The participants were enrolled 1 month after undergoing PCI with coronary stent implantation. They were interviewed using open-ended questions to provide them full freedom of expression. They were asked to describe their experiences of the PCI and stent implementation they have gone through. This study followed the recommendations of the Standard for Reporting Qualitative Research. RESULTS Our sample consisted of 15 participants. Data analysis revealed three main themes: (1) catheter lab and pain, (2) anxiety and feeling uncertain about the future, and (3) lifestyle changes. The anxiety theme encompassed two subthemes: (a) anxiety related to the procedure and (b) anxiety related to the continuation of life. CONCLUSION Our study is one of the first works to explicitly investigate the lived experiences of patients who underwent emergency PCI. Understanding the experiences of these patients is key in understanding their realistic needs and concerns. RELEVANCE TO CLINICAL PRACTICE Knowledge of the lived experiences of patients who underwent emergency PCI with coronary stent implantation is fundamental in identifying aspects that warrant tailored interventions.
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Affiliation(s)
- Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Myint PK, Kwok CS, Roffe C, Kontopantelis E, Zaman A, Berry C, Ludman PF, de Belder MA, Mamas MA. Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication. Stroke 2016; 47:1500-7. [DOI: 10.1161/strokeaha.116.012700] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.
Methods—
The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).
Results—
A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43–67.05) and 21.05 (13.25–33.44) for elective and 5.00 (3.96–6.31) and 6.25 (5.03–7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64–2.43) and 0.63 (0.35–1.15), respectively.
Conclusions—
Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.
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Affiliation(s)
- Phyo Kyaw Myint
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Chun Shing Kwok
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Christine Roffe
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Evangelos Kontopantelis
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Azfar Zaman
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Colin Berry
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Peter F. Ludman
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Mark A. de Belder
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
| | - Mamas A. Mamas
- From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology,
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Rittger H, Hochadel M, Behrens S, Hauptmann KE, Zahn R, Mudra H, Brachmann J, Zeymer U. Interventional treatment and outcome in elderly patients with stable coronary artery disease. Results from the German ALKK registry. Herz 2013; 39:212-8. [PMID: 23712825 DOI: 10.1007/s00059-013-3822-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/07/2013] [Accepted: 03/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of elderly and very elderly patients undergoing percutaneous coronary interventions (PCI) is increasing. We therefore analyzed data from the German ALKK registry (Arbeitsgemeinschaft Leitende Krankenhausärzte; Working Group of Hospital Cardiologists) to determine differences in procedural features, antithrombotic treatment, and in-hospital outcome in patients with coronary artery disease (CAD) according to age in a large series of patients. METHODS AND RESULTS The present analysis was based on the data of 35,534 consecutive patients undergoing elective PCI who were enrolled in the ALKK registry. Of these 27,145 (76.4 %) were younger than 75 years, 7,645 (21.5 %) were aged between 75 and 84 years, and 744 (2.1 %) patients were older than 85 years. Mean age was 68.5 years (60.9-74.5 years), and 25,784 patients (72.6 %) were male. Overall intraprocedural events were very low (1.1 %) and there was no significant difference between the three age groups [< 75 years (1.1 %); 75-< 85 years (1.2 %); ≥ 85 years (0.5 %) (p = not significant)]. Rates of in-hospital death, stroke and transient ischemic attack (TIA), as well as the combined endpoint in-hospital major adverse cardiac and cerebrovascular events (MACCE) were also very low (0.6 % vs. 0.9 % vs. 0.9 %; p < 0.001) but significantly higher in elderly patients with no further increase in the very elderly patient group. CONCLUSION We found no differences in this registry in intraprocedural complications during elective PCI between younger and elderly patients. Although in-hospital MACCE were somewhat higher in the elderly, the overall event rate was low and thus elderly patients should not be deprived from this therapy because of age alone.
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Affiliation(s)
- H Rittger
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany,
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Hsiao PG, Hsieh CA, Yeh CF, Wu HH, Shiu TF, Chen YC, Chu PH. Early prediction of acute kidney injury in patients with acute myocardial injury. J Crit Care 2012; 27:525.e1-7. [PMID: 22762928 DOI: 10.1016/j.jcrc.2012.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 04/28/2012] [Accepted: 05/09/2012] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Previous studies have revealed that acute myocardial infarction (AMI) with acute kidney injury (AKI), about 17%, is strongly related to long-term mortality and heart failure. The dynamic changes in renal function during AMI are strongly related to long-term mortality and heart failure. OBJECTIVES Our study used clinical parameters and AKI biomarkers including neutrophil gelatinase-associated lipocalin, interleukin (IL)-6, IL-18, and cystatin C to evaluate prognostic relevance of AKI in the setting of AMI. METHODS This prospective study was conducted from November 2009 to January 2011 and enrolled sequential 96 patients with catheter-proven AMI; it was approved by the institutional review board of Chang Gung Memorial Hospital, Taiwan (institutional review board no. 99-0140B) and conformed to the tenets of the Declaration of Helsinki. The definition of AKI is the elevation of serum creatinine of more than 0.3 mg/dL within 48 hours. RESULTS Our results show that the incidence of AKI after AMI is 17.7% (17 patients). The following could be statistically related to AKI after AMI: age (P = .012), cardiac functions (Killip stage and echocardiogram; P = .003 each), Thrombolysis in Myocardial Infarction (TIMI) flow grade (P < .001), stenting (P < .001), neutrophil gelatinase-associated lipocalin (P = .005), IL-6 (P = .01), IL-18 (P = .002), and cystatin C (P = .002) in serum. The TIMI flow grade and serum cystatin C were shown to be important predictors by using multivariate analysis. Both TIMI flow lower than grade 2 and serum cystatin C of more than 1364 mg/L could be used to predict AKI (both overall correctness, 0.78). Moreover, IL-6 in serum is also associated with the major cardiovascular events after AMI (P = .02), as demonstrated in our study. CONCLUSION In conclusion, the worse TIMI flow and high plasma cystatin C can be used to predict AKI after AMI. Moreover, IL-6 can also be used as a 30-day major cardiovascular event indicator after AMI. A larger prospective and longitudinal study should follow the relationship between AKI predictors after AMI.
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Affiliation(s)
- Ping-Gune Hsiao
- The Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan
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Dodson JA, Wang Y, Chaudhry SI, Curtis JP. Bleeding-avoidance strategies and outcomes in patients ≥80 years of age with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the NCDR CathPCI Registry). Am J Cardiol 2012; 110:1-6. [PMID: 22475362 DOI: 10.1016/j.amjcard.2012.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 01/24/2023]
Abstract
The purpose of our study was to evaluate the use of bleeding-avoidance strategies (BAS) and risk-adjusted bleeding over time in patients ≥80 years of age undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction. We analyzed data from the CathPCI Registry from July 1, 2006 through June 30, 2009. Patients were included if they were ≥80 years old, presented with ST-segment elevation myocardial infarction, and underwent primary PCI. We evaluated trends in use of BAS (direct thrombin inhibitors, vascular closure devices, and radial access) and risk-adjusted bleeding over time. Of 10,469 patients ≥80 years old undergoing primary PCI, 1,002, (9.6%) developed a bleeding complication. Use of direct thrombin inhibitors and vascular closure devices increased over time (12.8% to 24.9% and 29.2% to 32.7%, p <0.01 and <0.05 for trends, respectively). Radial access was extremely uncommon (<1%) and did not change over the course of the study. In multivariable analyses, use of BAS was associated with lower bleeding. However, over the course of the study period, overall risk-adjusted bleeding did not decrease significantly (9.9% to 9.4%, p = 0.14 for trend). In conclusion, patients ≥80 years old undergoing primary PCI are at high risk of bleeding, and despite significant increases in use of BAS, the overall rate of bleeding complications remains high.
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Nikolić Heitzler V, Babic Z, Milicic D, Bergovec M, Raguz M, Mirat J, Strozzi M, Plazonic Z, Giunio L, Steiner R, Starcevic B, Vukovic I. Results of the Croatian Primary Percutaneous Coronary Intervention Network for patients with ST-segment elevation acute myocardial infarction. Am J Cardiol 2010; 105:1261-7. [PMID: 20403476 DOI: 10.1016/j.amjcard.2009.12.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/16/2009] [Accepted: 12/16/2009] [Indexed: 11/18/2022]
Abstract
The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries.
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Affiliation(s)
- Vjeran Nikolić Heitzler
- Coronary Care Unit, Cardiovascular Department, Sestre Milosrdnice University Hospital, Zagreb, Croatia
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