1
|
Kaki A, Zein R, Patel C, Schreiber T, LaLonde T, Ghiu I, Grines C, O’Neill W, Mehta R. RACIAL DIFFERENCES IN CLINICAL FEATURES AND OUTCOMES OF PATIENTS UNDERGOING HIGH RISK PCI WITH HEMODYNAMIC SUPPORT IN A CONTEMPORARY COHORT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
2
|
Lemor A, Basir MB, Patel K, Kolski B, Kaki A, Kapur NK, Riley R, Finley J, Goldsweig A, Aronow HD, Belford PM, Tehrani B, Truesdell AG, Lasorda D, Bharadwaj A, Hanson I, LaLonde T, Gorgis S, O'Neill W, Lemor A, Basir MB, O'Neill WW, Patel K, Kolski B, Schreiber T, Kaki A, Tehrani B, Truesdell AG, Lasorda D, Bharadwaj A, Hanson I, Almany S, Timmis S, Dixon S, Lalonde T, Attallah A, Todd J, Marso S, Wilkins C, Patel N, Senter S, McRae T, Rahman A, Gelormini J, Kapur N, Singh IM, Riley R, O'Neill B, Overly T, Sharma R, Dupont A, Green M, Lim M, Khuddus M, Caputo C, Larkin T, Askari R, Marso S, Nsair A, Akhtar Y, Hanson I, Lin L, McAllister D, Finley J, Goldsweig A, Park J, Gorwara S, Nazir R, Martin S, Foster M, Smith C, Rangaswamy C, Zuberi O, Federici R, Baker J, Cawich I, Korpas D, Srivastava N, Aronow HD, Schaeffer M, Wohns D, Belford PM, Mehra A, Blank N, Alraies MC, Ashbrook M, Abdel-Hafez O, Khandelwal A, Alaswad K, Gorgis S, Johnson T, Hacala M. Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock. JACC Cardiovasc Interv 2020; 13:1171-1178. [DOI: 10.1016/j.jcin.2020.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/13/2020] [Accepted: 03/03/2020] [Indexed: 11/28/2022]
|
3
|
Patel VH, Vendittelli P, Garg R, Szpunar S, LaLonde T, Lee J, Rosman H, Mehta RH, Othman H. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8:9-17. [PMID: 30815378 PMCID: PMC6388309 DOI: 10.5492/wjccm.v8.i2.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient’s prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.
AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.
METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.
RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, P = 0.01], older age (OR = 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, P = 0.02) were independent predictors of death.
CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
Collapse
Affiliation(s)
- Vishal H Patel
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Philip Vendittelli
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajat Garg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44915, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Thomas LaLonde
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - John Lee
- Department of Critical Care Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Howard Rosman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 22705, United States
| | - Hussein Othman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| |
Collapse
|
4
|
Edla S, Rosman H, Neupane S, Boshara A, Szpunar S, Daher E, Rodriguez D, LaLonde T, Yamasaki H, Mehta RH, Attallah A. Early Versus Delayed Use of Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients With Acute Submassive Pulmonary Embolism. J Invasive Cardiol 2018; 30:157-162. [PMID: 29715164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The effect of early vs delayed use of ultrasound-assisted catheter-directed thrombolysis (USAT) on invasive hemodynamics and in-hospital outcomes in patients with acute submassive pulmonary embolism (PE) is not well known. METHODS We evaluated 41 patients with submassive PE to study the association of early USAT (≤24 hours; n = 21) vs delayed USAT (>24 hours; n = 20) with change in invasive hemodynamic measures from pre USAT to post USAT. RESULTS Significantly greater improvement was observed in the early USAT group compared to the delayed group for median cardiac index (0.6 L/min/m² [IQR, 0.4-1.1 L/min/ m²] vs 0.4 L/min/m² [IQR, 0.1-0.6 L/min/m²]; P=.03), median pulmonary vascular resistance (3.4 Wood units [IQR, 2.5-4.1 Wood units] vs 0.5 Wood units [IQR, 0.2-1.3 Wood units]; P<.001), and mean right ventricular stroke work index (3.5 ± 2.0 g-m/m²/beat vs 2.3 ± 1.6 g-m/m2/beat; P=.04). Although not statistically significant, a trend in favor of early treatment was found for improvement in mean right ventricle to left ventricle diameter ratio (0.38 ± 0.17 vs 0.33 ± 0.21; P=.40), mean pulmonary artery pressure (8.4 ± 7.1 mm Hg vs 5.3 ± 5.2 mm Hg; P=.13), and median pulmonary artery pulsatility index (1.14 [IQR, 2.01-0.45] vs 0.65 [IQR, 0.22-1.78]; P=.49). The mean postprocedural length of stay was significantly lower in the early-USAT group (6.0 ± 2.7 days vs 10.1 ± 7.0 days; P=.02). Three patients experienced moderate bleeding (2 patients in the early-USAT group and 1 patient in the delayed-USAT group) and no major bleeds or in-hospital mortality occurred. CONCLUSION Early USAT was associated with greater improvement in pulmonary hemodynamics and shorter postprocedural length of stay compared with delayed USAT in patients with acute submassive PE.
Collapse
Affiliation(s)
- Sushruth Edla
- VEP, 2nd Floor Cath Lab, 22101 Moross Road, Detroit, MI 48236 USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Song C, Sukul D, Seth M, Dupree JM, Khandelwal A, Dixon SR, Wohns D, LaLonde T, Gurm HS. Ninety-Day Readmission and Long-Term Mortality in Medicare Patients (≥65 Years) Treated With Ticagrelor Versus Prasugrel After Percutaneous Coronary Intervention (from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium). Am J Cardiol 2017; 120:1926-1932. [PMID: 29025684 DOI: 10.1016/j.amjcard.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022]
Abstract
Ticagrelor and prasugrel were found to be superior to clopidogrel for the treatment of acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI); however, the comparative effectiveness of these 2 drugs remains unknown. We compared postdischarge outcomes among older patients treated with ticagrelor versus prasugrel after PCI for ACS. We linked clinical data from PCIs performed in older patients (age ≥65) for ACS at 47 Michigan hospitals to Medicare fee-for-service claims from January 1, 2013, to December 31, 2014, to ascertain rates of 90-day readmission and long-term mortality. We used propensity score matching to adjust for the nonrandom use of ticagrelor and prasugrel at discharge. Logistic regression and Cox proportional hazards models were used to compare rates of 90-day readmission and long-term mortality, respectively. Patients discharged on ticagrelor (n = 1,243) were more frequently older, female, had a history of cerebrovascular disease, and presented with ST- or non-ST-elevation myocardial infarction compared with prasugrel (n = 1,014). After matching (n = 756 per group), there were no significant differences in the rates of 90-day readmission (16.7% ticagrelor vs 14.6% prasugrel; adjusted odds ratio 1.15, 95% confidence interval 0.86 to 1.55, p = 0.35) or 1-year mortality (5.4% ticagrelor vs 3.7% prasugrel; hazard ratio 1.3, 95% confidence interval 0.8 to 2.2, p = 0.31). In conclusion, we found no significant differences in the rates of 90-day readmission or long-term mortality between older patients treated with ticagrelor and patients treated with prasugrel after PCI for ACS. In the absence of randomized data to the contrary, these 2 treatments appear similarly effective.
Collapse
|
6
|
Jalal S, Zein R, Rosman H, LaLonde T, Davis T, Cohen G. Syncope Secondary to Amplatzer Cardiac Plug. Chest 2016. [DOI: 10.1016/j.chest.2016.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
7
|
Gurm HS, Seth M, Mehran R, Cannon L, Grines CL, LaLonde T, Briguori C. Impact of Contrast Dose Reduction on Incidence of Acute Kidney Injury (AKI) Among Patients Undergoing PCI: A Modeling Study. J Invasive Cardiol 2016; 28:142-146. [PMID: 26773238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acute kidney injury is a common complication associated with angiography and percutaneous coronary intervention (PCI). Increasing doses of contrast are associated with an increase in the likelihood of AKI. The objective of our study was to estimate projected reduction in the burden of AKI in association with varying degrees of contrast media dose reduction among patients undergoing PCI. METHODS We assessed the relationship between contrast volume to creatinine clearance among consecutive patients undergoing PCI in the state of Michigan between January 2010 and September 2013. Computational modeling was used to estimate the anticipated reduction in risk of AKI across varying degrees of reduction in contrast volume. RESULTS The risk of AKI was significantly and substantially increased in patients in whom the contrast dose exceeded 2.99 times the creatinine clearance. The benefit of contrast dose reduction was most evident in those at greater predicted risk of AKI. An across the board 30% reduction in contrast dose would be expected to prevent one-eighth of AKI cases, although clinical benefits could also be anticipated with smaller dose reductions. CONCLUSION Our study provides estimates of reduction in AKI that could be achieved with contrast dose reduction in clinical practice. These data should help guide planning of clinical trials and the application of contrast-saving strategies to routine clinical practice.
Collapse
Affiliation(s)
- Hitinder S Gurm
- University of Michigan Cardiovascular Center, 2A394, 1500 E. Medical Center Drive, Ann Arbor, MI 48109- 5853 USA.
| | | | | | | | | | | | | |
Collapse
|
8
|
Ambulgekar N, Grey SF, Rosman H, Othman H, Davis T, Nypaver T, Henke P, Schreiber T, LaLonde T, Gurm H, Mehta R, Grossman P. ASSOCIATION OF ANEMIA WTH OUTCOMES IN PATIENTS UNDERGOING PERCUTANEOUS PERIPHERAL VASCULAR DISEASE INTERVENTION: INSIGHTS FROM THE BMC2 VIC (BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM VASCULAR INTERVENTIONS COLLABORATIVE) REGISTRY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Piyaskulkaew C, Parvataneni K, Ballout H, Szpunar S, Sharma T, Almahmoud M, LaLonde T, Davis T, Mehta RH, Yamasaki H. Laser in infrapopliteal and popliteal stenosis 2 study (LIPS2): Long-term outcomes of laser-assisted balloon angioplasty versus balloon angioplasty for below knee peripheral arterial disease. Catheter Cardiovasc Interv 2015; 86:1211-8. [PMID: 26489379 DOI: 10.1002/ccd.26145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/17/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Laser-assisted balloon angioplasty (LABA) has been shown to be more effective in achieving angiographic success for treatment for below knee peripheral artery disease (PAD) compared with balloon angioplasty alone(BA). However, long-term outcomes of LABA compared with BA for popliteal and infrapopliteal PAD are unknown. METHODS We evaluated data on 726 patients undergoing LABA (n = 395) and BA (n = 331) for popliteal and infrapopliteal PAD retrospectively at a single center (2007-2012). Outcomes included long-term ipsilateral major limb amputation, revascularization and mortality (median follow-up = 36 months). RESULTS Baseline features were similar in two groups with the exception of more TASC-D lesions (92.4 vs. 66.5%; P < 0.0001) and chronic total occlusions (86.4 vs. 49.5%; P < 0.0001) in LABA group. Angiographic success was higher in LABA compared with BA (97.7 vs. 89.2%; P < 0.0001). Ipsilateral major limb amputation (4.1 vs. 5.1%, P = 0.48) and repeat revascularization (25.1 vs. 23.3%, P = 0.47) were similar in LABA and BA patients despite unfavorable baseline angiographic characteristics in the former. Compared with BA, death was more frequently in LABA group (35.2 and 26.3%, P = 0.01), a reflection of higher comorbid conditions in this group (adjusted HR 1.05, 95% CI 0.79-1.39). CONCLUSION Despite worse baseline angiographic characteristics compared with BA, LABA was associated with higher angiographic success and similar ipsilateral major amputation, repeat revascularization, and long-term mortality. Future randomized clinical trial should evaluate the efficacy of LABA compared with BA (particularly drug-eluting) in improving limb salvage and reducing repeat revascularization in these high-risk PAD patients.
Collapse
Affiliation(s)
| | - Kesav Parvataneni
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Hussein Ballout
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Susan Szpunar
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Tarun Sharma
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | | | - Thomas LaLonde
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Thomas Davis
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
| | - Hiroshi Yamasaki
- St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group)
| |
Collapse
|
10
|
Karve AM, Seth M, Sharma M, LaLonde T, Dixon S, Wohns D, Gurm HS. Contemporary Use of Ticagrelor in Interventional Practice (from Blue Cross Blue Shield of Michigan Cardiovascular Consortium). Am J Cardiol 2015; 115:1502-6. [PMID: 25846767 DOI: 10.1016/j.amjcard.2015.02.049] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
Ticagrelor has greater antiplatelet activity than clopidogrel and is approved for use in patients with acute coronary syndrome (ACS). There are limited data on use of ticagrelor in real-world practice. We assessed ticagrelor use in 64,600 patients who underwent percutaneous coronary intervention from January 2012 to March 2014 at 47 Michigan hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Preprocedural risk of major adverse events was estimated with Blue Cross Blue Shield of Michigan Cardiovascular Consortium risk prediction models. The proportion of patients receiving clopidogrel, prasugrel, and ticagrelor was 72% (n = 46,864), 20% (n = 12,596), and 8% (n = 5,140), respectively, using ticagrelor increasing over time. Ticagrelor was used at 45 hospitals, ranging from 0.5% to 64.9% of discharges. Patients receiving ticagrelor were older (63.6 vs 59.4), more often women (32.9% vs 26.7%), and were more likely to present with ST-segment elevation myocardial infarction (24.4% vs 18.8%), cardiogenic shock within 24 hours (1.3% vs 0.9%), and anginal class IV (47.8% vs 43.0%) (p <0.05). Compared with prasugrel, ticagrelor was prescribed in patients with a higher predicted risk of percutaneous coronary intervention complications: contrast nephropathy (2.5% vs 1.6%), transfusion (2.2% vs 1.4%), and death (1.2% vs 0.7%) (p <0.001); >10% of patients were given prasugrel or ticagrelor for a non-ACS indication. Ticagrelor is prescribed to a higher risk population, and 1 in 10 patients prescribed ticagrelor or prasugrel did not have ACS.
Collapse
|
11
|
Karve A, Seth M, Sharma M, LaLonde T, Dixon S, Wohns D, Gurm H. CONTEMPORARY USE OF TICAGRELOR IN THE COMMUNITY: INSIGHTS FROM THE BLUE CROSS BLUE SHIELD OF MICHIGAN CONSORTIUM REGISTRY (BMC2). J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60116-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Piyaskulkaew C, Parvataneni K, Ballout H, Sharma T, LaLonde T, Mehta RH, Yamasaki H. TCT-522 Outcomes of Laser-Assisted Balloon Angioplasty versus Balloon Angioplasty Alone for Below Knee Peripheral Arterial Disease. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Kooiman J, Seth M, Dixon S, Wohns D, LaLonde T, Rao SV, Gurm HS. Response to letters regarding article, "Risk of acute kidney injury after percutaneous coronary interventions using radial versus femoral vascular access: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium". Circ Cardiovasc Interv 2014; 7:421. [PMID: 24944310 DOI: 10.1161/circinterventions.114.001590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith Kooiman
- Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor
| | - Simon Dixon
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI
| | - David Wohns
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI
| | - Thomas LaLonde
- Department of Cardiology, St John Hospital and Medical Center, Detroit, MI
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC
| | - Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor
| |
Collapse
|
14
|
Basoor A, Patel KC, Halabi AR, Todorov M, Senthilvadivel P, Choksi N, Phan T, LaLonde T, Yamasaki H, DeGregorio M. Periprocedural and long-term outcomes of endovascular abdominal aortic aneurysm repair in cardiology practice. Catheter Cardiovasc Interv 2014; 84:1173-9. [DOI: 10.1002/ccd.25548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 05/17/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Abhijeet Basoor
- Division of Cardiology, Department of Medicine; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
- Department of Cardiology and Interventional Cardiology; St. John Hospital and Medical Center; Detroit Michigan
| | - Kiritkumar C. Patel
- Division of Cardiology, Department of Medicine; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | - Abdul R. Halabi
- Division of Cardiology, Department of Medicine; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | - Mina Todorov
- Department of Surgery; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | | | - Nishit Choksi
- Cardiology and Vascular Associates, William Beaumont Hospital; Berkley Michigan
| | - Thanh Phan
- Department of Surgery; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | - Thomas LaLonde
- Department of Cardiology and Interventional Cardiology; St. John Hospital and Medical Center; Detroit Michigan
| | - Hiroshi Yamasaki
- Department of Cardiology and Interventional Cardiology; St. John Hospital and Medical Center; Detroit Michigan
| | - Michele DeGregorio
- Division of Cardiology, Department of Medicine; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| |
Collapse
|
15
|
Gurm HS, Kooiman J, LaLonde T, Grines C, Share D, Seth M. A random forest based risk model for reliable and accurate prediction of receipt of transfusion in patients undergoing percutaneous coronary intervention. PLoS One 2014; 9:e96385. [PMID: 24816645 PMCID: PMC4015942 DOI: 10.1371/journal.pone.0096385] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/08/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transfusion is a common complication of Percutaneous Coronary Intervention (PCI) and is associated with adverse short and long term outcomes. There is no risk model for identifying patients most likely to receive transfusion after PCI. The objective of our study was to develop and validate a tool for predicting receipt of blood transfusion in patients undergoing contemporary PCI. METHODS Random forest models were developed utilizing 45 pre-procedural clinical and laboratory variables to estimate the receipt of transfusion in patients undergoing PCI. The most influential variables were selected for inclusion in an abbreviated model. Model performance estimating transfusion was evaluated in an independent validation dataset using area under the ROC curve (AUC), with net reclassification improvement (NRI) used to compare full and reduced model prediction after grouping in low, intermediate, and high risk categories. The impact of procedural anticoagulation on observed versus predicted transfusion rates were assessed for the different risk categories. RESULTS Our study cohort was comprised of 103,294 PCI procedures performed at 46 hospitals between July 2009 through December 2012 in Michigan of which 72,328 (70%) were randomly selected for training the models, and 30,966 (30%) for validation. The models demonstrated excellent calibration and discrimination (AUC: full model = 0.888 (95% CI 0.877-0.899), reduced model AUC = 0.880 (95% CI, 0.868-0.892), p for difference 0.003, NRI = 2.77%, p = 0.007). Procedural anticoagulation and radial access significantly influenced transfusion rates in the intermediate and high risk patients but no clinically relevant impact was noted in low risk patients, who made up 70% of the total cohort. CONCLUSIONS The risk of transfusion among patients undergoing PCI can be reliably calculated using a novel easy to use computational tool (https://bmc2.org/calculators/transfusion). This risk prediction algorithm may prove useful for both bed side clinical decision making and risk adjustment for assessment of quality.
Collapse
Affiliation(s)
- Hitinder S. Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Judith Kooiman
- Department of Thrombosis and Hemostasis and Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas LaLonde
- Department of Internal Medicine, St John Providence Health System, Detroit, Michigan, United States of America
| | - Cindy Grines
- Department of Internal Medicine, Detroit Medical Center, Detroit, Michigan, United States of America
| | - David Share
- Blue Cross Blue Shield of Michigan, Detroit, Michigan, United States of America
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
16
|
Othman H, Khambatta S, Seth M, LaLonde T, Rosman H, Gurm H, Mehta R. BLEEDING IS ASSOCIATED WITH A GREATER MORTALITY HAZARD IN WOMEN COMPARED WITH MEN: INSIGHTS FROM THE BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM REGISTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60033-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Piyaskulkaew C, Parvataneni K, Ballout H, Sharma T, Almahmoud M, Ketron L, Szpunar S, LaLonde T, Mehta R, Yamasaki H. OUTCOMES OF LASER-ASSISTED BALLOON ANGIOPLASTY VERSUS BALLOON ANGIOPLASTY ALONE FOR BELOW KNEE PERIPHERAL ARTERIAL DISEASE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
18
|
Kooiman J, Seth M, Dixon S, Wohns D, LaLonde T, Rao SV, Gurm HS. Risk of acute kidney injury after percutaneous coronary interventions using radial versus femoral vascular access: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Interv 2014; 7:190-8. [PMID: 24569598 DOI: 10.1161/circinterventions.113.000778] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transradial percutaneous coronary intervention (PCI [TRI]) does not involve catheter manipulation in the descending aorta, whereas transfemoral PCI (TFI) does. Therefore, the risk of acute kidney injury (AKI) after PCI might be influenced by vascular access site. We compared risks of AKI and nephropathy requiring dialysis (NRD) among patients treated with TRI and TFI. METHODS AND RESULTS We included patients across 47 hospitals in Michigan. Primary end point was AKI (serum creatinine increase ≥0.5 mg/dL). Secondary end points were NRD and postprocedural bleeding. Odds ratios (OR) for study end points were calculated for the entire and propensity-matched population, reported as crude, and values adjusted for preprocedural calculated AKI risk. Between 2010 and 2012, a total of 82 225 PCI procedures were performed, of which 8915 were TRI. After adjustment, TRI was associated with a reduction in AKI (OR, 0.76, 95% confidence intervals [0.62-0.92]) and bleeding with a trend toward lower NRD risk. The propensity-matched population consisted of 8857 procedures per group. In this population, TRI was associated with lower adjusted odds of AKI (OR, 0.74; 95% confidence intervals [0.58-0.96]), and bleeding (OR, 0.47; 95% confidence intervals [0.36-0.63]), but no difference in NRD was observed. Although postprocedural bleeding was independently associated with AKI (OR, 2.86; 95% confidence intervals [1.75-4.66]) in the propensity-matched population, the lower odds of AKI was not mediated by a reduction in bleeding with TRI. Sensitivity analysis demonstrated that the observed association between access site and AKI could potentially be explained by a moderately strong unknown confounder. CONCLUSIONS The risk of AKI was significantly lower after TRI compared with TFI. This finding needs to be evaluated in randomized controlled trials.
Collapse
Affiliation(s)
- Judith Kooiman
- From the Departments of Thrombosis and Hemostasis and Nephrology, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands (J.K.); Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.S., H.S.G.); Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (S.D.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); Department of Cardiology, St John Hospital and Medical Center, Detroit, MI (T.L.L.); and The Duke Clinical Research Institute, Durham, NC (S.V.R.)
| | | | | | | | | | | | | |
Collapse
|
19
|
Sandhu A, Seth M, Dixon S, Share D, Wohns D, LaLonde T, Moscucci M, Riba AL, Grossman M, Gurm HS. Contemporary Use of Prasugrel in Clinical Practice. Circ Cardiovasc Qual Outcomes 2013; 6:293-8. [DOI: 10.1161/circoutcomes.111.000060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice.
Methods and Results—
We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent.
Conclusions—
There has been a steady increase in the use of prasugrel with the drug being used in ≈22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.
Collapse
Affiliation(s)
- Amneet Sandhu
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Milan Seth
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Simon Dixon
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - David Share
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - David Wohns
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Thomas LaLonde
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Mauro Moscucci
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Arthur L. Riba
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Michael Grossman
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Hitinder S. Gurm
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| |
Collapse
|
20
|
Ali A, Hashem M, Rosman HS, Moser L, Rehan A, Davis T, Romanelli M, LaLonde T, Yamasaki H, Barbish B, Michael J, Ali SA, Schreiber TL, Gardin JM. Glycoprotein IIb/IIIa Receptor Antagonists and Risk of Bleeding: A Single-Center Experience in 1020 Patients. J Clin Pharmacol 2013; 44:1328-32. [PMID: 15496651 DOI: 10.1177/0091270004269559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The safety of glycoprotein (GP) IIb/IIIa inhibitors has been well documented in clinical trials. Although these trials have included a broad patient population, the strict enrollment criteria may have resulted in exclusion of patients at a higher risk of bleeding complications. The authors conducted a retrospective chart review of 1020 consecutive patients who received GP IIb/IIIa inhibitors and underwent percutaneous coronary intervention in a large community hospital. They used Thrombolysis in Myocardial Infarction (TIMI) criteria to define major or minor bleeding complications. Bleeding complications developed in 214 (21%) patients, with major bleeding in 89 (9%). Univariate predictors of bleeding were older age, lower body weight, elevated serum creatinine, higher activated partial thromboplastin time (aPTT) level, history of diabetes mellitus (DM), peripheral vascular disease (PVD), congestive heart failure (CHF), and emergency procedure for acute myocardial infarction (AMI). Multivariate predictors of major bleeding were PVD (20% in bleeding group vs 11% in nonbleeders, odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.2-2.6, P < .004), age (68 +/- 2 years, 95% CI = 66-70 in bleeding group vs 63 +/- 13 years, 95% CI = 61.2-63 in nonbleeders, P < .001), and higher aPTT level (66 +/- 27 seconds, 95% CI = 63-70 in bleeding group vs 53 +/- 28 seconds, 95% CI = 51-56 in nonbleeders, P < .001). The risk of bleeding in the large community hospital setting may be higher than in randomized clinical trials. This increased risk is associated with higher hospitalization costs. Recognition of predictors of bleeding should further enhance the safety of these antiplatelet agents.
Collapse
Affiliation(s)
- Arshad Ali
- St. John Hospital & Medical Center, Detroit, Michigan, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Perdoncin E, Zhang M, Riba A, LaLonde T, Grines C, Share D, Gurm H. THE IMPACT OF WORSENING RENAL DYSFUNCTION ON THE COMPARATIVE EFFICACY OF BIVALIRUDIN AND PLATELET GLYCOPROTEIN IIBIIIA INHIBITORS: INSIGHTS FROM BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM (BMC2). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Sandhu A, Moscucci M, LaLonde T, Share D, Dixon S, Wohns D, Smith D, Gurm HS. DIFFERENCES IN THE OUTCOME OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS AT TEACHING VERSUS NON-TEACHING HOSPITALS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Flynn A, Moscucci M, Share D, Smith D, LaLonde T, Changezi H, Riba A, Gurm HS. Trends in door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Arch Intern Med 2010; 170:1842-9. [PMID: 21059978 DOI: 10.1001/archinternmed.2010.381] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing percutaneous coronary intervention, current guidelines for reperfusion therapy recommend a door-to-balloon (DTB) time of less than 90 minutes. Considerable effort has focused on reducing DTB time with the assumption that a reduction in DTB time translates into a significant reduction in mortality; however, the clinical impact of this effort has not been evaluated. Therefore, our objective was to determine whether a decline in DTB time in patients with STEMI was associated with an improvement in clinical outcomes. METHODS We assessed the yearly trend in DTB time for 8771 patients with STEMI who were undergoing primary percutaneous coronary intervention from 2003 to 2008 as part of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium and correlated it with trends in in-hospital mortality. Patients were stratified according to risk of death using a mortality model to evaluate whether patient risk factors affect the relationship between DTB time and mortality. RESULTS Median DTB time decreased each year from 113 minutes in 2003 to 76 minutes in 2008 (P < .001), and the percentage of patients who were revascularized with a DTB time of less than 90 minutes increased from 28.5% in 2003 to 67.2% in 2008 (P < .001). In-hospital mortality remained unchanged at 4.10% in 2003, 4.02% in 2004, 4.40% in 2005, 4.42% in 2006, 4.73% in 2007, and 3.62% in 2008 (P = .69). After the differences in baseline characteristics were adjusted for, there was no difference in the standardized mortality ratios (SMRs) across the study period (SMR, 1.00; 95% confidence interval [CI], 0.74-1.26 in 2003 compared with SMR, 0.95; 95% CI, 0.77-1.13 in 2008). CONCLUSIONS There has been a dramatic reduction in median DTB time and increased compliance with the related national guideline. Despite these improvements, in-hospital mortality was unchanged over the study period. Our results suggest that a successful implementation of efforts to reduce DTB time has not resulted in the expected survival benefit.
Collapse
Affiliation(s)
- Anneliese Flynn
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Reed MC, Moscucci M, Smith DE, Share D, LaLonde T, Mahmood SA, D'Haem C, McNamara R, Greenbaum A, Gurm HS. The relative renal safety of iodixanol and low-osmolar contrast media in patients undergoing percutaneous coronary intervention. Insights from Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). J Invasive Cardiol 2010; 22:467-472. [PMID: 20944185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a common complication of percutaneous coronary intervention (PCI). Current guidelines support the use of iodixanol (Visipaque®, GE Healthcare, Princeton, New Jersey) in patients at high risk for CI-AKI. Recent trials and meta-analyses have shown no difference in CI-AKI when iodixanol is compared to low-osmolar contrast media (LOCM). We evaluated the incidence of CI-AKI, in-hospital dialysis and in-hospital death in 58,957 patients who underwent PCI in 2007 and 2008 in a large regional consortium of 31 hospitals and who were treated with iodixanol (n = 17,814) or LOCM (n = 41,143). Propensity-matched analysis was performed to adjust for differences in baseline variables. Patients treated with iodixanol compared to those treated with LOCM were slightly older, had more medical comorbidities and a higher baseline creatinine (1.35 ± 1.07 mg/dL versus 1.10 ± 0.85 mg/dL; p < 0.0001). In propensity-matched, risk-adjusted models, there was no significant difference between iodixanol and LOCM in the risk of CIAKI (4.54% vs. 4.14%; p = 0.14), need for dialysis (0.37% vs. 0.43%; p = 0.35) or death (1.46% vs. 1.39%; p = 0.18). Among patients undergoing PCI, the use of iodixanol was more frequent in older patients with more comorbidities and worse baseline renal function. There was no difference in the adjusted risk of CI-AKI among patients treated with iodixanol compared with those treated with LOCM.
Collapse
Affiliation(s)
- Michael C Reed
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Gualano SK, Gurm HS, Share D, Smith D, Aronow HD, LaLonde T, Bates ER, Changezi H, McNamara R, Moscucci M. Temporal trends in the use of drug-eluting stents for approved and off-label indications: a longitudinal analysis of a large multicenter percutaneous coronary intervention registry. Clin Cardiol 2010; 33:111-6. [PMID: 20186993 DOI: 10.1002/clc.20717] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosis in patients with DES at the 2006 meeting of the European Society of Cardiology (ESC). HYPOTHESIS To determine whether the decrease in use of DES has affected both on and off-label indications. METHODS The study cohort included patients undergoing coronary intervention in a large regional registry, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Patient demographic and clinical characteristics for patients with DES in the third quarter of 2006 (pre-ESC) were compared to those from the fourth quarter of 2008 (post-guideline changes). Use of DES for off-label indications, such as ST-segment elevation myocardial infarction (STEMI), in-stent restenosis (ISR), and saphenous vein graft (SVG) interventions, were evaluated. RESULTS The overall deployment of DES fell sharply from 83% pre-ESC to a plateau of 58% in the first quarter of 2008. This corresponded to a rise in BMS use, while angioplasty procedures stayed the same. The STEMI subgroup showed the most dramatic change, from 78% to only 36%. Off-label use in SVGs showed a similar trend, from 74% to 43%. Drug-eluting stent deployment for ISR was less affected, though it also fell 25% (from 79%-56%). CONCLUSIONS The use of DES has fallen dramatically from June 2006 to December 2008, particularly for nonapproved indications. Our study provides a real-world assessment of contemporary change in DES use in response to the presentation of negative observational studies.
Collapse
Affiliation(s)
- Sarah K Gualano
- Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Grossman PM, Gurm HS, McNamara R, LaLonde T, Changezi H, Share D, Smith DE, Chetcuti SJ, Moscucci M. Percutaneous Coronary Intervention Complications and Guide Catheter Size. JACC Cardiovasc Interv 2009; 2:636-44. [DOI: 10.1016/j.jcin.2009.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 05/21/2009] [Accepted: 05/21/2009] [Indexed: 11/16/2022]
|
27
|
Abstract
OBJECTIVES To determine if stents could be encapsulated with immunocompatible granulation tissue for the treatment of vascular diseases. METHODS Bare metal stents were implanted in New Zealand white rabbits so they would be encapsulated with immunocompatible granulation tissue. The granulation encapsulated stents (GES) were then treated with either mitomycin C or saline, and implanted into rabbit iliac arteries for 4 weeks. To test whether the effect of mitomycin C was retained, we co-cultured smooth muscle cells for 3 h with subcutaneous tissue (as control) or with granulation tissue from GES treated with mitomycin C and saline. RESULTS Vessels with GES treated with mitomycin C (MS) and washed with saline had significantly less neointimal area (NA) after 4 weeks (0.27 (SD 0.03) mm(2) than vessels containing bare metal stents (B) (1.15 (SD 0.10) mm(2), n = 5, p<0.05) or GES treated with saline (S) (4.78 (SD 0.72) mm(2), n = 5, p<0.05). The average vessel injury score was not significantly different among these three groups (S: 1.98 (SD 0.51), MS: 1.46 (SD 0.18) and B: 1.51 (SD 0.32)). GES treated with saline had significantly less NA than the other two groups and also blocked blood flow in the contralateral iliac artery in the abdominal aortic bifurcation immediately after implantation and 4 weeks later. Histology also showed neointimal overgrowth in the vessel wall over the contralateral iliac artery. CONCLUSIONS GES treated with mitomycin C can significantly inhibit neointimal formation in rabbit arteries due to the formation of granulation tissue. GES treated with saline demonstrated significantly increased NA and resisted normal rabbit artery pressures.
Collapse
Affiliation(s)
- Lilong Tang
- Division of Cardiology, The Fifth Affiliated Hospital to Sun Yat-Sen University, Meihua Dong Road 52, Zhuhai, Guangdong, China.
| | | | | | | | | |
Collapse
|
28
|
Awasthi A, Almanaseer Y, LaLonde T, Davis T. Percutaneous retrograde revascularization of lower extremity vessels by using the dorsalis pedis artery: two case reports. J Invasive Cardiol 2006; 18:76-8. [PMID: 16446521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Ashish Awasthi
- St. John Hospital and Medical Center, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
29
|
Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Faul J, Roychoudhury C, Borzak S, Fox S, Franklin M, Freundl M, Kline-Rogers E, LaLonde T, Orza M, Parrish R, Satwicz M, Smith MJ, Sobotka P, Winston S, Riba AA, Eagle KA. Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA 2002; 287:1269-76. [PMID: 11886318 DOI: 10.1001/jama.287.10.1269] [Citation(s) in RCA: 361] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Quality of care of patients with acute myocardial infarction (AMI) has received intense attention. However, it is unknown if a structured initiative for improving care of patients with AMI can be effectively implemented at a wide variety of hospitals. OBJECTIVE To measure the effects of a quality improvement project on adherence to evidence-based therapies for patients with AMI. DESIGN AND SETTING The Guidelines Applied in Practice (GAP) quality improvement project, which consisted of baseline measurement, implementation of improvement strategies, and remeasurement, in 10 acute-care hospitals in southeast Michigan. PATIENTS A random sample of Medicare and non-Medicare patients at baseline (July 1998--June 1999; n = 735) and following intervention (September 1--December 15, 2000; n = 914) admitted at the 10 study centers for treatment of confirmed AMI. A random sample of Medicare patients at baseline (January--December 1998; n = 513) and at remeasurement (March--August 2001; n = 388) admitted to 11 hospitals that volunteered, but were not selected, served as a control group. INTERVENTION The GAP project consisted of a kickoff presentation; creation of customized, guideline-oriented tools designed to facilitate adherence to key quality indicators; identification and assignment of local physician and nurse opinion leaders; grand rounds site visits; and premeasurement and postmeasurement of quality indicators. MAIN OUTCOME MEASURES Differences in adherence to quality indicators (use of aspirin, beta-blockers, and angiotensin-converting enzyme [ACE] inhibitors at discharge; time to reperfusion; smoking cessation and diet counseling; and cholesterol assessment and treatment) in ideal patients, compared between baseline and postintervention samples and among Medicare patients in GAP hospitals and the control group. RESULTS Increases in adherence to key treatments were seen in the administration of aspirin (81% vs 87%; P =.02) and beta-blockers (65% vs 74%; P =.04) on admission and use of aspirin (84% vs 92%; P =.002) and smoking cessation counseling (53% vs 65%; P =.02) at discharge. For most of the other indicators, nonsignificant but favorable trends toward improvement in adherence to treatment goals were observed. Compared with the control group, Medicare patients in GAP hospitals showed a significant increase in the use of aspirin at discharge (5% vs 10%; P<.001). Use of aspirin on admission, ACE inhibitors at discharge, and documentation of smoking cessation also showed a trend for greater improvement among GAP hospitals compared with control hospitals, although none of these were statistically significant. Evidence of tool use noted during chart review was associated with a very high level of adherence to most quality indicators. CONCLUSIONS Implementation of guideline-based tools for AMI may facilitate quality improvement among a variety of institutions, patients, and caregivers. This initial project provides a foundation for future initiatives aimed at quality improvement.
Collapse
Affiliation(s)
- Rajendra H Mehta
- Division of Cardiology, University of Michigan Hospital, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Mehta RH, Montoye CK, Gallogly M, Baker P, Blount A, Borzak S, Kline-Rogers E, LaLonde T, Orza M, Parrish R, Winston S, Riba AA, Eagle KA. Effectiveness of quality improvement initiative (Guidelines Applied to Practice [GAP] project) in improving the care of medicare patients and women with acute myocardial infarction. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)82034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|