Abstract 236: Coronary Artery Procedures in the Cardiac Catheterization Laboratory After Overnight Call: Are Patients at Higher Risk?

Background: Overnight call can lead to sleep deprivation and fatigue. It was hypothesized that complications will increase when coronary artery procedures are performed the day after overnight call (i.e. post-call). The present study was undertaken to test this hypothesis.

Methods: From June 2009 to May 2013, >20,000 patients underwent a cardiac procedure in a large referral catheterization laboratory of which 10,190 patients (12.7%, n=1,298 post-call) underwent only coronary arteriography with (37%) or without (83%) percutaneous coronary intervention (PCI) with no other cardiac procedure(s). Procedural complications related to post-call status were determined.

Results: Mean age was 61±12 years (male 65%). Overall complications were 2.6%: 1.0% bleeding, 1.0% myocardial infarction (MI), 0.3% new dialysis, 0.3% heart failure, 0.1% cardiogenic shock, 0.2% vascular, 0.1% stroke and 0.01% cardiac tamponade (certain patients had >1 complication). Overall there was statistically greater procedural complications when performed post-call (3.5%) compared to no post-call (2.5%; p=0.04); however, when adjusting for significant baseline variables, there was no difference seen between groups. From multivariate analysis of 23 factors, the following contributed independently to complications: ST-elevation MI (odds ratio 4.2, confidence interval [CI] 2.3-7.1), femoral vs. radial access (odds ratio 2.4, CI 1.7-3.3), non-ST-elevation MI (odds ratio 2.1, confidence interval [CI] 1.6-2.7), PCI (odds ratio 2.1, CI 1.6-2.7), history of heart failure (odds ratio 1.6, CI 1.2-2.1), female (odds ratio 1.4, CI 1.1-1.8), and age (odds ratio 1.2, CI 1.1-1.3 per 10 years). Glomerular filtration rate <60 ml/min was associated with more complications compared to >60 ml/min (p=0.007).

Conclusion: There were greater procedural complications when performed post-call compared to no post-call; however, when adjusting for significant baseline variables, there was no significant difference seen between groups. Taking into consideration factors that contributed to procedural complications most likely will improve patient outcomes.

Comparison of Impella and intra-aortic balloon pump in high-risk percutaneous coronary intervention: vascular complications and incidence of bleeding

OBJECTIVE

Compare vascular complications and incidence of bleeding of Impella 2.5 and intra-aortic balloon pump (IABP) in high-risk percutaneous coronary interventions (PCI).

BACKGROUND

Large arterial sheath size for device insertion is associated with vascular and/or bleeding complications; gastrointestinal bleeding may also occur with anti-coagulation use.

METHODS

Patients with an acute coronary syndrome receiving Impella 2.5 or IABP during high-risk PCI were studied (13 Impella; 62 IABP). Vascular complications and incidence of bleeding were compared.

RESULTS

Post-procedure hematocrit was similar between groups. Blood transfusion occurred in 38.4% and 32.2% of patients in the Impella and IABP groups, respectively (P = NS); 65.3%, 30.7% and 3.8% of bleeding were due to vascular access site/procedure related, gastrointestinal and genitourinary, respectively. There was no statistical significant difference in vascular complications between the Impella and IABP groups (15.3% and 6.4% of patients, respectively); mesenteric ischemia (n = 1) and aortic rupture (n = 1) were only in the IABP group. In-hospital and one-year mortality were not statistically significant between groups.

CONCLUSION

Impella can be used as safely as IABP during high-risk PCI with similar vascular and bleeding complications. Importantly, approximately one third of bleeding was from the gastrointestinal system warranting careful prophylactic measures and monitoring.