A National Evaluation of Emergency Cardiac Surgery After Percutaneous Coronary Intervention and Postsurgical Patient Outcomes

Background: Percutaneous coronary intervention is performed by operators with differing experience, technique, and case mix. It is unknown if operator practice patterns impact patient outcomes. We sought to determine if a cluster algorithm can identify distinct profiles of percutaneous coronary intervention operators and if these profiles are associated with patient outcomes. Methods: Operators performing at least 25 annual procedures between 2014 and 2018 were clustered using an agglomerative hierarchical clustering algorithm. Risk-adjusted in-hospital mortality was compared between clusters. Results: We identified 4 practice profiles among 7706 operators performing 2 937 419 procedures. Cluster 1 (n=3345) demonstrated case mix and practice patterns similar to the national median. Cluster 2 (n=1993) treated patients with lower clinical acuity and were less likely to use intracoronary diagnostics, atherectomy, and radial access. Cluster 3 (n=1513) had the lowest case volume, were more likely to work at rural hospitals, and cared for a higher proportion of patients with ST-segment–elevation myocardial infarction and cardiogenic shock. Cluster 4 (n=855) had the highest case volume, were most likely to treat patients with high anatomic complexity and use atherectomy, intracoronary diagnostics, and mechanical support. Compared with cluster 1, adjusted in-hospital mortality was similar for cluster 2 (estimated difference, −0.03 [95% CI, −0.10 to 0.04]), higher for cluster 3 (0.14 [0.07–0.22]), and lower for cluster 4 (−0.15 [−0.24 to −0.06]). Conclusions: Distinct percutaneous coronary intervention operator profiles are differentially associated with patient outcomes. A phenotypic approach to physician assessment may provide actionable feedback for quality improvement.

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Current state of the performance of percutaneous coronary intervention in centres without on-site cardiac surgery

Internal Medicine Journal ◽

10.1111/j.1445-5994.2012.02898.x ◽

2012 ◽

Vol 42 ◽

pp. 58-67

Author(s):

E. Oqueli

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Coronary Intervention ◽

Current State ◽

Percutaneous Coronary

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Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽

10.1093/med/9780198784906.003.0639 ◽

2018 ◽

pp. 2659-2663

Author(s):

Fabio Rigamonti ◽

Marco Roffi

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Myocardial Revascularization ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Drug Eluting Stent ◽

Metal Stents ◽

Percutaneous Coronary ◽

Reduction Strategies ◽

Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

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Rotate-on-Retract Procedural Automation for Robotic-Assisted Percutaneous Coronary Intervention: First Clinical Experience

Case Reports in Cardiology ◽

10.1155/2018/6086034 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Arif Al Nooryani ◽

Wael Aboushokka

Keyword(s):

Percutaneous Coronary Intervention ◽

Patient Outcomes ◽

Coronary Intervention ◽

Robotic Platform ◽

Robotic Assisted ◽

Endovascular Interventions ◽

Calcified Lesion ◽

Percutaneous Coronary ◽

Human Use ◽

Improve Patient

The advent of percutaneous coronary intervention (PCI) has dramatically changed the outlook for patients with cardiovascular disease. However, room for improvement and advancement remains in the safety, speed, and efficiency of manually guided PCI. In recent years, the CorPath robotic platform (Corindus Inc., Waltham, MA) has been approved to aid the interventionalist during PCI and other endovascular interventions. Favorable results in several clinical studies suggest that robotic-assisted PCI may further improve patient outcomes while also benefiting the interventionalist through reduced orthopedic strain and less exposure to ionizing radiation. In this report, we communicate our experience with the first-in-human use of a new, optional automation feature that has been added to the platform’s guidance software. This “Rotate-on-Retract” feature is designed to facilitate faster and more precise maneuvering of the guidewire through tortuous vessels by automatically rotating the guidewire whenever it is retracted by the operator. This movement changes the tip’s orientation in preparation for the next advancement. We evaluated this feature in a patient undergoing PCI to treat a severe (90% stenotic), long, diffuse, and calcified lesion of the proximal to mid LAD segments.

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