Care following percutaneous coronary intervention

2018 ◽  
pp. 81-90
Author(s):  
Kevin O’Gallagher ◽  
Jonathan Byrne ◽  
Philip MacCarthy
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
Outpatient Setting ◽  
Know How ◽  
Non Invasive ◽  
Percutaneous Coronary ◽  
Term Management

This chapter covers how to take care of a patient in both the short term and the long term after a percutaneous coronary intervention (PCI) procedure. Post-procedural care involves monitoring the patient for any signs of complications and taking the appropriate steps to correct these in a timely manner. Certain patients, based on various criteria, are more likely to have complications than others and it is vital to know how to identify these patients. Prompt identification and treatment of complications improves outcomes. The length of hospital stay will also vary from patient to patient, and this chapter covers how to assess when a patient is stable and suitable for discharge. Longer term management in the outpatient setting after PCI is described, with guidance on the indications for repeat non-invasive testing/angiography.

Acute Kidney Injury and In-Hospital Mortality after Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention: A Nationwide Study

2017 ◽  
Vol 45 (3) ◽  
pp. 217-225 ◽  
Author(s):  
Wen Shen ◽  
Rodrigo Aguilar ◽  
Alex R. Montero ◽  
Stephen J. Fernandez ◽  
Allen J. Taylor ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Background: Post-procedural acute kidney injury (AKI) is associated with significantly increased short- and long-term mortalities, and renal loss. Few studies have compared the incidence of post-procedural AKI and in-hospital mortality between 2 major modalities of revascularization - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - and results have been inconsistent. Methods: We generated a propensity score-matched cohort that includes a total of 286,670 hospitalizations with multi-vessel coronary disease undergoing CABG or PCI (2004-2012) from the National Inpatient Sample database. We compared incidence of AKI, AKI requiring renal replacement therapy (RRT), in-hospital mortality, hospital stay, and charges between CABG and PCI groups. Results: The incidence of AKI after CABG was higher than PCI (8.9 vs. 4.5%, OR 2.05, 95% CI 1.99-2.12, p < 0.001). The incidence of AKI requiring RRT was also higher after CABG (1.1 vs. 0.5%, OR 2.14, 95% CI 1.96-2.34, p < 0.001). Likewise, in-hospital mortality was higher after CABG than PCI (2.0 vs. 1.4%, OR 1.44, 95% CI 1.35-1.52, p < 0.001). Among patients with pre-existing chronic kidney disease (stages I-IV), those undergoing CABG was associated with 2.0-2.3-fold higher odds of developing AKI than those undergoing PCI. The patients treated with CABG had a significantly longer hospital stay and higher hospital charges. Conclusions: Patients undergoing CABG are associated with (1) increased risk of developing post-procedural AKI, (2) higher likelihood of receiving RRT, and (3) worse short-term survival. Long-term renal outcome remains to be studied.

77 Impact of Frailty on Length of Hospital Stay After Percutaneous Coronary Intervention

Heart ◽  
2014 ◽  
Vol 100 (Suppl 3) ◽  
pp. A45.1-A45 ◽  
Author(s):  
Rachel Murali-Krishnan ◽  
Javaid Iqbal ◽  
Rebecca Rowe ◽  
Yasir Parviz ◽  
Ayyaz Sultan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
Percutaneous Coronary

scholarly journals Prevention of Risk and Complications Associated with Heart Catheterization

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Mary W Mwaura
Keyword(s):  
Health Care ◽  
Percutaneous Coronary Intervention ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Interdisciplinary Team ◽  
Coronary Intervention ◽  
Heart Catheterization ◽  
Nursing Theory ◽  
Access Site ◽  
Percutaneous Coronary

Nurses play a dynamic role, in the interdisciplinary team within the health care arena. The purpose of this paper is to demonstrate the nurse’s role in the prevention of risks and access site complications following heart catheterization using complexity integration nursing theory. The initiative could save our nation tax dollars towards health care by reducing length of hospital stay, loss of work days and reduce exorbitant costs related to the management of access site complications following percutaneous coronary intervention

Abstract 14055: Trend and Predictors of Prolonged Length of Hospital Stay Following Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in The United States: A 10 Year Perspective

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hemang B Panchal ◽  
Sreenivas P Veeranki ◽  
Samit Bhatheja ◽  
Ashraf Abusara ◽  
Timir Paul
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Stay ◽  
Stent Placement ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
The United States ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Length of hospital stay (LOS) following percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) significantly affects healthcare utilization and cost. There is paucity of data in the United States on the optimal LOS following PCI for STEMI. Our study objective is to assess the trend and predictors of prolonged LOS following PCI with stent placement for STEMI. Methods: Data were obtained from nationwide inpatient sample from 2003-2012, which is a 20% stratified probability sample of all non-federal acute care hospitalizations. Study outcome was prolonged LOS defined as stay in hospital for >4 days following PCI for STEMI. Cochrane-Armitage trend test and multivariable logistic regression models were used to delineate the predictors of prolonged LOS which included patient’s demographics, baseline comorbidities, presenting illnesses and in-hospital complications following PCI for STEMI. Results: A total of 223,267 patients with STEMI underwent PCI with stent placement with a mean LOS of 3.3±3.3 days. There were 16.1% patients who had prolonged LOS. The trend analysis showed that incidence of prolonged LOS decreased from 17.1% in year 2003 to 14.3% in year 2012 (p<0.05) (figure 1A). Pneumonia and peri-procedural intra-aortic balloon pump use were the strongest predictors for prolonged LOS. Other significant predictors for prolonged LOS following PCI for STEMI were history of congestive heart failure, anemia, respiratory failure requiring ventilator use; peri-procedural stroke and anemia or hemorrhage requiring blood transfusion (figure 1B). Conclusions: Incidence of prolonged LOS has consistently decreased over 10 years. Patient’s baseline comorbidities, illnesses at presentation and in-hospital complications can predict prolonged LOS following PCI for STEMI. Implementing an aggressive standard of care to prevent in-hospital complications can further shorten the LOS following PCI for STEMI.

Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System

2016 ◽  
Vol 11 (1) ◽  
pp. 33
Author(s):  
Yohei Sotomi ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Percutaneous Coronary ◽  
Orbital Atherectomy ◽  
Long Term Follow Up ◽  
Coronary Lesions ◽  
Calcified Coronary Lesions

Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (&gt;50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF&lt;40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF&lt;40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p&lt;0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p&lt;0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p&lt;0.001) and median age (61 vs. 59 vs. 64 years, p&lt;0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p&lt;0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p&lt;0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p&lt;0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (&lt;40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

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