Abstract 17081: Outcomes of Percutaneous Coronary Intervention in Cirrhosis: Does the Stent Type Matter?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Juan Daniel Del Cid Fratti ◽  
Miguel Salazar ◽  
Pedro Palacios ◽  
Tauseef Akhtar ◽  
Ezequiel Muñoz
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Hospital Charges ◽  
Decompensated Cirrhosis ◽  
Metal Stents ◽  
Total Hospital ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Hospitalization Costs

Methods: National Inpatient Sample was queried from 2016-2017 for discharges of adult patients with cirrhosis who underwent percutaneous coronary intervention (PCI) with placement of drug-eluding-stents (DES) and bare-metal-stents (BMS) using ICD-10CM/PCS-codes. Patients were subsequently divided between compensated/decompensated cirrhosis as per the BAVENO Score. The primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications, length of stay (LOS), total hospital charges/costs. Multivariate logistic regression analysis was performed to adjust for confounders. Results: 899,899 PCIs were identified out of which 0.6% (n=5,983) had concomitant cirrhosis. Patients with compensated and decompensated cirrhosis had higher odds of BMS placement when undergoing PCI when compared with patients without cirrhosis [aOR 1.57; (P<0.01)], [aOR 1.54; (P=0.05) respectively]. There was no significant difference in mortality between BMS and DES in patients with compensated-cirrhosis, and similar results were obtained in patients with decompensated-cirrhosis. DES was associated to higher LOS when compared to BMS in patients with decompensated-cirrhosis [4.93; (P:<0.01)], and higher total hospital costs [16, 031.94; (P:<0.01)]. Patients with decompensated-cirrhosis and DES had higher risk of post-procedure bleeding when compared with BMS [aOR 4.22; (P:<0.01)]. Conclusions: Patients admitted for PCI with decompensated-cirrhosis have higher LOS and total hospitalization costs when DES is placed. Likely driven by higher post-procedural bleeding in this set of patients, requiring further intervention. BMS seemed to be safe when used in patients with cirrhosis and is not associated with higher in-hospital mortality even in patients with decompensated-cirrhosis.

scholarly journals Sex Disparities in the Management and Outcomes of Cardiogenic Shock Complicating Acute Myocardial Infarction in the Young

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Lina Ya’Qoub ◽  
Mandeep Singh ◽  
Malcolm R. Bell ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Percutaneous Coronary ◽  
Hospitalization Costs

Background: There are limited data on how sex influences the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in young adults. Methods: A retrospective cohort of AMI-CS admissions aged 18 to 55 years, during 2000 to 2017, was identified using the National Inpatient Sample. Use of coronary angiography, percutaneous coronary intervention, mechanical circulatory support and noncardiac interventions was identified. Outcomes of interest included in-hospital mortality, use of cardiac interventions, hospitalization costs, and length of stay. Results: A total 90 648 AMI-CS admissions ≤55 years of age were included, of which 26% were women. Higher rates of CS were noted in men (2.2% in 2000 to 4.8% in 2017) compared with women (2.6% in 2000 to 4.0% in 2017; P <0.001). Compared with men, women with AMI-CS were more frequently of Black race, from a lower socioeconomic status, with higher comorbidity, and admitted to rural and small hospitals (all P <0.001). Women had lower rates of ST-segment elevation presentation (73.0% versus 78.7%), acute noncardiac organ failure, cardiac arrest (34.3% versus 35.7%), and received less-frequent coronary angiography (78.3% versus 81.4%), early coronary angiography (49.2% versus 54.1%), percutaneous coronary intervention (59.2% versus 64.0%), and mechanical circulatory support (50.3% versus 59.2%; all P <0.001). Female sex was an independent predictor of in-hospital mortality (23.0% versus 21.7%; adjusted odds ratio, 1.11 [95% CI, 1.07–1.16]; P <0.001). Women had lower hospitalization costs ($156 372±$198 452 versus $167 669±$208 577; P <0.001) but comparable lengths of stay compared with men. Conclusions: In young AMI-CS admissions, women are treated less aggressively and experience higher in-hospital mortality than men.

Abstract 1685: Clinical and Angiographic Outcomes following Percutaneous Coronary Intervention with Sirolimus-Eluting Stents vs. Bare Metal Stents in Hemodialysis Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sen Yachi ◽  
Kengo Tanabe ◽  
Hirosada Yamamoto ◽  
Shuji Otsuki ◽  
Atsuhiko Yagishita ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Hemodialysis Patients ◽  
Metal Stents ◽  
Control Group ◽  
Bare Metal ◽  
Percutaneous Coronary ◽  
Significant Difference

Background Percutaneous coronary intervention in hemodialysis patients has been hampered by high rate of major adverse cardiac events (MACE). It remains uncertain whether sirolimus-eluting stent (SES) improves clinical outcomes in hemodialysis patients compared to bare metal stent (BMS). Methods The present study consisted of consecutive 46 hemodialysis patients with 57 lesions treated with SES from August 2004 to April 2006. For comparison, the control group was composed of 67 hemodialysis patients with 70 lesions who were treated with BMS in three years before the introduction of SES. Clinical and angiographic follow-up were performed after 8 months. MACE included all-cause death, myocardial infarction and repeat target vessel revascularization. Results Baseline characteristics were comparable between the 2 groups except for lesion length. Clinical follow-up was available in all patients. Angiographic follow-up was obtained in 39 patients (84.8%) in the SES group and 49 patients (73.1%) in the BMS group. There was no difference in MACE between the 2 groups (SES;28.3%, BMS;40.3%, p=0.19). As shown in the table , quantitative angiographic analysis revealed a significant difference in late lumen loss (SES;0.66±0.80mm, BMS;1.07±0.75mm, p=0.01), however, the rate of binary restenosis was identical (SES;31.9%, BMS;40.4%, p=0.38). Of the angiographic restenosis lesions analyzed, focal restenosis pattern was frequently observed in the SES group than the BMS group(SES;93.3%, BMS;23.8%, p<0.0001), whereas diffuse restenosis pattern was dominant in the BMS group. Conclusion Angiographic parameters favored inhibition of neointimal hyperplasia by SES. However, the inhibitory effect of sirolimus was not translated into clinical superiority over BMS in hemodialysis patients. Table. Serial QCA data

scholarly journals Prognostic significance of inflammatory biomarkers in diabetic and non-diabetic patients with STEMI, treated with primary percutaneous coronary intervention

2019 ◽  
Vol 76 (10) ◽  
pp. 979-984
Author(s):  
Veljko Milic ◽  
Boris Dzudovic ◽  
Slobodan Obradovic
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Primary Percutaneous Coronary Intervention ◽  
Prognostic Significance ◽  
Coronary Intervention ◽  
Inflammatory Biomarkers ◽  
Diabetic Patients ◽  
Percutaneous Coronary ◽  
Tertiary Center ◽  
Significant Difference

Background/Aim. Although the prognostic significance of inflammatory biomarkers, C-reactive protein (CRP) and fibrinogen, in the patients with the ST-segment elevation myocardial infarction (STEMI) is already known, the specific difference between such patients according to diabetic status remains unknown. Methods. The study was conducted in a single tertiary center. The values of CRP and fibrinogen were measured during the first 48 h in consecutive patients with first STEMI treated with primary percutaneous coronary intervention (pPCI). The patients were divided into two groups: with diabetes and without diabetes. The aim of this study was to determine a prognostic significance of maximal values of these two inflammatory biomarkers for in-hospital and six-month mortality in these two groups. Results. Among 475 patients, 126 (26.5%) were with diabetes and 349 (73.5%) were without diabetes. The patients with diabetes had significantly higher median values of CRP and fibrinogen compared to the nondiabetic patients [29.6 (10.4?91.8) mg/L vs 22.4 (9.79?49.2) mg/L, p = 0.046 and 4.7 (3.6?6.3) g/L vs 4.3 (3.6?5.4) g/L, p = 0.026, respectively]. However, the multivariate survival analysis using the Cox regression model showed that in the nondiabetic STEMI patients CRP and fibrinogen had significant prognostic value for in-hospital mortality [hazard ratio (HR) = 1.013, 95% confidence interval (CI) (1.004?1.022), p = 0.004; HR = 1.529 (1.023?2.287), p = 0.039, respectively]. Regarding six-month mortality, no significant difference was achieved. Overall survival was the lowest in the fourth quartile of CRP in the patients without diabetes. Conclusion. The higher values of CRP are the significant independent predictor of in-hospital and overall mortality in the STEMI patients without diabetes treated with primary PCI. Fibrinogen can also be used as an additional prognostic inflammatory biomarker for in-hospital mortality in the non-diabetics with STEMI.

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

scholarly journals In-Hospital Mortality in Patients Receiving Percutaneous Coronary Intervention According to Nurse Staffing Level: An Analysis of National Administrative Health Data

2020 ◽  
Vol 17 (11) ◽  
pp. 3799
Author(s):  
Yunmi Kim ◽  
Jiyun Kim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Nurse Staffing ◽  
Coronary Intervention ◽  
First Grade ◽  
Estimation Model ◽  
Staffing Level ◽  
Percutaneous Coronary ◽  
General Wards

The increasing incidence of ischemic heart disease is concomitantly increasing percutaneous coronary intervention (PCI) treatments. Adequate nurse staffing has enhanced quality of care and this study was conducted to determine the relationship between survival-related PCI treatment and the level of nursing staff who care for patients admitted to receive PCI. National Health Insurance claims data from 2014 to 2015 for 67,927 patients who underwent PCI in 43 tertiary hospitals were analyzed. The relationships of nurse staffing in intensive care units (ICUs) and general wards with survival after PCI were investigated using logistic regression analyses with a generalized estimation model. The in-hospital mortality rate in ICUs was lower in hospitals with first-grade nurse staffing {odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.23–0.48}, second-grade nurse staffing (OR = 0.55, 95% CI = 0.40–0.77), or third-grade nurse staffing (OR = 0.71, 95% CI = 0.53–0.95) than in hospitals with fifth-grade nurse staffing. Nurse staffing in general wards was not related to in-hospital mortality due to PCI treatment. This study found that nurse staffing in PCI patients requiring short-term intensive care significantly affected patient survival. An understanding of the importance of managing the ICU nursing workforce for PCI treatment is required.

scholarly journals Prasugrel versus ticagrelor in patients with myocardial infarction undergoing percutaneous coronary intervention

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318694
Author(s):  
Dimitrios Venetsanos ◽  
Erik Träff ◽  
David Erlinge ◽  
Emil Hagström ◽  
Johan Nilsson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Similar Efficacy ◽  
Efficacy And Safety ◽  
Adjusted Risk ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Evidence Based Care

ObjectiveThe comparative efficacy and safety of prasugrel and ticagrelor in patients with myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) remain unclear. We aimed to investigate the association of treatment with clinical outcomes.MethodsIn the SWEDEHEART (Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies) registry, all patients with MI treated with PCI and discharged on prasugrel or ticagrelor from 2010 to 2016 were included. Outcomes were 1-year major adverse cardiac and cerebrovascular events (MACCE, death, MI or stroke), individual components and bleeding. Multivariable adjustment, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for confounders.ResultsWe included 37 990 patients, 2073 in the prasugrel group and 35 917 in the ticagrelor group. Patients in the prasugrel group were younger, more often admitted with ST elevation MI and more likely to have diabetes. Six to twelve months after discharge, 20% of patients in each group discontinued the P2Y12 receptor inhibitor they received at discharge. The risk for MACCE did not significantly differ between prasugrel-treated and ticagrelor-treated patients (adjusted HR 1.03, 95% CI 0.86 to 1.24). We found no significant difference in the adjusted risk for death, recurrent MI or stroke alone between the two treatments. There was no significant difference in the risk for bleeding with prasugrel versus ticagrelor (2.5% vs 3.2%, adjusted HR 0.92, 95% CI 0.69 to 1.22). IPTW and PSM analyses confirmed the results.ConclusionIn patients with MI treated with PCI, prasugrel and ticagrelor were associated with similar efficacy and safety during 1-year follow-up.

scholarly journals Retrospective cohort analysis of Spanish national trends of coronary artery bypass grafting and percutaneous coronary intervention from 1998 to 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046141
Author(s):  
Manuel Carnero Alcazar ◽  
Daniel Hernandez-Vaquero ◽  
Hector Cubero-Gallego ◽  
Jose Lopez Menendez ◽  
Miguel Piñon ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Artery Bypass ◽  
National Health System ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Percutaneous Coronary

IntroductionSpain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG).ObjectivesTo investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain.DesignRetrospective cohort study. Analysis of in-hospital outcomes.SettingMinimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System.Participants603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded.Primary and secondary outcomesWe investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques.ResultsWe observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998–2002) to 8.1 (2013–2017). Charlson’s index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p<0.001) and a small increase in PCI (1.2% vs 1.5%, p<0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p<0.001), and PCI (1.42 vs 1.05, p<0.001).ConclusionWe detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced.

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