Percutaneous Coronary Intervention Following Diagnostic Angiography by Noninterventional Versus Interventional Cardiologists: Insights From the CathPCI Registry

2021 ◽  
Author(s):  
Fabio V. Lima ◽  
Pratik Manandhar ◽  
Daniel Wojdyla ◽  
Tracy Wang ◽  
Herbert D. Aronow ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Ad Hoc ◽  
Major Adverse Cardiovascular Event ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Diagnostic Cardiac Catheterization ◽  
Percutaneous Coronary

Background: There are limited contemporary, national data describing diagnostic cardiac catheterization with subsequent percutaneous coronary intervention (ad hoc percutaneous coronary intervention [PCI]) performed by an invasive-diagnostic and interventional (Dx/IC) operator team versus solo interventional operator (solo-IC). Using the CathPCI Registry, this study aimed at analyzing trends and outcomes in ad hoc PCI among Dx/IC versus solo-IC operators. Methods: Quarterly rates (January 2012 to March 2018) of ad hoc PCI cases by Dx/IC and solo-IC operators were obtained. Odds of inhospital major adverse cardiovascular events, net adverse cardiovascular events (ie, composite major adverse cardiovascular event+bleeding), and rarely appropriate PCI were estimated using multivariable regression. Results: From 1077 sites, 1 262 948 patients were included. The number of invasive-diagnostic operators and cases performed by Dx/IC teams decreased from nearly 9% to 5% during the study period. Patients treated by Dx/IC teams were more often White and had fewer comorbidities compared with patients treated by solo-IC operators. Considerable variation existed across sites, and over two-fifths of sites had 0% ad hoc PCI performed by Dx/IC. In adjusted analyses, ad hoc performed by Dx/IC had similar risks of major adverse cardiovascular event (OR, 1.04 [95% CI, 0.97–1.11]) and net adverse cardiovascular events (OR, 0.98 [95% CI, 0.94–1.03]) compared with solo-IC. Rarely appropriate PCI, although low overall (2.1% versus 1.9%) occurred more often by Dx/IC compared with solo-IC (OR, 1.20 [95% CI, 1.13–1.26]). Conclusions: Contemporary, nationwide data from the CathPCI Registry demonstrates the number of Dx/IC operator teams and cases has decreased but that case volume is stable among operators. Outcomes were independent of operator type, which supports current practice patterns. The finding of a higher risk of rarely appropriate PCI in Dx/IC teams should be further studied.

scholarly journals Comparison of Admission Lung Ultrasound and Left Ventricular End-Diastolic Pressure in Patients Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Gustavo Neves de Araujo ◽  
Rafael Beltrame ◽  
Guilherme Pinheiro Machado ◽  
Julia Luchese Custodio ◽  
Andre Zimerman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiovascular Event ◽  
Primary Percutaneous Coronary Intervention ◽  
Major Adverse Cardiovascular Event ◽  
Coronary Intervention ◽  
Adverse Cardiovascular Event ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Background: Left ventricular end-diastolic pressure (LVEDP) is related to ventricular dysfunction and increased retrograde pulmonary capillary pressure. Lung ultrasound (LUS) is a sensitive and easy-to-use method for assessment of pulmonary congestion. Both methods have shown prognostic value in patients with ST-segment–elevation myocardial infarction. Our aim was to evaluate the correlation between LVEDP and bedside LUS and to compare their prognostic value in patients undergoing primary percutaneous coronary intervention. Methods: Prospective cohort study of ST-segment–elevation myocardial infarction patients treated in a tertiary care hospital in Brazil. LUS was performed immediately before coronary angiography. LVEDP was recorded before primary percutaneous coronary intervention, blinded to LUS results. Primary outcome was any in-hospital major adverse cardiovascular event, defined as in-hospital mortality, new myocardial infarction, stroke, and new cardiogenic shock. Results: In total, 218 patients were included; their mean age was 60 (±12) years, and 64% were men. Cardiogenic shock was present in 16.5% of patients on admission. Overall in-hospital mortality was 15%. Median LVEDP was 19 mm Hg (interquartile range, 13–28); median LUS zones positive for pulmonary congestion were 1/patient (interquartile range, 0–5); Spearman correlation between them was 0.33 ( P <0.001). LVEDP and LUS C statistic for in-hospital major adverse cardiovascular event was 0.63 ([95% CI, 0.55–0.70] P =0.002) and 0.71 ([95% CI, 0.64–0.77] P <0.001), respectively. In multivariable analysis, LUS remained associated with in-hospital major adverse cardiovascular event (odds ratio, 1.14 [95% CI, 1.06–1.23]; P =0.01) for every positive LUS zone; LVEDP, however, did not (odds ratio, 1.01 [95% CI, 0.99–1.03]; P =0.23). Conclusions: We found a weak correlation between LVEDP and LUS in our cohort of ST-segment–elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Pulmonary congestion in acute heart failure is a complex pathophysiological process and goes beyond fluid overload and hemodynamics. Unlike LVEDP, LUS was significantly associated with in-hospital major adverse cardiovascular event, new cardiogenic shock, and in-hospital mortality in multivariable analysis.

scholarly journals Major adverse cardiovascular event (MACE) after percutaneous coronary intervention in one-year follow-up study

10.19082/6383 ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. 6383-6389 ◽  
Author(s):  
Hossein Farshidi ◽  
Ahmadnoor Abdi ◽  
Abdulhussain Madani ◽  
Shahram Moshiri ◽  
Abolfazl Ghasemi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiovascular Event ◽  
Major Adverse Cardiovascular Event ◽  
Coronary Intervention ◽  
Adverse Cardiovascular Event ◽  
Follow Up Study ◽  
Percutaneous Coronary ◽  
One Year

scholarly journals EFFECTIVENESS OF TICAGRELOR COMPARED TO CLOPIDOGREL IN REDUCING THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY HEART DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTION

2017 ◽  
Vol 9 (9) ◽  
pp. 178 ◽  
Author(s):  
Hendra Wana Nur’amin ◽  
Iwan Dwiprahasto ◽  
Erna Kristin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Repeat Revascularization ◽  
Percutaneous Coronary

Objective: Antiplatelet therapy is recommended in patients with coronary heart disease (CHD) who had the percutaneous coronary intervention (PCI) procedure to reduce major adverse cardiovascular events (MACE). There has been a lack of population-based studies that showed the superior effectiveness of ticagrelor over clopidogrel and similar studies have not been conducted in Indonesia yet. The aim of the study was to investigate the effectiveness of ticagrelor compared to clopidogrel in reducing the risk of MACE in patients with CHD after PCI.Methods: A retrospective cohort study with 1-year follow-up was conducted. 361 patients consisted of 111 patients with ticagrelor exposure and 250 patients with clopidogrel exposure. The primary outcome was MACE, defined as a composite of repeat revascularization, myocardial infarction, or all-cause death. The association between antiplatelet exposure and the MACE was analyzed with Cox proportional hazard regression, adjusted for sex, age, comorbid, PCI procedures and concomitant therapy.Results: MACE occurred in 22.7% of the subjects. Clopidogrel had a significantly higher risk of MACE compared with ticagrelor (28.8%, vs 9.0%, hazard ratio (HR): 1.96 (95% CI 1.01 to 3.81, p=0.047). There were no significant differences in risk of repeat revascularization (20.40% vs 5.40%, HR: 2.32, 95% CI 0.99 to 5.42, p = 0.05), myocardial infarction (11.60% vs 3.60%, HR: 2.08, 95% CI, 0.73 to 5.93, p = 0.17), and death (1.60% vs 1.80%, HR: 0.77, 95% CI, 0.14 to 4.25, p = 0.77).Conclusion: Clopidogrel had a higher risk of MACE compared to clopidogrel in patients with CHD after PCI, but there were no significant differences in the risk of repeat revascularization, myocardial infarction, and all-cause death. 

Abstract 12728: Untreated Sleep Apnea Syndrome is Associated With Higher Incidence of Cardiovascular Events After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kazuhiro Fujiyoshi ◽  
Yoshiyasu Minami ◽  
Kohki Ishida ◽  
Miwa Ishida ◽  
Ken-ichiro Wakabayashi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Sleep Apnea ◽  
Cardiovascular Events ◽  
Sleep Apnea Syndrome ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Apnea Syndrome ◽  
The Impact

Introduction: Sleep apnea syndrome (SAS) is a risk factor of cardiovascular disease. However, the impact of SAS on the clinical course after percutaneous coronary intervention (PCI) remains to be elucidated. Methods: A total of 206 consecutive patients who underwent PCI were included. The incidence of major adverse cardiovascular events (MACE) at 3-year was compared among patients with untreated SAS (untreated SAS group; n=60), those with SAS treated by continuous positive alveolar pressure (CPAP group; n=20) and those without SAS (non-SAS group; n=96). MACE included cardiac death, non-fatal myocardial infarction, target vessel revascularization (TVR), and non-TVR (NTVR). Results: There was no significant difference in baseline clinical characteristics among the untreated SAS group, the CPAP group and the non-SAS groups, other than in age (74.1 ± 9.6 vs. 71.2 ± 0.33 vs. 68.2 ± 10.7, p = 0.002) and hemoglobin A1c levels (6.54 ± 0.87 vs. 6.61 ± 0.58 vs. 6.09 ± 0.70 %, p < 0.001). The incidence of MACE, TLR and TVR was significantly higher in the untreated SAS group than in the CPAP group and the Non-SAS group although there was no significant difference in the incidence of NTVR among the three groups (Figure). The untreated SAS was independently associated with the incidence of 3-year MACE (odds ratio 3.24, 95% confidence interval 1.36-8.20, p = 0.008). Conclusions: The incidence of MACE was significantly higher in patients with untreated SAS than in those treated with CPAP and those without SAS after PCI. The present findings may highlight the importance of SAS management in patients requiring PCI.

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