Abstract 71: Causes of 30-day Readmission Rates after Percutaneous Coronary Intervention - Lessons from Direct Chart Review

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jason H Wasfy ◽  
Jordan B Strom ◽  
Kenneth Rosenfield ◽  
Adrian Zai ◽  
Jennifer M Luttrell ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Medical Record ◽  
Stent Thrombosis ◽  
Massachusetts General Hospital ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Readmission Rates ◽  
Quality Metric ◽  
Percutaneous Coronary

Background: Policymakers have designated 30-day readmission after percutaneous coronary intervention (PCI) as an important quality metric. Nevertheless, detailed descriptions of the causes and preventability of readmissions after PCI are lacking, leading some to question the usefulness of readmission as a quality metric. Determination of the causes of 30-day readmissions can help clarify the clinical validity of this measure and enable hospitals to develop strategies to reduce readmission rates. Methods: We identified all readmissions after PCI at the Massachusetts General Hospital occurring within 30 days of discharge from 2007 - 2011. For patients with multiple readmissions, only the first readmission was included. Detailed patient medical record reviews were conducted to ascertain documented reasons for readmission. Results: Among 5573 patients receiving PCI, we identified 651 readmissions within 30 days for medical record review representing 625 unique readmitted patients (11.2%). Of these, 241 readmissions (37.0%) were for the evaluation of chest pain, pressure, or other symptoms concerning for angina without an immediately obvious stent thrombosis. Of those, 21 required repeat PCI (8.7%) and 3 (1.2%) required CABG. Forty patients (6.1%) were readmitted for planned, staged procedures in the absence of new symptoms (“staged PCI”); 18 patients (2.8%) were readmitted non-urgently for peripheral vascular procedures or surgery unrelated to the PCI procedure; 24 patients (3.7%) were admitted for vascular or bleeding complications of the PCI procedure. Conclusions: In this single center study, the largest proportion of readmissions after PCI is due to symptoms that prompt concern for angina, the overwhelming majority of which (90.0%) do not require repeat revascularization. Hospitals may be able to minimize 30-day readmission rates after PCI substantially by postponing non-urgent, non-coronary procedures after PCI. Transferring the evaluation of low-risk chest pain to the outpatient setting or to emergency department observation units could dramatically reduce 30 day readmission rates after PCI. Table 1: Main reason for readmission (N = 651) Chest pain or other symptoms concerning for angina - 238 (36.6%) ** Subset of those patients who received repeat PCI - 21 (3.2%) Staged PCI - 40 (6.1%) Stent thrombosis - 19 (2.9%) Sudden cardiac death - 4 (0.6%) Elective peripheral procedure or surgery not related to PCI - 18 (2.8%) Elective CABG - 14 (2.2%) ** Subset of those patients with failed PCI - 10 (1.5%) ** Subset of those patients with staged CABG after PCI - 4 (0.6%) Vascular/bleeding complication of PCI - 24 (3.7%) Atrial fibrillation - 11 (1.7%) Congestive heart failure - 39 (6.0%) Cholecystitis or cholangitis - 7 (1.1%) Gastrointestinal hemorrhage - 25 (3.8%) Venous thromboembolism - 6 (0.9%) Pneumonia - 10 (1.5%) Urinary tract infection - 9 (1.4%)

scholarly journals Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study)

2018 ◽  
Vol 118 (07) ◽  
pp. 1250-1256 ◽  
Author(s):  
Wael Sumaya ◽  
William Parker ◽  
Rebekah Fretwell ◽  
Ian Hall ◽  
David Barmby ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Pharmacodynamic Effects ◽  
Delayed Onset ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Acute Stent Thrombosis

AbstractDelayed onset of action of oral P2Y12 inhibitors in ST-elevation myocardial infarction (STEMI) patients may increase the risk of acute stent thrombosis. Available parenteral anti-thrombotic strategies, to deal with this issue, are limited by added cost and increased risk of bleeding. We investigated the pharmacodynamic effects of a novel regimen of enoxaparin in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Twenty patients were recruited to receive 0.75 mg/kg bolus of enoxaparin (pre-PPCI) followed by infusion of enoxaparin 0.75 mg/kg/6 h. At four time points (pre-anti-coagulation, end of PPCI, 2–3 hours into infusion and at the end of infusion), anti-Xa levels were determined using chromogenic assays, fibrin clots were assessed by turbidimetric analysis and platelet P2Y12 inhibition was determined by VerifyNow P2Y12 assay. Clinical outcomes were determined 14 hours after enoxaparin initiation. Nineteen of 20 patients completed the enoxaparin regimen; one patient, who developed no-reflow phenomenon, was switched to tirofiban after the enoxaparin bolus. All received ticagrelor 180 mg before angiography. Mean (± standard error of the mean) anti-Xa levels were sustained during enoxaparin infusion (1.17 ± 0.06 IU/mL at the end of PPCI and 1.003 ± 0.06 IU/mL at 6 hours), resulting in prolonged fibrin clot lag time and increased lysis potential. Onset of platelet P2Y12 inhibition was delayed in opiate-treated patients. No patients had thrombotic or bleeding complications. In conclusion, enoxaparin 0.75 mg/kg bolus followed by 0.75 mg/kg/6 h provides sustained anti-Xa levels in PPCI patients. This may protect from acute stent thrombosis in opiate-treated PPCI patients who frequently have delayed onset of oral P2Y12 inhibition.

scholarly journals Acute Pericarditis after Percutaneous Coronary Intervention: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 490
Author(s):  
Greta Rodevič ◽  
Povilas Budrys ◽  
Giedrius Davidavičius
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chest Pain ◽  
Troponin I ◽  
Stable Condition ◽  
Coronary Intervention ◽  
Prior History ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Background: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. Case Summary: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. Conclusions: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

Abstract 317: Costs and Benefits Associated with Transradial Percutaneous Coronary Intervention in China

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Chen Jin ◽  
Xin-ran Tang ◽  
Qiu-ting Dong ◽  
Wei Li ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Length Of Stay ◽  
Cost Saving ◽  
Coronary Intervention ◽  
Observational Research ◽  
Bleeding Complications ◽  
Costs And Benefits ◽  
Hospital Outcomes ◽  
Percutaneous Coronary

Background: Transradial percutaneous coronary intervention (TRI) has been increasingly used in the treatment of ischemic heart disease. While there are few studies examining the costs and benefits of transradial vs. transfemoral (TFI) in experienced centers among highly selected patients, treatment patterns and cost data obtained from the United States and European countries might not be generalizable to the developing world. Methods: We performed a retrospective analysis of patients undergoing PCI in the largest heart center in China between January and December 2010. Propensity score inverse probability weighting (IPW) method was used to compare costs and in-hospital outcomes between TRI and TFI, while controlling for potential treatment selection inherent in observational research. Results: Of 5,307patients undergoing PCI, 4,684 (88.3%) received TRI. Those undergoing TRI were younger, were less likely to be female, less likely to have prior myocardial infarction, PCI, or CABG, and more often presented with STEMI. After IPW adjustment, TRI was associated with fewer bleeding complications (BARC≥3 0.7% vs. 2.2%, OR 0.36, 95% CI 0.18-0.68), major adverse cardiovascular event (a composite of death, myocardial infarction, BARC bleeding≥3 or unplanned revascularization; 1.8% vs. 4.0%, OR 0.49, 95% CI 0.31-0.79), and shorter length of stay (6.1 vs 8.3 days, adjusted difference -1.5 days, 95% CI -1.9 to -1.2; Table ). TRI was associated with a cost saving of $1,261 (95% CI $967-$1,557) as compared with TFI. The cost saving was mainly driven by reduced procedural-related cost ($761) from differential use of vascular closure device and lower hospitalization cost ($217) related to shorter length of stay. Similar results were found in clinically relevant groups of myocardial infarction (STEMI and NSTEMI), acute coronary syndrome (STEMI, NSTEMI, and unstable angina), and stable angina. Conclusions: Compared with the TFI approach, TRI was associated with fewer complications, shorter length of stay, lower costs, and improved in-hospital outcomes.

scholarly journals Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashraf Alazzoni ◽  
Ayman Al-Saleh ◽  
Sanjit S. Jolly
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Stent Thrombosis ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Vessel ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Target Vessel Revascularization ◽  
Percutaneous Coronary

Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20–0.51; P<0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P=0.0005), (ii) late (day 31–365) (0.2% versus 0.6%; OR: 0.32; P=0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.

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