scholarly journals Percutaneous Coronary Intervention Outcomes Based on Decision‐Making Capacity

Author(s):  
Jarmanjeet Singh ◽  
Nicholas Kassis ◽  
Keerat R. Ahuja ◽  
Chirag Sheth ◽  
Beni R. Verma ◽  
...  

Background Long‐term outcomes of percutaneous coronary intervention (PCI) based on patients’ decision‐making ability have not been studied. Our objective was to assess long‐term outcomes after PCI in patients who provided individual versus surrogate consent. Methods and Results Data were collected retrospectively for patients who underwent PCI at Cleveland Clinic between January 1, 2015 and December 31, 2016. Inclusion criteria consisted of hospitalized patients aged ≥20 years who had PCI. Patients with outpatient PCI, or major surgery 30 days before or 90 days after PCI, were excluded. Patients who underwent PCI with surrogate consent versus individual consent were matched using the propensity analysis. Kaplan–Meier, log rank, t ‐statistic, and χ 2 tests were used for statistical analysis. The study was approved by the Institutional Review Board at Cleveland Clinic, Ohio. Of 3136 patients who underwent PCI during the study period, 183 had surrogate consent. Propensity matching yielded 149 patients from each group. Two‐year all‐cause mortality was significantly higher in the surrogate consent group (38 [25.5%] versus 16 [10.7%] deaths, log‐rank χ 2 =10.16, P <0.001). The 2‐year major adverse cardiac events rate was also significantly higher in the surrogate consent group (60 versus 36 events, log‐rank χ 2 =8.36, P =0.003). Conclusions Patients with surrogate consent had significantly higher all‐cause mortality and higher major adverse cardiac events when compared with patients with individual consent. This study emphasizes the fact that patients with an inability to give consent are at high risk and may need special attention in postprocedural and postdischarge care.

2021 ◽  
Vol 17 ◽  
Author(s):  
Azka Latif ◽  
Muhammad Junaid Ahsan ◽  
Noman Lateef ◽  
Vikas Kapoor ◽  
Hafiz Muhammad Fazeel ◽  
...  

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.


Author(s):  
Andrew Kei‐Yan Ng ◽  
Pauline Yeung Ng ◽  
April Ip ◽  
Man‐Hong Jim ◽  
Chung‐Wah Siu

Background Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long‐term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory‐wide retrospective cohort study including 26 022 patients who underwent first‐ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all‐cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all‐cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63–0.78; P <0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73–0.83, P <0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70–0.87, P <0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68–0.85, P <0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82–1.13, P =0.655). Conclusions Radial access was associated with a significant reduction in all‐cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Takahashi ◽  
T Dohi ◽  
T Funamizu ◽  
H Endo ◽  
H Wada ◽  
...  

Abstract Background Inflammatory status pre-percutaneous coronary intervention (PCI) and post-PCI has been reported not only associated with poor prognosis, but also to impair renal function. Statins reduce cardiovascular events by lowering lipids and have anti-inflammatory impacts, but residual inflammatory risk (RIR) exists. It remains unclear that the synergistic effect of RIR and chronic kidney disease (CKD) on long-term clinical outcome in stable coronary artery disease (CAD) patients undergoing PCI in statin era. Aim The aim of this study was to investigate the long-term combined impact of RIR evaluating hs-CRP at follow-up and CKD among stable CAD patients undergoing PCI in statin era. Methods This is a single-center, observational, retrospective cohort study assessing consecutive 2,984 stable CAD patients who underwent first PCI from 2000 to 2016. We analyzed 2,087 patients for whom hs-CRP at follow-up (6–9 months later) was available. High residual inflammatory risk was defined as hs-CRP &gt;0.6 mg/L according to the median value at follow up. Patients were assigned to four groups as Group1 (high RIR and CKD), Group2 (low RIR and CKD), Group3 (high RIR and non-CKD) or Group4 (low RIR and non-CKD). We evaluated all-cause death and major adverse cardiac events (MACE), defined as a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke. Results Of patients (83% men; mean age 67 years), there were 299 (14.3%) patients in group 1, 201 (9.6%) patients in group 2, 754 (36.1%) patients in group 3, and 833 (39.9%) patients in group 4. The median follow-up period was 5.2 years (IQR, 1.9–9.9 years). In total, 189 (frequency, 16.1%) cases of all-cause death and 128 (11.2%) MACE were identified during follow-up, including 53 (4.6%) CV deaths, 27 (2.4%) MIs and 52 (4.8%) strokes. The rate of all-cause death and MACE in group 1 was significantly higher than other groups (p&lt;0.001, respectively). There was a stepwise increase in the incidence rates of all-cause death and MACE. After adjustment for important covariates, the presence of high RIR and/or CKD were independently associated with higher incidence of MACE and higher all-cause mortality. (shown on figure). Conclusion The presence of both high RIR and CKD conferred a synergistic adverse effect on the risk for long-term adverse cardiac events in patients undergoing PCI. Kaplan-Meier curve Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Ryota ◽  
K Wakabayasi ◽  
K Shibata ◽  
T Nishikura ◽  
T Shinke ◽  
...  

Abstract Background The appropriate treatment for silent myocardial ischemia (SMI) is controversial. The prognosis of asymptomatic patients after percutaneous coronary intervention (PCI) is unknown. Asymptomatic patients might be sicker and have delay of diagnosis when they have coronary events in clinical course. We, thus, hypothesized SMI are associate with the poor outcomes after PCI for stable coronary artery disease (CAD). Purpose The present study compared the long-term outcomes of patients with SMI vs. stable angina pectoris (SAP) after elective PCI. Methods Our prospective registry database included 923 consecutive patients with CAD who underwent PCI from October 2015 to August 2018. Patients with emergent PCI, acute coronary syndrome at admission, or chronic total occlusion patients were not included. A total 613 patients (71.4±11.2 years, 75.7% male) who underwent elective PCI were studied. The end points included all-cause mortality, non-fatal myocardial infarction, and repeat revascularization. Results They were divided into 2 groups according to symptom status: SMI (n=392) and SAP (n=221). SMI patients were predominantly men, and more frequently had diabetes mellitus (197 [50.4%] vs. 91 [41.2%], p=0.028), previous myocardial infarction (44 [11.3%] vs. 8 [3.6%], p=0.001) and heart failure hospitalization.Echocardiography showed SMI groups had reduced ejection fraction (56.9±12.6 vs 63.3±9.1, P&lt;0.001), extended left ventricular internal dimension in diastole (48.5±6.2 vs 47.4±5.8, p=0.048) and left ventricular diameter at end systole (32.8±7.6 vs 30.5±7.5, p=0.001). Mean duration of follow-up was 20.9±10.6 months. The incidence of non-fatal myocardial infarction and repeat revascularization was similar between the 2 groups (10 [2.6%] vs. 5 [2.3%], p=0.82, and 50 [12.8%] vs. 30 [13.6%], p=0.77, respectively). The incidence of all-cause and cardiovascular mortality was more frequent in SMI patients (26 [6.6%] vs. 6 [2.7%], p=0.036, and 9 [3.1%] vs 1 [0.5%], p=0.035, respectively). Kaplan-Meier survival curves indicated that SMI patients had significantly higher all cause-mortality than SAP patients (log-rank, p=0.0184, Hazard ratio 1.24 (1.05–1.47), p=0.013). In multivariable analysis, SMI was an independent predictor of all cause-mortality (Hazard-ratio 5.17, 95% CI 1.35–34.29, p=0.014). Conclusion In patients with stable CAD undergoing elective PCI, SMI was associated with an increase in mortality. Optimal care for SMI patients after PCI should be clarified in future studies. Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 73 (4) ◽  
pp. 662-667
Author(s):  
Nataliya V. Izhytska ◽  
Dmytro I. Besh ◽  
Olesya M. Besh ◽  
Adrian Y. Fil

The aim: To investigate long-term effects of primary percutaneous coronary interventions (pPCI) in patients with STEMI basing on the prevalence of clinically relevant endpoints. Materials and methods: Totally 200 patients with STEMI hospitalized within a period of “therapeutic window” for revascularization were included into the study. 100 patients who additionally to pPCI underwent manual thromboaspiration entered the main group. The comparison group consisted of 100 patients who underwent standard pPCI. Results: Six months after the pPCI, the incidence of either major adverse cardiac events and the combined endpoint did not differ in the main and comparative groups (11.8% vs. 12.5%, p = 0.888 and 18.2% vs. 20.8%, p = 0.658, respectively). There were no significant differences in these endpoints taken separately. In twelve months after procedure, also there were no significant differences between the groups. However, a tendency toward lower incidence of chest pain was observed in the main group (p = 0.08) during this period that was lost in 24 months after pPCI. None of these techniques demonstrated significant advantages during the whole duration of the follow-up period. Conclusions: The addition of manual thromboaspiration to the standard pPCI in patients with STEMI and severe thrombosis of the culprit artery did not significantly influence the prognosis.


Angiology ◽  
2008 ◽  
Vol 60 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Qiangjun Cai ◽  
Kimberly Skelding ◽  
Armstrong Arthur ◽  
Dipan Desai ◽  
G. Craig Wood ◽  
...  

Limited data exist regarding the predictors of long-term clinical outcomes following elective percutaneous coronary intervention (PCI) in the current era of stenting. The authors investigated the predictors of major adverse cardiac events (MACE) and clinical restenosis in 740 consecutive patients who underwent successful elective PCI with bare metal stents (BMSs) or drug-eluting stents (DESs). At 30-month follow -up, compared with BMS recipients, DES recipients had a significantly lower rate of MACE, which was mainly driven by a decreased repeat target vessel PCI. The rate of 30-month clinical restenosis was significantly lower in DES recipients. The authors conclude that baseline clinical, angiographic, and procedural characteristics determine long-term MACE and clinical restenosis after elective PCI, with DES being the independent predictor for both.


2020 ◽  
Vol 5 (01) ◽  
pp. 18-24
Author(s):  
A. Siva Ramakrishna ◽  
V. Satish Kumar Rao ◽  
Garre Indrani

Abstract Background We aimed to recognize the predictors of long-term major adverse cardiac events (MACE) in the elderly candidates for elective percutaneous coronary intervention (PCI) in relation to gender at our center. Methods In this retrospective cohort study, we reviewed the data of the elderly patients (age ≥70 years) who underwent elective PCI who met our study criteria in our institution during 2008 and 2018. Demographical data, clinical history, angiographic details, PCI procedure, and follow-up data of the patients enrolled in the study were studied by using the angiographic and PCI procedure details. Patients were characterized in the study group as those with or without MACE, which were then compared and analyzed using the statistical analysis in a univariable and binary linear regression analysis. Results A total of 355 elderly patients (older than 70 years) undergoing elective PCI were selected who fulfilled the inclusion criteria; 277 patients were men and had more comorbidities, including hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease, history of heart failure, previous coronary artery bypass graft, and presentation with acute coronary syndrome. MACE occurred in 24 events patients of whom 20 were suffering from DM. Binary logistic regression showed that the only determinant for the 1-year follow-up outcome is diabetes (p = 0.000). Even in univariate analysis, DM (0.01) is the determinant. DM is a strong predictor for death in univariate analysis (p = 0.00). Conclusion PCI is a safe and effective method of coronary revascularization in elderly patients, and some risk factors can predict long-term MACE in this group of patients.


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