scholarly journals Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey

2017 ◽  
Vol 17 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Bypass Graft ◽  
Participation Rate ◽  
Coronary Intervention ◽  
Lower Probability ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim: The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. Methods: Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008–2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. Results: Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%–31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74–3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32–1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05–1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32–0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey

2020 ◽  
pp. 147451512094053
Author(s):  
Ji-Su Kim ◽  
Gwang S Kim ◽  
Seok-Min Kang ◽  
Sang H Chu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Health Behaviour ◽  
Odds Ratio ◽  
Health Belief ◽  
Coronary Intervention ◽  
Education Programme ◽  
Symptom Experience ◽  
Percutaneous Coronary

Background: Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. Aims: The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. Methods: A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. Results: Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45–8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28–6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08–1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02–1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00–1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. Conclusion: This study provides evidence that educational programmes to help improve patients’ perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.

scholarly journals Personalized Antiplatelet Therapy Based on CYP2C19 Genotypes in Chinese ACS Patients Undergoing PCI: A Randomized Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiujin Shi ◽  
Yunnan Zhang ◽  
Yi Zhang ◽  
Ru Zhang ◽  
Baidi Lin ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Chinese Patients ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of pharmacogenomic antiplatelet therapy in Chinese patients.Methods: Patients with acute coronary syndrome planning to undergo percutaneous coronary intervention were eligible for this study and were randomly divided into a genotype-guided treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group underwent CYP2C19 genotyping (*2 and *3 alleles), and the results were considered in selecting P2Y12 receptor inhibitors. Patients in the RT group were treated with P2Y12 receptor inhibitors according to their clinical characteristics. The primary endpoint was a composite of major adverse cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant bleeding events.Results: Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years. In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16 patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE rates than the RT group (6/189 vs. 10/92, 3.2 vs. 10.9%, hazard ratio: 0.281, 95% confidence interval: 0.102–0.773, P = 0.009). There was no statistically difference in significant bleeding events between the GT and RT groups (4.2 vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349–4.956, P = 0.685).Conclusion: Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000034352.

scholarly journals The Rise of Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndromes in Australia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ryan James Ocsan ◽  
Ata Doost ◽  
Paul Marley ◽  
Ahmad Farshid
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Bypass Graft ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Percutaneous Coronary

Objectives. The aim of this study was to evaluate the outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) via transradial artery access (TRA) or transfemoral artery access (TFA). Background. Over the last decade, evidence for the benefit of TRA for PCI has grown, leading to a steady uptake of TRA around the world. Despite this, the topic remains controversial with contrary evidence to suggest no significant benefit over TFA. Methods. A retrospective study of consecutive ACS patients from 2011 to 2017 who underwent PCI via TRA or TFA. The primary outcome was Major Adverse Cardiovascular Events (MACE), a composite of death, myocardial infarction (MI), target lesion revascularisation (TLR), or coronary artery bypass graft surgery (CABG) at 12 months. Secondary outcomes included Bleeding Academic Research Consortium (BARC) bleeding events scored 2 or higher, haematoma formation, and stent thrombosis, in addition to all individual components of MACE. Results. We treated 3624 patients (77% male), with PCI via TFA (n = 2391) or TRA (n = 1233). Transradial artery access was associated with a reduction in mortality (3% vs 6.3%; p < 0.0001 ), MI (1.8% vs 3.9%; p = 0.0004 ), CABG (0.6% vs 1.5%; p = 0.0205 ), TLR (1% vs 2.9%; p < 0.0001 ), large haematoma (0.4% vs 1.8%; p = 0.0003 ), BARC 2 (0.2% vs 1.1%; p = 0.0029 ), and BARC 3 events (0.4% vs 1.0%; p = 0.0426 ). On multivariate Cox regression analysis, TFA, age ≥ 75, prior PCI, use of bare metal stents, cardiogenic shock, cardiac arrest, and multivessel coronary artery disease were associated with an increased risk of MACE. Conclusion. Despite the limitations secondary to the observational nature of our study and multiple confounders, our results are in line with results of major trials and, as such, we feel that our results support the use of TRA as the preferred access site in patients undergoing PCI for ACS to improve patient outcomes.

scholarly journals The Clinical Prediction Factors for Non-Culprit Lesion Progression in Patients with Acute ST Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
jian wang ◽  
Cheng-ying Yan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background To investigate the relationship between the clinical features and progression of non-culprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods A total of 480 patients (57.1 ± 9.2 y) with STEMI who underwent PPCI between January 2016 and December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as a treatment for culprit lesions. Clinical and angiographic follow-up were performed for 12 months. All patients were divided into a non-culprit lesions (NCL) progression group (205 cases) and a control group (275 cases) based on angiographic follow-up outcomes at 12 months. The clinical and angiographic features were analyzed. Results Body mass index (BMI), serum creatinine (Scr), fasting blood glucose (FBG), glycated serum albumin, glycated hemoglobin and homocysteine levels in the NCL progression group were significantly higher than those in the control group (P < 0.05). A logistic regression analysis showed that FBG (odds ratio = 1.274, 95% confidence interval: 1.077–1.505, P = 0.005) and Scr (odds ratio = 1.020, 95% confidence interval: 1.002–1.038, P = 0.027) were independent predictors of NCL progression. A partial correlation analysis showed that FBG was positively correlated with NCL progression (r = 0.231, P = 0.001). A receiver operating characteristic curve showed that the boundary point of FBG to predict NCL progression was 5.715 mmol/L, and the sensitivity was 74.4% and the specificity was 46.4%. Conclusions FBG is a valuable predictor for NCL progression in patients with STEMI after PPCI.

Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium

2021 ◽  
Author(s):  
Devraj Sukul ◽  
Milan Seth ◽  
Michael P. Thompson ◽  
Steven J. Keteyian ◽  
Thomas F. Boyden ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Administrative Claims ◽  
Odds Ratios ◽  
Clinical Registry ◽  
Hospital Referral ◽  
Percutaneous Coronary ◽  
Ratio Range

BACKGROUND: Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators. Methods: We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics. Results: Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06–5.42) and 1.64 (95% CI, 1.55–1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63–2.15) and 1.40 (95% CI, 1.35–1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52–2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92–3.75) and operator (odds ratio range, 1.26–2.82). Conclusions: In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.

scholarly journals Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART

2019 ◽  
Vol 9 (5) ◽  
pp. 480-487 ◽  
Author(s):  
Sebastian Völz ◽  
Petur Petursson ◽  
Oskar Angerås ◽  
Jacob Odenstedt ◽  
Dan Ioanes ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Entire Study ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
One Year

Aims: Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old. Methods and results: We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12–0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36–2.51, p = 0.847). Conclusions: PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.

scholarly journals Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

2020 ◽  
Vol 9 (11) ◽  
pp. 3612
Author(s):  
Yohei Numasawa ◽  
Taku Inohara ◽  
Hideki Ishii ◽  
Kyohei Yamaji ◽  
Shun Kohsaka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Bleeding Complications ◽  
Dialysis Patients ◽  
Nationwide Registry ◽  
Percutaneous Coronary

Although baseline hemoglobin and renal function are both important predictors of adverse outcomes after percutaneous coronary intervention (PCI), scarce data exist regarding the combined impact of these factors on outcomes. We sought to investigate the impact and threshold value of the hemoglobin to creatinine (Hgb/Cr) ratio, on in-hospital adverse outcomes among non-dialysis patients in a Japanese nationwide registry. We analyzed 157,978 non-dialysis patients who underwent PCI in 884 Japanese medical institutions in 2017. We studied differences in baseline characteristics and in-hospital clinical outcomes among four groups according to their quartiles of the Hgb/Cr ratios. Compared with patients with higher Hgb/Cr ratios, patients with lower ratios were older and had more comorbidities and complex coronary artery disease. Patients with lower hemoglobin and higher creatinine levels had a higher rate of in-hospital adverse outcomes including in-hospital mortality and procedural complications (defined as occurrence of cardiac tamponade, cardiogenic shock after PCI, emergency operation, or bleeding complications that required blood transfusion). On multivariate analyses, Hgb/Cr ratio was inversely associated with in-hospital mortality (odds ratio: 0.91, 95% confidence interval: 0.89–0.92; p < 0.001) and bleeding complications (odds ratio: 0.92, 95% confidence interval: 0.90–0.94; p < 0.001). Spline curve analysis demonstrated that these risks started to increase when the Hgb/Cr ratio was <15, and elevated exponentially when the ratio was <10. Hgb/Cr ratio is a simple index among non-dialysis patients and is inversely associated with in-hospital mortality and bleeding complications after PCI.

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