scholarly journals Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention

2020 ◽  
pp. ASN.2020040502
Author(s):  
Joseph Lunyera ◽  
Robert M. Clare ◽  
Karen Chiswell ◽  
Julia J. Scialla ◽  
Patrick H. Pun ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Racial Differences ◽  
Medical Center ◽  
Reference Value ◽  
Coronary Intervention ◽  
Absolute Increase ◽  
Black Patients ◽  
Percutaneous Coronary ◽  
Duke University ◽  
Multiple Domains

BackgroundUndergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure.MethodsWe examined the association of self-reported race (Black, White, or other) and baseline eGFR with AKI incidence among patients who underwent PCI at Duke University Medical Center between January 1, 2003, and December 31, 2013. We defined AKI as a 0.3 mg/dl absolute increase in serum creatinine within 48 hours, or ≥1.5-fold relative elevation within 7 days post-PCI from the reference value ascertained within 30 days before PCI.ResultsOf 9422 patients in the analytic cohort (median age 63 years; 33% female; 75% White, 20% Black, 5% other race), 9% developed AKI overall (14% of Black, 8% of White, 10% of others). After adjustment for demographics, socioeconomic status, comorbidities, predisposing medications, PCI indication, periprocedural AKI prophylaxis, and PCI procedural characteristics, Black race was associated with increased odds for incident AKI compared with White race (odds ratio [OR], 1.79; 95% confidence interval [95% CI], 1.48 to 2.15). Compared with Whites, odds for incident AKI were not significantly higher in other patients (OR, 1.30; 95% CI, 0.93 to 1.83). Low baseline eGFR was associated with graded, higher odds of AKI incidence (P value for trend <0.001); however, there was no interaction between race and baseline eGFR on odds for incident AKI (P value for interaction = 0.75).ConclusionsBlack patients had greater odds of developing AKI after PCI compared with White patients. Future investigations should identify factors, including multiple domains of social determinants, that predispose Black individuals to disparate AKI risk after PCI.

Clopidogrel Adherence following Percutaneous Coronary Intervention with a Drug-Eluting Stent in a VA Medical Center

2009 ◽  
Vol 25 (3) ◽  
pp. 164-168 ◽  
Author(s):  
Adhir Shroff ◽  
Ambreen Ali ◽  
Vicki L Groo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Medical Center ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Duration Of Therapy ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Clopidogrel Therapy

Background: Antiplatelet therapy with aspirin and a thienopyridine is the standard of care for prevention of thrombosis following coronary stent implantation. Recent evidence suggests a prolonged risk of stent thrombosis; therefore, clopidogrel therapy for at least 1 year is recommended following implantation of a drug-eluting stent. Premature discontinuation of clopidogrel is a well-recognized risk factor for stent thrombosis. Objective: To identify the rate of adherence to clopidogrel therapy among patients who have undergone percutaneous coronary intervention (PCI). Methods: We queried the central Veteran Affairs (VA) pharmacy database for each patient who underwent PCI with a drug-eluting stent between September 2004 and August 2005 at a single VA medical center. Based on pharmacy refill records, patients were considered adherent to clopidogrel if they filled more than 80% of the clopidogrel prescriptions. Results: We observed that 20.3% of patients were nonadherent to clopidogrel therapy for the course that they were assigned. Shorter duration of therapy was the only factor that predicted increased adherence. Race, polypharmacy, marital status, prior clopidogrel use, and age did not have a significant impact on adherence. Multivariable analysis did not demonstrate any other significant relationships. Conclusions: In this high-risk cohort of patients who have undergone PCI, we observed a 20% incidence of nonadherence to clopidogrel therapy. Shorter duration of therapy had a significant impact on improving rates of adherence in our analysis. This observation is of particular concern given the recent recommendations to prolong antiplatelet therapy to at least 1 year following PCI with a drug-eluting stent.

Outcomes Following Percutaneous Coronary Intervention Before, During, and After Transition to a Default Transradial Approach at a Veterans Affairs Medical Center

Angiology ◽  
2020 ◽  
Vol 71 (7) ◽  
pp. 602-608
Author(s):  
Jayant Bagai ◽  
Azad R. Bhuiyan ◽  
Christopher J. White ◽  
Debabrata Mukherjee ◽  
Timir K. Paul
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Veterans Affairs ◽  
Major Adverse Cardiovascular Events ◽  
Time Period ◽  
Percutaneous Coronary ◽  
Short Time

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.

P6529Safety of emergency pretreatment regimen for contrast allergy before percutaneous coronary intervention for ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Jha ◽  
A Berger ◽  
J Blankenship
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Medical Center ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prior History ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Contrast Allergy

Abstract Background Primary percutaneous coronary intervention (PPCI) is the best treatment for ST-elevation myocardial infarction (STEMI). However, patients with prior contrast reactions may not receive PCI due to concern over a recurrent contrast reaction. Purpose To determine the clinical efficacy of emergency pretreatment regimens for contrast allergy in STEMI patients undergoing PPCI. Methods We retrospectively identified all individuals with a history of contrast allergy who presented with STEMI, were pretreated for contrast allergy, and underwent PPCI at our medical center between January 2005 to May 2018. Emergency pretreatment regimen included a combination of intravenous (IV) steroid, IV famotidine and IV diphenhydramine administered immediately before PCI. Laboratory records, inpatient notes, and discharge summaries were reviewed to confirm the severity of the original contrast allergy and identify any allergic breakthrough reaction after pretreatment with an emergency regimen. Reactions were characterized as mild, moderate, severe, or of unknown severity. Results During the study period 15,712 individuals underwent PCI, of which 176 patients presented with STEMI, had confirmed contrast allergy, and were pretreated before undergoing PCI. No patient with a history of contrast allergy underwent PPCI without pre-treatment. Mean age was 64 years, with 52% males, and all individuals were white. The majority had hypertension (77%), 67% had dyslipidemia, 29% had diabetes mellitus, and 20% patients had a prior history of MI. Intravenous steroids used in the emergency regimen included methylprednisone (n=100), hydrocortisone (n=70), and dexamethasone (n=6). The original allergic response to ICM was mild in 59% patients, moderate in 15%, severe in 20% and of unknown severity in 13% patients. Of the 176 patients only 10 (5.6%) developed a breakthrough reaction. Most of which were mild; none was fatal. Median length of hospital stays was three days and nine patients (10.8%) passed away within 30 days of hospital admission. Conclusions Patients with prior contrast allergy presenting with STEMI can safely undergo PPCI after emergency pretreatment. Breakthrough reactions are infrequent and mild.

Racial Differences in Long-Term Outcomes after Percutaneous Coronary Intervention with Paclitaxel-Eluting Coronary Stents

2012 ◽  
Vol 26 (1) ◽  
pp. 49-57 ◽  
Author(s):  
WAYNE B. BATCHELOR ◽  
STEPHEN G. ELLIS ◽  
JOHN A. ORMISTON ◽  
GREGG W. STONE ◽  
ANITA A. JOSHI ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Racial Differences ◽  
Coronary Intervention ◽  
Coronary Stents ◽  
Long Term Outcomes ◽  
Percutaneous Coronary

scholarly journals The effect of chronic total coronary occlusion percutaneous coronary intervention on absolute perfusion in remote myocardium

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R W De Winter ◽  
S P Schumacher ◽  
P A Van Diemen ◽  
R A Jukema ◽  
Y B O Somsen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion ◽  
Linear Correlation ◽  
Coronary Occlusion ◽  
Coronary Intervention ◽  
Remote Myocardium ◽  
Absolute Increase ◽  
Percutaneous Coronary ◽  
Positive Linear Correlation ◽  
Chronic Total Coronary Occlusion

Abstract Background Successful revascularization of a chronic total coronary occlusion (CTO) impacts coronary physiology of the remote myocardial territory. Purpose This study evaluated the effect of CTO percutaneous coronary intervention (PCI) on changes in absolute perfusion in remote myocardium as assessed by serial [15O]H2O positron emission tomography (PET) perfusion imaging. Methods A total of 164 patients underwent [15O]H2O PET imaging at baseline and 3 months after successful single-vessel revascularization of a CTO to evaluate changes in hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in the remote myocardial territory supplied by both non-target coronary arteries. Results Remote hMBF and CFR improved (2.29±0.67 to 2.48±0.75 mL min–1 g–1 and 2.48±0.76 to 2.74±0.85, respectively) after CTO revascularization (p&lt;0.01 for both). Absolute perfusion indices in the CTO vessel and the remote myocardium showed a positive linear correlation, both before (r=0.75, p&lt;0.01 and r=0.77, p&lt;0.01 for hMBF and CFR, respectively) and after (hMBF: r=0.87, p&lt;0.01 and CFR: r=0.81, p&lt;0.01) CTO PCI. Absolute increases in remote myocardial perfusion were largest in patients with a higher increase in hMBF (βeta [β] 0.56; 95% CI: 0.47–0.65; p&lt;0.01) and CFR (β 0.51 (0.42–0.60); p&lt;0.01) in the CTO territory, independent of clinical, angiographic and procedural characteristics. Furthermore, baseline (hMBF: β −0.24 (−0.39, −0.08); p&lt;0.01 and CFR: β −0.26 (−0.41, −0.11); p&lt;0.01) and post-PCI perfusion (hMBF: β 0.36; (0.27, 0.46); p&lt;0.01 and CFR: β 0.30 (0.21, 0.40); p&lt;0.01) in the CTO vessel were independently associated with the increase in remote myocardial perfusion after CTO PCI. Conclusions An overall increase in remote myocardial perfusion was observed following CTO PCI. Absolute perfusion indices in the remote myocardium showed a positive linear correlation with perfusion in the CTO vessel, before and after CTO revascularization. Importantly, baseline, post-PCI and the absolute increase in perfusion in the CTO territory were independently associated with increases in remote myocardial perfusion after revascularization. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Challenges of Using Peri-procedural Myocardial Infarction as a Quality Measure Among Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tracy Y Wang
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Quality Measure ◽  
Data Registry ◽  
Percutaneous Coronary ◽  
Duke University ◽  
National Cardiovascular

Abstract 1754 Tracy Y Wang, David Dai, Eric D Peterson, Sunil V Rao, Matthew T Roe, Duke University, Durham, NC; on behalf of the National Cardiovascular Data Registry Tracy Y Wang, 2007 Finalist and Presenting Author

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