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.

scholarly journals Variation in in-hospital mortality and its association with percutaneous coronary intervention-related bleeding complications: A report from nationwide registry in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261371
Author(s):  
Yuichi Sawayama ◽  
Kyohei Yamaji ◽  
Shun Kohsaka ◽  
Takashi Yamamoto ◽  
Yosuke Higo ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
High Mortality ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Percutaneous Coronary ◽  
Institutional Variation ◽  
Very High

Large-scale registries have demonstrated that in-hospital mortality after percutaneous coronary intervention (PCI) varies widely across institutions. However, whether this variation is related to major procedural complications (e.g., bleeding) is unclear. In this study, institutional variation in in-hospital mortality and its association with PCI-related bleeding complications were investigated. We analyzed 388,866 procedures at 718 hospitals performed from 2017 to 2018, using data from a nationwide PCI registry in Japan. Hospitals were stratified into quintiles according to risk-adjusted in-hospital mortality (very low, low, medium, high, and very high). Incidence of bleeding complications, defined as procedure-related bleeding events that required a blood transfusion, and in-hospital mortality in patients who developed bleeding complications were calculated for each quintile. Overall, 4,048 (1.04%) in-hospital deaths and 1,535 (0.39%) bleeding complications occurred. Among patients with bleeding complications, 270 (17.6%) died during hospitalization. In-hospital mortality ranged from 0.22% to 2.46% in very low to very high mortality hospitals. The rate of bleeding complications varied modestly from 0.27% to 0.57% (odds ratio, 1.95; 95% confidence interval, 1.58–2.39). However, mortality after bleeding complications markedly increased by quintile and was 6-fold higher in very high mortality hospitals than very low mortality hospitals (29.0% vs. 4.8%; odds ratio, 12.2; 95% confidence interval, 6.90–21.7). In conclusion, institutional variation in in-hospital mortality after PCI was associated with procedure-related bleeding complications, and this variation was largely driven by differences in mortality after bleeding complications rather than difference in their incidence. These findings underscore the importance of efforts toward reducing not only bleeding complications but also, even more importantly, subsequent mortality once they have occurred.

scholarly journals Sex-related impacts on clinical outcomes after percutaneous coronary intervention

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyun Woo Park ◽  
Seungbong Han ◽  
Gyung-Min Park ◽  
Soe Hee Ann ◽  
Jon Suh ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Hazard Ratio ◽  
Post Discharge ◽  
Percutaneous Coronary

Abstract The aim of this study is to investigate sex-related impacts on clinical outcomes after percutaneous coronary intervention (PCI). We analyzed 90,305 patients (29.0% of women) with the first episode of coronary artery disease who underwent PCI from the Korean National Health Insurance claims database between July 2013 and June 2017. Women were significantly older than men (71.5 ± 10.5 vs. 61.8 ± 11.7 years, p < 0.001). The study population had a median follow-up of 2.2 years (interquartile range, 1.2–3.3). In the propensity-score matched angina population (15,104 pairs), the in-hospital mortality of women was not different from men (odds ratio, 0.87; 95% confidence interval: 0.71–1.08, p = 0.202). However, the post-discharge mortality of women was significantly lower (hazard ratio, 0.74; 95% confidence interval: 0.69–0.80, p < 0.001) than that of men. In the propensity-score matched acute myocardial infarction (AMI) population (8,775 pairs), the in-hospital mortality of women was significantly higher than that of men (odds ratio, 1.19; 95% confidence interval: 1.05–1.34, p = 0.006). Meanwhile, there was no difference in mortality after discharge (hazard ratio, 0.98; 95% confidence interval: 0.91–1.06, p = 0.605). The post-discharge mortality of women was not higher than men under the contemporary PCI treatment. Altered sex-related impacts on clinical outcomes might be attributed to improved medical and procedural strategies.

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.

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.

Heparins crossover in percutaneous coronary intervention: is it a real issue in real-world practice?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Li ◽  
H.Y Weng ◽  
L Zhang ◽  
J Jiang ◽  
Y Zhang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Real World ◽  
Odds Ratio ◽  
Vital Signs ◽  
Coronary Intervention ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Funding Source ◽  
Logistic Regression Models ◽  
Percutaneous Coronary

Abstract Background/Introduction Current guidelines do not recommend heparins crossover in percutaneous coronary intervention (PCI) between unfractionated heparin (UFH) and low molecular weight heparin (LMWH), which is only based on the post-randomization crossovers analysis of SYNERGY trial. However, in real-world practice, heparins crossover is common. Purpose To evaluate bleeding complications in patients who underwent PCI using periprocedural crossover of heparin therapy. Methods From January 2015 to December 2019, all consecutive patients who underwent PCI in our hospital were retrospectively enrolled in this analysis. The primary outcome was a hemoglobin drop ≥3g/dl within 72 hours after the procedure. Results A total of 5,001 patients, including 4,487 (89.72%) with heparins crossover. As shown in figure 1, after a 1:4 ratio of propensity score matching of age, gender, prior medical history, vital signs, body mass index, puncture site, coronary lesion number, stent number, baseline hemoglobin and platelet counts, 539 with crossover and 165 without were matched. There was no difference of the incident of bleeding (1.67% vs. 0.61%, P=0.562) and thrombocytopenia (1.86% vs. 1.82%, P=0.562) between the two groups. In multivariate adjusted logistic regression models, there was no significant association with heparins crossover and bleeding (odds ratio: 0.36; 95% CI, 0.05–2.85) or thrombocytopenia (odds ratio: 0.95; 95% CI, 0.26–3.53). Conclusion(s) In this real-world retrospective analysis of a single center, the periprocedural heparins crossover was not associated with increased bleeding or thrombocytopenia risk. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Youth clinical research project of Peking University First Hospital

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 The Evolving Landscape of Impella Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention With Mechanical Circulatory Support

Circulation ◽  
2020 ◽  
Vol 141 (4) ◽  
pp. 273-284 ◽  
Author(s):  
Amit P. Amin ◽  
John A. Spertus ◽  
Jeptha P. Curtis ◽  
Nihar Desai ◽  
Frederick A. Masoudi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Mechanical Circulatory Support ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Circulatory Support ◽  
Association Analyses ◽  
Percutaneous Coronary

Background: Impella was approved for mechanical circulatory support (MCS) in 2008, but large-scale, real-world data on its use are lacking. Our objective was to describe trends and variations in Impella use, clinical outcomes, and costs across US hospitals in patients undergoing percutaneous coronary intervention (PCI) treated with MCS (Impella or intra-aortic balloon pump). Methods: From the Premier Healthcare Database, we analyzed 48 306 patients undergoing PCI with MCS at 432 hospitals between January 2004 and December 2016. Association analyses were performed at 3 levels: time period, hospital, and patient. Hierarchical models with propensity adjustment were used for association analyses. We examined trends and variations in the proportion of Impella use, and associated clinical outcomes (in-hospital mortality, bleeding requiring transfusion, acute kidney injury, stroke, length of stay, and hospital costs). Results: Among patients undergoing PCI treated with MCS, 4782 (9.9%) received Impella; its use increased over time, reaching 31.9% of MCS in 2016. There was wide variation in Impella use across hospitals (>5-fold variation). Specifically, among patients receiving Impella, there was a wide variation in outcomes of bleeding (>2.5-fold variation), and death, acute kidney injury, and stroke (all ≈1.5-fold variation). Adverse outcomes and costs were higher in the Impella era (years 2008–2016) versus the pre-Impella era (years 2004–2007). Hospitals with higher Impella use had higher rates of adverse outcomes and costs. After adjustment for the propensity score, and accounting for clustering of patients by hospitals, Impella use was associated with death: odds ratio, 1.24 (95% CI, 1.13–1.36); bleeding: odds ratio, 1.10 (95% CI, 1.00–1.21); and stroke: odds ratio, 1.34 (95% CI, 1.18–1.53), although a similar, nonsignificant result was observed for acute kidney injury: odds ratio, 1.08 (95% CI, 1.00–1.17). Conclusions: Impella use is rapidly increasing among patients undergoing PCI treated with MCS, with marked variability in its use and associated outcomes. Although unmeasured confounding cannot be ruled out, when analyzed by time periods, or at the hospital level or the patient level, Impella use was associated with higher rates of adverse events and costs. More data are needed to define the appropriate role of MCS in patients undergoing PCI.

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.

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