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Shamkhani W, Rashid M, Moledina S, Ludman P, Curzen N, Wijeysundera HC, Grines CL, Mamas MA. Complex High-Risk Percutaneous Coronary Intervention Types, Trends, and Outcomes in Nonsurgical Centres. Can J Cardiol 2024:S0828-282X(24)00010-2. [PMID: 38215968 DOI: 10.1016/j.cjca.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Limited data are available on complex high-risk percutaneous coronary intervention (CHiP) trends and outcomes in nonsurgical centres (NSCs), particularly in health care systems where most centres are NSCs. METHODS Using data from a national registry, we studied the characteristics and outcomes of CHiP procedures performed for stable angina from 2006 to 2017 according to the presence or absence of on-site surgical cover. Multivariate regression analyses and propensity score matching were used to determine risks for in-hospital death, major bleeding, and major cardiovascular or cerebral events (MACCE). RESULTS Out of 134,730 CHiP procedures, 42,433 (31.5%) were performed in NSCs, increasing from 12.5% in 2006 to 42% in 2017. Compared with surgical centres (SCs), patients who had a CHiP procedure undertaken in NSCs were, on average, 2.4 years older and had a greater prevalence of cardiovascular risks. Common CHiP procedures performed in NSCs included poor left ventricular function (41.6%), chronic renal failure (38.8%), and chronic total occlusion percutaneous coronary intervention (31.1%). NSC-based CHiP is associated with lower odds of mortality (adjusted odds ratio [aOR] 0.7, 95% confidence interval [CI] 0.5-0.8) and major bleeding (aOR 0.7, 95% CI 0.6-0.8). In both groups, MACCE odds were similar (aOR 1.0, 95% CI 0.9-1.1). CONCLUSIONS CHiP numbers have steadily increased in NSCs. NSC patients were older and had a higher prevalence of cardiovascular risks than SC patients. Mortality and major bleeding odds were significantly lower in those cases undertaken in NSCs, although MACCE odds were not different between the groups.
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Affiliation(s)
- Warkaa Shamkhani
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, United Kingdom
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom; Coronary Research Group, University Hospital Southampton, Southampton, United Kingdom
| | | | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
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Grines CL, Box LC, Mamas MA, Abbott JD, Blankenship JC, Carr JG, Curzen N, Kent WDT, Khatib Y, Matteau A, Rymer JA, Schreiber TL, Velagapudi P, Vidovich MI, Waldo SW, Seto AH. SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup. JACC Cardiovasc Interv 2023; 16:847-860. [PMID: 36725479 DOI: 10.1016/j.jcin.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Lyndon C Box
- West Valley Medical Center, Caldwell, Idaho, USA
| | | | - J Dawn Abbott
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - James C Blankenship
- The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jeffrey G Carr
- CardiaStream-Tyler Cardiac and Endovascular Center, Tyler, Texas, USA
| | - Nick Curzen
- University of Southampton, Southampton, United Kingdom
| | - William D T Kent
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yazan Khatib
- First Coast Cardiovascular Institute, Jacksonville, Florida, USA
| | - Alexis Matteau
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | | | | | | | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Arnold H Seto
- Long Beach VA Health Care System, Long Beach, California, USA.
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Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Card Fail 2016; 21:499-518. [PMID: 26036425 DOI: 10.1016/j.cardfail.2015.03.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.
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Affiliation(s)
- Charanjit S Rihal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Srihari S Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wilson Y Szeto
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James A Burke
- Division of Cardiology, Lehigh Valley Heart Specialists, Allentown, Pennsylvania
| | - Navin K Kapur
- Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Morton Kern
- Division of Cardiology, UCI Medical Center, Orange, California
| | - Kirk N Garratt
- Department of Cardiac and Vascular Services, Heart and Vascular Institute of New York, Lenox Hill Hospital, New York, New York
| | - James A Goldstein
- Division of Cardiology, Beaumont Heart Center Clinic, Royal Oak, Michigan
| | - Vivian Dimas
- Pediatric Cardiology, UT Southwestern, Dallas, Texas
| | - Thomas Tu
- Louisville Cardiology Group, Interventional Cardiology, Louisville, Kentucky
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The Effect of Treatment Delays Associated with Inpatient Inter-hospital Transfer from Peripheral to Tertiary Hospitals for the Surgical Treatment of Cardiology Patients. Heart Lung Circ 2016; 25:75-81. [DOI: 10.1016/j.hlc.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 05/10/2015] [Accepted: 05/23/2015] [Indexed: 11/21/2022]
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2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care. J Am Coll Cardiol 2015; 65:e7-e26. [DOI: 10.1016/j.jacc.2015.03.036] [Citation(s) in RCA: 354] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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6
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Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino America. Catheter Cardiovasc Interv 2015; 85:E175-96. [DOI: 10.1002/ccd.25720] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/25/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | - Srihari S. Naidu
- Division of Cardiology; Winthrop University Hospital; Mineola New York
| | | | - Wilson Y. Szeto
- Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - James A. Burke
- Division of Cardiology; Lehigh Valley Heart Specialists; Allentown, PA
| | | | - Morton Kern
- Division of Cardiology; UCI Medical Center; Orange CA
| | - Kirk N. Garratt
- Department of Cardiac and Vascular Services, Heart and Vascular Institute of New York; Lenox Hill Hospital; New York New York
| | - James A. Goldstein
- Division of Cardiology; Beaumont Heart Center Clinic; Royal Oak Michigan
| | - Vivian Dimas
- Pediatric Cardiology; UT Southwestern; Dallas Texas
| | - Thomas Tu
- Louisville Cardiology Group; Interventional Cardiology; Louisville Kentucky
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv 2015; 84:169-87. [PMID: 25045090 DOI: 10.1002/ccd.25371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Baylor Scott & White Health, Central Texas, Temple, TX. SCAI Writing Committee Member and Chair
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8
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 update on percutaneous coronary intervention without on-site surgical backup. J Am Coll Cardiol 2014; 63:2624-2641. [PMID: 24651052 DOI: 10.1016/j.jacc.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Johnson A, Falase B, Ajose I, Onabowale Y. A cross-sectional study of stand-alone percutaneous coronary intervention in a Nigerian cardiac catheterization laboratory. BMC Cardiovasc Disord 2014; 14:8. [PMID: 24433419 PMCID: PMC3897932 DOI: 10.1186/1471-2261-14-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/13/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a paucity of diagnostic and therapeutic facilities in Nigeria to confirm coronary artery disease and offer appropriate interventional therapy. There is now a private cardiac catheterization laboratory in Lagos but as there are no sustained Open Heart Surgery programmes, percutaneous coronary interventions are currently being performed without surgical backup. This study was designed to assess results of stand-alone percutaneous coronary intervention (PCI) as currently practiced in Lagos, Nigeria. METHODS This cross-sectional study was conducted between July 2009 and July 2012. The study included all patients that underwent PCI in Lagos. Data was extracted from a prospectively maintained database. RESULTS Coronary artery disease was confirmed in 80 (52.6%) of 152 Nigerians referred with a diagnosis of Ischaemic Heart Disease. There were 53 males (66.2%) and 27 females (33.8%). The average age was 60.3 +/-9.6 years and average euroscore was 4.5 +/-3.1. Of the 80 patients, 77 (96.3%) had significant stenoses and were candidates for revascularization. Distribution of significant stenoses was one in 32 patients (41.5%), two in 11 patients (14.3%), three in 19 patients (24.7%), four in 13 patients (16.9%) and five in 2 patients (2.6%). PCI was performed in 48 (62.3%) of the patients eligible for revascularization as the coronary anatomy in the remaining patients was not suitable for PCI. The indication for PCI was for myocardial infarction or unstable angina in 39 patients (81.2%). PCI was performed with PTCA plus stenting in 41 patients (85.4%) and with PTCA alone in 7 patients (14.6%) with good angiographic results. Overall 29 of the 48 patients (60.4%) had complete revascularization of significant stenoses. Complications of PCI were bleeding that required blood transfusion in 1 patient (2.1%), minor femoral haematomas in 2 patients (4.2%), and a major adverse clinical event in 1 patient (2.1%). CONCLUSION A stand-alone PCI programme has been developed in Lagos, Nigeria. Both elective and urgent PCIs have been performed with no mortalities and a low complication rate. Increased volumes will however accrue and complete revascularization rates would be improved with the establishment of Open Heart Surgery programmes to provide CABG as back-up for PCI and alternate therapy for more complex lesions.
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Affiliation(s)
| | - Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Ifeoluwa Ajose
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yemi Onabowale
- Reddington Multispecialty Hospital, Victoria Island, Lagos, Nigeria
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Langabeer JR, Henry TD, Kereiakes DJ, Dellifraine J, Emert J, Wang Z, Stuart L, King R, Segrest W, Moyer P, Jollis JG. Growth in percutaneous coronary intervention capacity relative to population and disease prevalence. J Am Heart Assoc 2013; 2:e000370. [PMID: 24166491 PMCID: PMC3886741 DOI: 10.1161/jaha.113.000370] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The access to and growth of percutaneous coronary intervention (PCI) has not been fully explored with regard to geographic equity and need. Economic factors and timely access to primary PCI provide the impetus for growth in PCI centers, and this is balanced by volume standards and the benefits of regionalized care. Methods and Results Geospatial and statistical analyses were used to model capacity, growth, and access of PCI hospitals relative to population density and myocardial infarction (MI) prevalence at the state level. Longitudinal data were obtained for 2003–2011 from the American Hospital Association, the U.S. Census, and the Centers for Disease Control and Prevention (CDC) with geographical modeling to map PCI locations. The number of PCI centers has grown 21.2% over the last 8 years, with 39% of all hospitals having interventional cardiology capabilities. During the same time, the US population has grown 8.3%, from 217 million to 235 million, and MI prevalence rates have decreased from 4.0% to 3.7%. The most densely concentrated states have a ratio of 8.1 to 12.1 PCI facilities per million of population with significant variability in both MI prevalence and average distance between PCI facilities. Conclusions Over the last decade, the growth rate for PCI centers is 1.5× that of the population growth, while MI prevalence is decreasing. This has created geographic imbalances and access barriers with excess PCI centers relative to need in some regions and inadequate access in others.
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11
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Mol KA, Rahel BM, Eerens F, Aydin S, Troquay RPT, Meeder JG. The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes. Neth Heart J 2013; 21:449-55. [PMID: 23975617 PMCID: PMC3776073 DOI: 10.1007/s12471-013-0447-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo. Background Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome. Methods Retrospective cohort study reporting characteristics, PCI and FFR specifications, complications and 6-month follow-up for all consecutive patients from the beginning of off-site PCI in Venlo until July 2012. If possible, the data were compared with those of Medical Centre Alkmaar, the first off-site PCI centre in the Netherlands. Results Of the 333 patients, 19 (5.7 %) had a procedural complication. At 6 months, a major adverse cardiovascular event (MACE) occurred in 43 (13.1 %) patients. There were no deaths or emergency surgery related to the PCI or FFR procedures. There was no significant difference in occurrence of a MACE or adverse cerebral event between the Alkmaar and Venlo population in the 30-day follow-up. Conclusion This study demonstrates off-site PCI at VieCuri Venlo to have a high success rate. Furthermore, there was a low complication rate, low MACE and no procedure-related mortality.
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Affiliation(s)
- K A Mol
- Department of Cardiology, VieCuri Medical Center Venlo, Tegelseweg 210, 5912BL, Venlo, the Netherlands,
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12
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Hannan EL, Zhong Y, Walford G, Jacobs AK, Venditti FJ, Stamato NJ, Holmes DR, Sharma S, Gesten F, King SB. Underutilization of percutaneous coronary intervention for ST-elevation myocardial infarction in medicaid patients relative to private insurance patients. J Interv Cardiol 2013; 26:470-81. [PMID: 23962131 DOI: 10.1111/joic.12059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether disparities in access to invasive cardiac procedures still exist for Medicaid patients, given how old earlier studies are and given changes in the interim in appropriateness guidelines. PATIENTS AND METHODS A total of 5,022 Medicaid and private insurance patients in New York from January 1, 2008 through December 31, 2009 under age 65 with ST-elevation myocardial infarction (STEMI) were compared with regard to their access to percutaneous coronary interventions (PCI) before and after controlling for numerous patient characteristics and other important factors. RESULTS Medicaid patients were significantly less likely to be admitted initially to a hospital certified to perform PCI (90.4% vs. 94.3%, P < 0.001). Also, Medicaid patients were found to be significantly less likely to undergo PCI than other patients (adjusted odds ratio [AOR] = 0.81, 95% CI 0.66, 0.98, P = 0.03). When the probability of each hospital performing PCI for STEMI patients was controlled for, Medicaid patients were still less likely to undergo PCI after controlling for other risk factors (AOR = 0.80, 95% CI 0.65, 0.99, P = 0.04). CONCLUSIONS Medicaid STEMI patients are significantly less likely to undergo PCI within the same day of admission as private pay patients even after adjusting for patient characteristics related to receiving PCI, and the strength of this relationship is not diminished when controlling for whether the admitting hospital has approval to perform PCI or controlling for the tendency of the admitting hospital to treat STEMI with PCI.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, Albany, New York
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Jacobs AK, Normand SLT, Massaro JM, Cutlip DE, Carrozza JP, Marks AD, Murphy N, Romm IK, Biondolillo M, Mauri L. Nonemergency PCI at hospitals with or without on-site cardiac surgery. N Engl J Med 2013; 368:1498-508. [PMID: 23477625 DOI: 10.1056/nejmoa1300610] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain. METHODS We enrolled patients with indications for nonemergency PCI who presented at hospitals in Massachusetts without on-site cardiac surgery and randomly assigned these patients, in a 3:1 ratio, to undergo PCI at that hospital or at a partner hospital that had cardiac surgery services available. A total of 10 hospitals without on-site cardiac surgery and 7 with on-site cardiac surgery participated. The coprimary end points were the rates of major adverse cardiac events--a composite of death, myocardial infarction, repeat revascularization, or stroke--at 30 days (safety end point) and at 12 months (effectiveness end point). The primary end points were analyzed according to the intention-to-treat principle and were tested with the use of multiplicative noninferiority margins of 1.5 (for safety) and 1.3 (for effectiveness). RESULTS A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point. CONCLUSIONS Nonemergency PCI procedures performed at hospitals in Massachusetts without on-site surgical services were noninferior to procedures performed at hospitals with on-site surgical services with respect to the 30-day and 1-year rates of clinical events. (Funded by the participating hospitals without on-site cardiac surgery; MASS COM ClinicalTrials.gov number, NCT01116882.).
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Affiliation(s)
- Alice K Jacobs
- Boston University School of Medicine, Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Tongsai S, Thamlikitkul V. The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions: A meta-analysis. Int J Nurs Stud 2012; 49:1084-90. [DOI: 10.1016/j.ijnurstu.2012.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/24/2012] [Accepted: 03/30/2012] [Indexed: 12/29/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79:453-95. [PMID: 22328235 DOI: 10.1002/ccd.23438] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Shahian DM, Meyer GS, Yeh RW, Fifer MA, Torchiana DF. Percutaneous coronary interventions without on-site cardiac surgical backup. N Engl J Med 2012; 366:1814-23. [PMID: 22571203 DOI: 10.1056/nejmra1109616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David M Shahian
- Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.08.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:2574-609. [PMID: 22064598 DOI: 10.1161/cir.0b013e31823a5596] [Citation(s) in RCA: 381] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1719] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 894] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zia MI, Wijeysundera HC, Tu JV, Lee DS, Ko DT. Percutaneous Coronary Intervention With vs Without On-Site Cardiac Surgery Backup: A Systematic Review and Meta-analysis. Can J Cardiol 2011; 27:664.e9-16. [DOI: 10.1016/j.cjca.2010.12.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/07/2010] [Indexed: 11/29/2022] Open
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Outcomes of Nonemergent Percutaneous Coronary Intervention With and Without On-site Surgical Backup: A Meta-Analysis. Am J Ther 2011; 18:e22-8. [DOI: 10.1097/mjt.0b013e3181bc0f5a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A comparison of the health status after percutaneous coronary intervention at a hospital with and without on-site cardiac surgical backup: a randomized trial in nonemergent patients. ACTA ACUST UNITED AC 2010; 17:235-43. [DOI: 10.1097/hjr.0b013e3283378880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Levy AR, Terashima M, Travers A. Should geographic analyses guide the creation of regionalized care models for ST-segment elevation myocardial infarction? OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2010; 4:e22-5. [PMID: 21686288 PMCID: PMC3116665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 01/28/2010] [Indexed: 10/31/2022]
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Hannan EL, Zhong Y, Racz M, Jacobs AK, Walford G, Cozzens K, Holmes DR, Jones RH, Hibberd M, Doran D, Whalen D, King SB. Outcomes for Patients With ST-Elevation Myocardial Infarction in Hospitals With and Without Onsite Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2009; 2:519-27. [DOI: 10.1161/circinterventions.109.894048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery.
Methods and Results—
Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared. For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [
P
=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%,
P
=0.06), 3-year mortality (7.1% versus 5.9%,
P
=0.07), or 3-year subsequent revascularization (23.8% versus 21.5%,
P
=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%,
P
=0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%,
P
=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75).
Conclusions—
No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.
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Affiliation(s)
- Edward L. Hannan
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Ye Zhong
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Michael Racz
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Alice K. Jacobs
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Gary Walford
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Kimberly Cozzens
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - David R. Holmes
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Robert H. Jones
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Mary Hibberd
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Donna Doran
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Deborah Whalen
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Spencer B. King
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
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Dehmer GJ, Kutcher MA. ST-Segment-Elevation Myocardial Infarction Treated at Hospitals With and Without On-Site Cardiac Surgery. Circ Cardiovasc Interv 2009; 2:497-9. [DOI: 10.1161/circinterventions.109.921346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory J. Dehmer
- From the Department of Medicine (G.J.D.), Texas A&M University Health Science Center College of Medicine; Cardiology Division (G.J.D.), Scott & White Healthcare, Temple, Tex; and Wake Forest University School of Medicine (M.A.K.), Cardiology Division, Winston-Salem, NC
| | - Michael A. Kutcher
- From the Department of Medicine (G.J.D.), Texas A&M University Health Science Center College of Medicine; Cardiology Division (G.J.D.), Scott & White Healthcare, Temple, Tex; and Wake Forest University School of Medicine (M.A.K.), Cardiology Division, Winston-Salem, NC
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Dehmer GJ, Brindis RG. Non–ST-Segment Elevation Myocardial Infarction Treated at Hospitals With and Without On-Site Cardiac Surgery. JACC Cardiovasc Interv 2009; 2:953-5. [DOI: 10.1016/j.jcin.2009.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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33
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Tebbe U, Hochadel M, Bramlage P, Kerber S, Hambrecht R, Grube E, Hauptmann KE, Gottwik M, Elsässer A, Glunz HG, Bonzel T, Carlsson J, Zeymer U, Zahn R, Senges J. In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup. Clin Res Cardiol 2009; 98:701-7. [DOI: 10.1007/s00392-009-0045-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
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34
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Kutcher MA, Klein LW, Ou FS, Wharton TP, Dehmer GJ, Singh M, Anderson HV, Rumsfeld JS, Weintraub WS, Shaw RE, Sacrinty MT, Woodward A, Peterson ED, Brindis RG. Percutaneous Coronary Interventions in Facilities Without Cardiac Surgery On Site: A Report From the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol 2009; 54:16-24. [DOI: 10.1016/j.jacc.2009.03.038] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 02/18/2009] [Accepted: 03/10/2009] [Indexed: 11/17/2022]
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35
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Peels J, Hautvast R, de Swart J, Huybregts M, Umans V, Arnold A, Jessurun G, Zijlstra F. Percutaneous coronary intervention without on site surgical back-up; two-years registry of a large Dutch community hospital. Int J Cardiol 2009; 132:59-65. [DOI: 10.1016/j.ijcard.2007.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 07/18/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
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36
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Safety and efficacy of offsite percutaneous coronary interventions in 1,348 consecutive patients in rural Tasmania. Am J Cardiol 2008; 102:1323-7. [PMID: 18993149 DOI: 10.1016/j.amjcard.2008.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 07/08/2008] [Accepted: 07/13/2008] [Indexed: 11/22/2022]
Abstract
Despite controversy, a growing body of data exists suggesting that percutaneous coronary intervention (PCI) with no surgical onsite availability is safe and efficacious. Over a period of 3 years all patients requiring PCI had their intervention performed at the Launceston General Hospital, a regional hospital serving rural Tasmania, Australia. There were no exclusion criteria uniformly adopted. Primary end points included angiographic success and major procedure-related complications. A total cohort of 1,348 consecutive patients underwent PCI during the calendar years of 2005 through 2007, including patients with ST-elevation myocardial infarction. Angiographic success for all patients was >98%. In-hospital mortality was 0.8% overall. Only 1 patient required urgent transfer to a cardiac surgical center. Bleeding rates requiring transfusion were approximately 1%. Excellent clinical outcomes have been achieved in a relatively remote PCI center in rural, northern Tasmania, where there is no emergency cardiac surgical availability. Angiographic success was high and complication rates were low, consistent with worldwide standards. In conclusion, PCI without onsite surgery appears safe and efficacious when well-trained staffing is available.
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37
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38
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Stone GW. Angioplasty strategies in ST-segment-elevation myocardial infarction: part I: primary percutaneous coronary intervention. Circulation 2008; 118:538-51. [PMID: 18663102 DOI: 10.1161/circulationaha.107.756494] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Gregg W Stone
- Columbia University Medical Center, 111 E 59th St, 11th Floor, New York, NY 10022, USA.
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39
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Buckley JW, Bates ER, Nallamothu BK. Primary percutaneous coronary intervention expansion to hospitals without on-site cardiac surgery in Michigan: a geographic information systems analysis. Am Heart J 2008; 155:668-72. [PMID: 18371474 DOI: 10.1016/j.ahj.2007.10.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND In 2005, Michigan expanded primary percutaneous coronary intervention (P-PCI) capability to 12 hospitals without on-site cardiac surgery. We determined the potential impact of this expansion on geographic access to P-PCI for patients. METHODS Geographic information systems using the US Census Survey and hospital data from the state of Michigan were used to construct maps with 20-mile hospital service areas around P-PCI hospitals with and without on-site cardiac surgery. Geographic access was calculated as the percentage of the population living within the hospital service areas of these 2 types of hospitals. RESULTS Of 9,938,444 persons in Michigan, 7,694,834 (77.4%) lived within 20 miles of a P-PCI hospital. Thirty centers with on-site cardiac surgery provided access for 7,219,995 persons (72.6%). The 12 P-PCI hospitals without on-site cardiac surgery increased access by 474,839 persons (4.8%). Of these, 3 geographically isolated facilities, which were at least 20 miles away from another P-PCI hospital, accounted for the greatest improvement in geographic access (n = 425,700 [4.3%]), whereas the remaining 9 hospitals increased access by only 49,139 persons (0.5%). CONCLUSIONS Expansion of P-PCI to hospitals without on-site cardiac surgery in Michigan improved geographic access to a modest extent.
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40
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Frutkin AD, Mehta SK, Patel T, Menon P, Safley DM, House J, Barth CW, Grantham JA, Marso SP. Outcomes of 1,090 consecutive, elective, nonselected percutaneous coronary interventions at a community hospital without onsite cardiac surgery. Am J Cardiol 2008; 101:53-7. [PMID: 18157965 DOI: 10.1016/j.amjcard.2007.07.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 07/09/2007] [Accepted: 07/09/2007] [Indexed: 11/25/2022]
Abstract
We evaluated the efficacy and safety of elective percutaneous coronary intervention (PCI) at a hospital without onsite cardiac surgery. A growing number of hospitals without onsite cardiac surgery perform elective PCI. Few hospitals have reported outcomes, despite controversy surrounding this practice. From August 2003 to December 2005, 1,090 elective PCI were performed at Saint Luke's South Hospital (SLS), a hospital without onsite cardiac surgery, for which the referral center is the Mid America Heart Institute (MAHI). The elective PCI program used experienced interventionalists, technicians, and nurses; a tested helicopter transport protocol; a well-equipped catheterization laboratory; and a quality assurance process. Baseline characteristics, procedural success, and adverse clinical outcomes were compared. Observed frequencies of in-hospital death, a combined end point of Q-wave myocardial infarction (MI)/emergency coronary artery bypass grafting (CABG) surgery, and vascular complications were compared with prediction models. SLS, with lower risk characteristics than MAHI, had unadjusted frequencies of procedural success (93% vs 94%, p = NS), Q-wave MI (0.3% vs 0.3%, p = NS), emergency CABG surgery (0.2% vs 0.03%, p = 0.09), vascular complications (0.6% vs 0.6%, p = NS), and in-hospital death (0.1% vs 0.8%, p = 0.002) that compared favorably with MAHI. Two patients transferred from SLS to MAHI for emergency CABG surgery without adverse effects. Fewer in-hospital deaths and vascular complications were observed at SLS than predicted by models. In conclusion, favorable clinical outcomes were achieved for elective PCI at a hospital without onsite cardiac surgery that used strict program requirements.
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42
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Dehmer GJ. Passing the torch: challenges ahead. Catheter Cardiovasc Interv 2007; 69:928-30. [PMID: 17427208 DOI: 10.1002/ccd.21193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Texas A & M School of Medicine, Cardiology Division, Scott & White Clinic, Society for Cardiovascular Angiography and Interventions, Temple, Texas, USA.
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43
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Affiliation(s)
- Gregory J Dehmer
- Texas A & M School of Medicine, and Cardiology Division, Scott & White Clinic, 2401 South 31st Street, Temple, TX 76508, USA.
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