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Doolub G, Mamas MA, Dziewierz A, Malinowski KP, Oleś I, Kuleta M, Zdzierak B, Siudak Z. Do two operators improve outcomes in left main percutaneous coronary intervention? Insights from the ORPKI Registry. Minerva Cardiol Angiol 2024; 72:79-86. [PMID: 37870423 DOI: 10.23736/s2724-5683.23.06364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant left main coronary artery (LMCA) disease is prevalent in 7% of patients undergoing angiography. Limited data exists on the impact of double scrubbing in LMCA PCI. We sought to assess periprocedural outcomes in two-operator LMCA percutaneous coronary intervention (PCI). METHODS Using data from the Polish National Registry of PCI (ORPKI), we collected data on 28,745 patients undergoing LMCA PCI from 154 centers. Patients were divided into two groups based on the number of operators performing PCI (one vs. two operators). RESULTS LMCA PCI was performed by a single operator in 86% of the cases and by two operators in 14% of cases. Patients treated by two operators had a greater comorbidity burden including diabetes mellitus, arterial hypertension, previous myocardial infarction, and previous revascularization. In addition, these were more likely to be treated in high-volume centers, by operators with higher volume of LMCA PCIs. The risk of periprocedural death (2.37% vs. 2.44%; P=0.78), as well as cardiac arrest, coronary artery perforation, no-reflow, and puncture site bleeding was comparable between the two groups. On multivariable analysis, we found that a two-operator strategy was an independent predictor of periprocedural death, with this effect being much more profound in an elective setting (OR=5.13 [1.37-19.26]; P=0.015), compared to an urgent (ACS) setting (OR=1.32 [1.00-1.73]; P=0.047). CONCLUSIONS Our study suggests that a two-operator approach is not necessarily routinely recommended for LMCA interventions, although it can be considered for more complex cases.
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Affiliation(s)
- Gemina Doolub
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
- Unit of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mamas A Mamas
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Artur Dziewierz
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital of Krakow, Krakow, Poland
| | - Krzysztof P Malinowski
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
- Jagiellonian University Medical College, Digital Medicine and Robotics Center, Krakow, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Barbara Zdzierak
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
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2
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Moady G, Ovdat T, Rubinshtein R, Eitan A, Daud E, Arow Z, Atar S. The impact of on-site cardiac surgical backup on clinical outcomes of acute coronary syndrome-analysis of the ACSIS national registry. Front Cardiovasc Med 2023; 10:1207473. [PMID: 37727307 PMCID: PMC10505675 DOI: 10.3389/fcvm.2023.1207473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Background The availability of advanced technologies for mechanical support in hospitals with on-site cardiac surgery (CS), along with the ability to perform urgent coronary artery bypass graft (CABG) surgery, may result in improved clinical outcomes in patients with acute coronary syndrome (ACS). Methods We conducted a retrospective analysis of the bi-annually Acute Coronary Syndrome Israeli Survey (ACSIS) registry from the year 2000 to 2020, performed in hospitals with and without CS. Mortality rates and major adverse cardiac and cerebrovascular events (MACCE) rates are reported. We evaluated two periods of the study-early (2000-2010) vs. late (2011-2020). Propensity score matching was performed to reduce bias between the two groups. Results The study included 16,979 patients (52.3% in the on-site CS group). Patients in the on-site CS group were more likely to undergo percutaneous coronary intervention (PCI), (odds ratio [OR], 1.26 [95% CI, 1.18-1.35]; p < 0.001) and CABG [OR, 1.91 (95%CI, 1.63-2.24); P < 0.001], and patients in hospitals without on-site CS had higher 30-day MACCE [OR, 1.17 (95% CI, 1.07-1.27); p < 0.0005]. Overall, there was no difference in 1-year mortality (hazard ratio [HR], 0.98 [95% CI, 0.89-1.08]; p = 0.71) between the groups. During the late period of the study, patients in the group without on-site CS had lower 30-day mortality [OR, 0.69 (95% CI, 0.49-0.97); P = 0.04], yet with no difference in 1-year mortality [HR, 0.81 (95% CI, 0.65-1.01); p = 0.07]. Conclusions The availability of on-site CS resulted in variations in treatment modality, yet it did not affect the clinical outcomes of ACS. A trend to a better short-term outcomes was noted in hospitals without CS during the late period of the study, which warrants further investigation.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Tal Ovdat
- The Israeli Center of Cardiovascular Research, Tel Hashomer, Israel
| | - Ronen Rubinshtein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Heart Institute, Edith Wolfson Medical Center, Holon, Israel
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Elias Daud
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Ziad Arow
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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3
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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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4
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Dziewierz A, Zdzierak B, Malinowski KP, Siudak Z, Zasada W, Tokarek T, Zabojszcz M, Dolecka-Ślusarczyk M, Dudek D, Bartuś S, Surdacki A, Rakowski T. Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry). J Clin Med 2022; 11:jcm11216284. [PMID: 36362512 PMCID: PMC9657628 DOI: 10.3390/jcm11216284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients.
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Affiliation(s)
- Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Barbara Zdzierak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Wojciech Zasada
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | | | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-50
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5
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Sielski J, Kaziród-Wolski K, Jurys K, Wałek P, Siudak Z. The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019. J Clin Med 2021; 10:jcm10235716. [PMID: 34884418 PMCID: PMC8658305 DOI: 10.3390/jcm10235716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences.
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Affiliation(s)
- Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
| | - Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
| | - Karolina Jurys
- Hospital Emergency Department, Provincial Hospital, 25-736 Kielce, Poland;
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
- Correspondence: ; Tel.: +48-41-3671-493
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
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6
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Abaza R, Martinez O, Murphy C, Urkmez A, Davis J. Adoption of Single-Port Robotic Prostatectomy: Two Alternative Strategies. J Endourol 2020; 34:1230-1234. [DOI: 10.1089/end.2020.0425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ronney Abaza
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Oscar Martinez
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Christopher Murphy
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Ahmet Urkmez
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Davis
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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