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Nguyen MT, Ali A, Ngo L, Ellis C, Psaltis PJ, Ranasinghe I. Thirty-Day Unplanned Readmissions Following Elective and Acute Percutaneous Coronary Intervention. Heart Lung Circ 2023; 32:619-628. [PMID: 37003938 DOI: 10.1016/j.hlc.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/04/2022] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Prior studies have reported a high rate of unplanned readmissions following acute percutaneous coronary intervention (PCI). Data outside the USA comparing 30-day unplanned readmissions following elective PCI to those who undergo acute PCI remain limited. METHODS Patients who underwent a PCI procedure in Australia and New Zealand between 2010 and 2015 were included. We determined the rates, causes and predictors of 30-day unplanned readmissions, as well as rates of repeat revascularisation procedures, for patients who underwent an elective or acute PCI. Predictors of readmissions were identified using logistic regression. RESULTS A total of 199,686 PCI encounters were included, of which 74,890 (37.5%) were elective and 124,796 (62.5%) were acute procedures. Overall, 10.6% of patients had at least one unplanned readmission within 30 days of discharge with lower rates following elective PCI (7.0%) compared to acute PCI (12.7%) (p<0.01). Non-specific chest pain was the commonest cause of readmission after elective and acute PCI, accounting for 20.7% and 21.5% of readmission diagnoses, respectively. Readmissions for acute myocardial infarction (13.0% vs 4.6%, p<0.01) and heart failure (6.5% vs 3.3%, p<0.01) were higher following acute PCI compared to elective PCI. Among readmitted patients, 16.7% had a coronary catheterisation, 12.2% had a PCI and 0.7% had coronary artery bypass surgery. Multivariable predictors of 30-day unplanned readmission included female sex and comorbidities such as heart failure, metastatic disease, chronic lung disease and renal failure (p<0.0001 for all). CONCLUSIONS Unplanned readmissions following elective or acute PCI are high. Clinical and quality-control measures are required to prevent avoidable readmissions in both settings.
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Affiliation(s)
- Mau T Nguyen
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
| | - Anna Ali
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - Linh Ngo
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Chris Ellis
- Cardiology Department, Auckland City Hospital, Auckland, New Zealand
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Isuru Ranasinghe
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Qld, Australia
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Arnold SV, Bhatt DL, Barsness GW, Beatty AL, Deedwania PC, Inzucchi SE, Kosiborod M, Leiter LA, Lipska KJ, Newman JD, Welty FK. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e779-e806. [PMID: 32279539 DOI: 10.1161/cir.0000000000000766] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes.
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Derington CG, Heath LJ, Kao DP, Delate T. Validation of algorithms to identify elective percutaneous coronary interventions in administrative databases. PLoS One 2020; 15:e0231100. [PMID: 32255803 PMCID: PMC7138319 DOI: 10.1371/journal.pone.0231100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Elective percutaneous coronary interventions (PCI) are difficult to discriminate from non-elective PCI in administrative data due to non-specific encounter codes, limiting the ability to track outcomes, ensure appropriate medical management, and/or perform research on patients who undergo elective PCI. The objective of this study was to assess the abilities of several algorithms to identify elective PCI procedures using administrative data containing diagnostic, utilization, and/or procedural codes. METHODS AND RESULTS For this retrospective study, administrative databases in an integrated healthcare delivery system were queried between 1/1/2015 and 6/31/2016 to identify patients who had an encounter for a PCI. Using clinical criteria, each encounter was classified via chart review as a valid PCI, then as elective or non-elective. Cases were tested against nine pre-determined algorithms. Performance statistics (sensitivity, specificity, positive predictive value, and negative predictive value) and associated 95% confidence intervals (CI) were calculated. Of 521 PCI encounters reviewed, 497 were valid PCI, 93 of which were elective. An algorithm that excluded emergency room visit events had the highest sensitivity (97.9%, 95%CI 92.5%-99.7%) while an algorithm that included events occurring within 90 days of a cardiologist visit and coronary angiogram or stress test had the highest positive predictive value (62.2%, 95%CI 50.8%-72.7%). CONCLUSIONS Without an encounter code specific for elective PCI, an algorithm excluding procedures associated with an emergency room visit had the highest sensitivity to identify elective PCI. This offers a reasonable approach to identify elective PCI from administrative data.
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Affiliation(s)
- Catherine G. Derington
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, United States of America
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United States of America
| | - Lauren J. Heath
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America
| | - David P. Kao
- Cardiac and Vascular Center, University of Colorado Health, Aurora, CO, United States of America
- Department of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Thomas Delate
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, United States of America
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, United States of America
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Abstract
PURPOSE OF REVIEW Our review discusses the management of post percutaneous coronary intervention angina (PPCIA) which negatively impacts 20-40% of patients and imposes a high burden on the healthcare system. RECENT FINDINGS Mechanisms of PPCIA include microvascular dysfunction, distal coronary vasospasm or disease, microembolization, myocardial bridge, coronary artery disease (CAD) progression, and rarely stent thrombosis or in-stent restenosis. Nitrates, beta blockers (BB), calcium channel blockers, and ranolazine are the common medical management options. Only BB showed 1-year mortality benefit following myocardial infarction. Stress echocardiography and cardiac magnetic resonance are the best to detect CAD vs. microvascular dysfunction. Invasively, vasoprovocative testing and fractional flow reserve provide useful prognostic information. If the ischemia burden is ≤10%, conservative management should be considered based upon the individual patient scenario. The optimal management of PPCIA remains unclear and further research is necessary. Multiple treatment options exist, which should be implemented in an individualized fashion.
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Affiliation(s)
- Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
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Vogel B, Goel R, Kunadian V, Kalkman DN, Chieffo A, Appelman Y, Mehran R. Residual angina in female patients after coronary revascularization. Int J Cardiol 2019; 286:208-13. [DOI: 10.1016/j.ijcard.2019.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
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Rezende PC, Hueb W, Rahmi RM, Scudeler TL, de Azevedo DFC, Garzillo CL, Segre CAW, Ramires JAF, Filho RK. Myocardial injury in diabetic patients with multivessel coronary artery disease after revascularization interventions. Diabetol Metab Syndr 2017; 9:92. [PMID: 29201152 PMCID: PMC5697213 DOI: 10.1186/s13098-017-0292-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD). METHODS Patients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI), off-pump or on-pump bypass surgery (CABG). Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72 h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c) levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI) on CMR. RESULTS Ninety (44.5%) of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14) and 2.24 (0.69, 5.42) ng/mL (P = 0.81), and median peak CK-MB was 14.1 (6.8, 31.7) and 14.0 (4.2, 29.8) ng/mL (P = 0.43), in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (P = 0.91), and myocardial edema in 15.5 and 22.9% (P = 0.39) in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (P = 0.98), and in the A1c tertiles was 19.1% versus 13.3% versus 22.2% (P = 0.88). CONCLUSIONS In this study, diabetes mellitus did not add risk of myocardial injury after revascularization interventions in patients with multivessel coronary artery disease. Trial Registration Name of Registry: Evaluation of cardiac biomarker elevation after percutaneous coronary intervention or coronary artery bypass graft; URL: http://www.controlled-trials.com.ISRCTN09454308.
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Affiliation(s)
- Paulo Cury Rezende
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Whady Hueb
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Rosa Maria Rahmi
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Thiago Luis Scudeler
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Diogo Freitas Cardoso de Azevedo
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Cibele Larrosa Garzillo
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Carlos Alexandre Wainrober Segre
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Jose Antonio Franchini Ramires
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor) of the University of São Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, AB sala 114, Cerqueira César, São Paulo, SP CEP 05403-900 Brazil
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