1
|
Saczkowski R, Spada S, Hromadnik K. Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates. Perfusion 2024; 39:506-513. [PMID: 36749309 DOI: 10.1177/02676591221149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. METHODS The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. RESULTS There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. CONCLUSION There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.
Collapse
Affiliation(s)
- Richard Saczkowski
- Interior Health Cardiac Sciences Program, Department of Cardiovascular Perfusion, Kelowna General Hospital, Kelowna, BC, Canada
| | - Saverio Spada
- Interior Health Cardiac Sciences Program, Department of Cardiovascular Perfusion, Kelowna General Hospital, Kelowna, BC, Canada
| | - Kris Hromadnik
- Department of Cardiovascular Perfusion, Queen Elizabeth II Hospital, Halifax, NS, Canada
| |
Collapse
|
2
|
Mijares-Rojas IA, Trujillo LG, Lecompte-Osorio PA, Martinez Trevino EF, Munagala M. Aortic Dissection From an Intra-aortic Balloon Pump: A Dangerous Complication to Keep in Mind. Cureus 2023; 15:e39122. [PMID: 37332456 PMCID: PMC10273174 DOI: 10.7759/cureus.39122] [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] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Despite the benefits of the intra-aortic balloon pump (IABP) being a subject of debate, it remains a widely available and easy-to-use mechanical circulatory support device. Nonetheless, its use is not exempt from complications. Aortic dissection from IABP is an infrequent but deathly complication. We describe a case in which early recognition of the condition led to control through an endovascular approach. A 57-year-old male was admitted for acute decompensated heart failure requiring intravenous inotropic agents. While undergoing assessment for a heart transplant, he developed cardiogenic shock requiring initiation of mechanical circulatory support with an IABP. A few hours after device implantation, the patient developed acute tearing chest pain and was found to have an acute dissection in the descending thoracic aorta. Prompt liaison with the endovascular team led to a thoracic endovascular aortic repair to control the extent of the lesion.
Collapse
Affiliation(s)
- Ivan A Mijares-Rojas
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Luis G Trujillo
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Paola A Lecompte-Osorio
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | | | | |
Collapse
|
3
|
González LS, Grady M. Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications. Int Anesthesiol Clin 2022; 60:16-23. [PMID: 35975922 DOI: 10.1097/aia.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
4
|
Rhodes NG, Johnson TF, Boyum JH, Khandelwal A, Howell BD, Froemming AT, Behfar A. Radiology of Intra-Aortic Balloon Pump Catheters. Radiol Cardiothorac Imaging 2022; 4:e210120. [PMID: 35506140 DOI: 10.1148/ryct.210120] [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: 04/29/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
Radiographs play an important role in ascertaining appropriate placement of the intra-aortic balloon pump catheter. This imaging essay highlights correct and incorrect positioning of these catheters, with emphasis on the variability of radiopaque markers used with different catheter models and on axillary versus femoral catheter placement routes. Keywords: Conventional Radiography, CT, Percutaneous, Cardiac, Vascular, Aorta, Anatomy, Cardiac Assist Devices, Catheters © RSNA, 2022.
Collapse
Affiliation(s)
- Nicholas G Rhodes
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Tucker F Johnson
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - James H Boyum
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ashish Khandelwal
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Barrett D Howell
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Adam T Froemming
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Atta Behfar
- Department of Radiology (N.G.R., T.F.J., J.H.B., A.K., B.D.H., A.T.F.) and Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine (A.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| |
Collapse
|
5
|
Ashraf H, Hafeez A, Ruth G, Choi C. Left Axillary Intra-Aortic Balloon Pump Prolapsing in the Ascending Aorta in an End-Stage Heart Failure Patient Awaiting Transplant. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:166-168. [PMID: 33965335 DOI: 10.1016/j.carrev.2021.04.030] [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: 02/26/2021] [Revised: 04/11/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Patients with end-stage heart failure with reduced ejection fraction requiring mechanical support while awaiting heart transplant present a clinical dilemma. Intra-aortic balloon pump (IABPs) provide a modest improvement in hemodynamics and are easy to implant. Left axillary IABP implantation allows patients to engage in daily physical activity pre-transplant. We present a case of a patient awaiting heart transplant with a left axillary IABP that prolapsed above the aortic valve in the ascending aortic root requiring immediate removal. We describe our multi-modal imaging evaluation, and technique to safely remove the IABP and replace a new one into the same left axillary access while preserving vascular access.
Collapse
Affiliation(s)
- Hassan Ashraf
- University of Florida College of Medicine, Department of General Internal Medicine, 1600 SW Archer Rd., Gainesville, FL 32610, USA.
| | - Adam Hafeez
- University of Florida College of Medicine, Department of Medicine Division of Cardiovascular Medicine, 1600 SW Archer Rd,, Gainesville, FL 32610, USA.
| | - Garrett Ruth
- University of Florida College of Medicine, Department of Medicine Division of Cardiovascular Medicine, 1600 SW Archer Rd,, Gainesville, FL 32610, USA.
| | - Calvin Choi
- University of Florida College of Medicine, Department of Medicine Division of Cardiovascular Medicine, 1600 SW Archer Rd,, Gainesville, FL 32610, USA.
| |
Collapse
|
6
|
Hess NR, Seese LM, Hong Y, Afflu D, Wang Y, Thoma FW, Kilic A. Gastrointestinal complications after cardiac surgery: Incidence, predictors, and impact on outcomes. J Card Surg 2021; 36:894-901. [PMID: 33428223 DOI: 10.1111/jocs.15321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the incidence, predictors, and long-term impact of gastrointestinal (GI) complications following adult cardiac surgery. METHODS Index Society of Thoracic Surgeons (STS) adult cardiac operations performed between January 2010 and February 2018 at a single institution were included. Patients were stratified by the occurrence of postoperative GI complications. Outcomes included early and late survival as well as other associated major postoperative complications. A subanalysis of propensity score-matched patients was also performed. RESULTS A total of 10,285 patients were included, and the overall rate of GI complications was 2.4% (n = 246). Predictors of GI complications included dialysis dependency, intra-aortic balloon pump, congestive heart failure, chronic obstructive pulmonary disease, and longer aortic cross-clamp times. Thirty-day (2.6% vs. 24.8%), 1- (6.3% vs. 41.9%), and 3-year (11.1% vs. 48.4%) mortality were substantially higher in patients who experienced GI complications (all p < .001). GI complication was associated with a threefold increased hazard for mortality (hazard ratio = 3.1, 95% confidence interval = 2.6-3.7) after risk adjustment, and there was an association between the occurrence of GI complications and increased rates of renal failure (39.4% vs. 2.5%), new dialysis dependency (31.3% vs. 1.5%), multisystem organ failure (21.5% vs .1.0%), and deep sternal wound infections (2.6% vs. 0.2%; all p < .001). These results persisted in propensity-matched analysis. CONCLUSION GI complications are infrequent but have a profound impact on early and late survival, and often occur in association with other major complications. Risk factor modification, heightened awareness, and early detection and management of GI complications appear warranted.
Collapse
Affiliation(s)
- Nicholas R Hess
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura M Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yeahwa Hong
- Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Derek Afflu
- Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Floyd W Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
7
|
Daubenspeck D, González LS, Gerlach RM, Chaney MA. Unique Complications Associated With the Subclavian Intra-Aortic Balloon Pump. J Cardiothorac Vasc Anesth 2020; 35:2212-2222. [PMID: 33485757 DOI: 10.1053/j.jvca.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Rebecca M Gerlach
- Department of Anesthesiology and Critical Care, Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM; Preoperative Anesthesia Clinic, University of New Mexico, Albuquerque, NM
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| |
Collapse
|
8
|
Kapur NK, Whitehead EH, Thayer KL, Pahuja M. The science of safety: complications associated with the use of mechanical circulatory support in cardiogenic shock and best practices to maximize safety. F1000Res 2020; 9. [PMID: 32765837 PMCID: PMC7391013 DOI: 10.12688/f1000research.25518.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/16/2022] Open
Abstract
Acute mechanical circulatory support (MCS) devices are widely used in cardiogenic shock (CS) despite a lack of high-quality clinical evidence to guide their use. Multiple devices exist across a spectrum from modest to complete support, and each is associated with unique risks. In this review, we summarize existing data on complications associated with the three most widely used acute MCS platforms: the intra-aortic balloon pump (IABP), Impella systems, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We review evidence from available randomized trials and highlight challenges comparing complication rates from case series and comparative observational studies where a lack of granular data precludes appropriate matching of patients by CS severity. We further offer a series of best practices to help shock practitioners minimize the risk of MCS-associated complications and ensure the best possible outcomes for patients.
Collapse
Affiliation(s)
- Navin K Kapur
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Evan H Whitehead
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Katherine L Thayer
- The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
| | - Mohit Pahuja
- Division of Cardiology, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
9
|
Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes. Anesth Analg 2020; 131:776-791. [DOI: 10.1213/ane.0000000000004954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Alvarez CK, Alvarez Villela M, Wiley JM, Taveras JM, Goldstein DJ, Sims DB, Jorde UP. Axillary Intra-Aortic Balloon Pump Migration Into the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support. Circ Heart Fail 2020; 13:e007017. [PMID: 32354279 DOI: 10.1161/circheartfailure.120.007017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Jose M Wiley
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | - Jose M Taveras
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | | | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
11
|
Subramaniam AV, Barsness GW, Vallabhajosyula S, Vallabhajosyula S. Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature. Cardiol Ther 2019; 8:211-228. [PMID: 31646440 PMCID: PMC6828896 DOI: 10.1007/s40119-019-00152-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiogenic shock (CS) is associated with hemodynamic compromise and end-organ hypoperfusion due to a primary cardiac etiology. In addition to vasoactive medications, percutaneous mechanical circulatory support (MCS) devices offer the ability to support the hemodynamics and prevent acute organ failure. Despite the wide array of available MCS devices for CS, there are limited data on the complications from these devices. In this review, we seek to summarize the complications of MCS devices in the contemporary era. Using a systems-based approach, this review covers domains of hematological, neurological, vascular, infectious, mechanical, and miscellaneous complications. These data are intended to provide a balanced narrative and aid in risk-benefit decision-making in this acutely ill population.
Collapse
Affiliation(s)
| | | | | | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
12
|
Morris BN, Sheehan MK, Royster RL. Predictive Modeling for Nonocclusive Mesenteric Ischemia. J Cardiothorac Vasc Anesth 2018; 33:1298-1300. [PMID: 30455144 DOI: 10.1053/j.jvca.2018.09.033] [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: 09/20/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin N Morris
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Maureen K Sheehan
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Roger L Royster
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
13
|
Risk factors for postoperative acute mesenteric ischemia among adult patients undergoing cardiac surgery: A systematic review and meta-analysis. J Crit Care 2017; 42:294-303. [DOI: 10.1016/j.jcrc.2017.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/25/2017] [Accepted: 08/11/2017] [Indexed: 12/30/2022]
|
14
|
Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg 2016; 11:122. [PMID: 27487772 PMCID: PMC4972967 DOI: 10.1186/s13019-016-0513-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/27/2016] [Indexed: 11/18/2022] Open
Abstract
Treatment with the intraaortic balloon pump (IABP) is the most common form of mechanical support for the failing heart. Augmentation of diastolic pressure during balloon inflation contributes to the coronary circulation and the presystolic deflation of the balloon reduces the resistance to systolic output. Consequently, the myocardial work is reduced. The overall effect of the IABP therapy is an increase in the myocardial oxygen supply/demand ratio and thus in endocardial viability. This is an overall synopsis of what we need to know regarding IABP. Furthermore, this review article attempts to systematically delineate the pathophysiology linked with the hemodynamic consequences of IABP therapy. The authors also look at the future of the use of the balloon pump and conclude that the positive multi-systemic hemodynamic regulation during IABP treatment should further justify its use.
Collapse
Affiliation(s)
- H Parissis
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - V Graham
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland.
| | - S Lampridis
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - M Lau
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - G Hooks
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| | - P C Mhandu
- Cardiothoracics Department, Royal Victoria Hospital, Belfast, Northern Ireland
| |
Collapse
|
15
|
Didier R, Gaglia MA, Koifman E, Kiramijyan S, Negi SI, Omar AF, Gai J, Torguson R, Pichard AD, Waksman R. Cerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and associated variables. Am Heart J 2016; 172:80-7. [PMID: 26856219 DOI: 10.1016/j.ahj.2015.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cerebrovascular accident (CVA) and transient ischemic attack (TIA) related to percutaneous coronary intervention (PCI) are relatively rare complications, but they are associated with high morbidity and mortality. Given the evolution of both CVA risk and PCI techniques over time, this study was conducted to evaluate trends in CVA and TIA associated with PCI and to identify variables associated with neurologic events. METHODS Consecutive patients undergoing PCI at the Washington Hospital Center between January 2002 and June 2015 were included. Prespecified data were prospectively collected, including baseline and procedural characteristics, in-hospital outcomes, and 1-year mortality. The subjects who had a CVA or TIA during or immediately after PCI were compared with those without procedure-associated CVA or TIA. RESULTS Overall, 25,626 patients were included in the study. The mean age was 65.0 ± 12.4 years, 16,949 (65.2%) were male, and 7,436 (28.6%) were African American. From 2002 to 2015, 110 neurologic events post-PCI were diagnosed (0.43%); this included 86 CVAs (0.34%) and 24 TIAs (0.09%). The annual rate of postprocedural neurologic events was 0.42% ± 0.12%. There were significant changes in baseline risk factors over time, with increasing age, incidence of insulin-dependent diabetes, and chronic kidney disease. Patients with neurologic events were more often African American (43.6% vs 28.6%, P < .001) with prior history of CVA (24.5% vs 7.8%, P < .001), chronic renal insufficiency (26.6% vs 15.2%, P < .001), and insulin-dependent diabetes (19.1% vs 12.4%, P = .03). Acute myocardial infarction (56% vs 30.4%, P < .001) and cardiogenic shock (20.2% vs 3%, P < .001) were also more common among patients with neurologic events post-PCI. After multivariable adjustment, use of an intraaortic balloon pump was strongly associated with neurologic events (odds ratio [OR] 4.9, 95% CI 2.7-8.8, P < .001), as was prior CVA (OR 2.4, 95% CI 1.4-4.4, P = .002) and African American race (OR 2.4, 95% CI 1.5-3.9, P < .001); there was a borderline association with the use of a thrombus extraction device (OR 1.7, 95% CI 0.9-3.2, P = .09). In-hospital mortality (20.0% vs 1.5%, P < .001) and 1-year mortality (45.0% vs 7.3%, P < .001) were also much higher in patients with neurologic events. CONCLUSION Neurologic events post-PCI are associated with markedly worse in-hospital outcomes. The incidence of CVA and TIA post-PCI, however, remained stable over the last 12 years despite an increase in risk factors for CVA.
Collapse
|