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van Diepen S, Zheng Y, Senaratne JM, Tyrrell BD, Das D, Thiele H, Henry TD, Bainey KR, Welsh RC. Reperfusion in Patients With ST-Segment-Elevation Myocardial Infarction With Cardiogenic Shock and Prolonged Interhospital Transport Times. Circ Cardiovasc Interv 2024; 17:e013415. [PMID: 38293830 DOI: 10.1161/circinterventions.123.013415] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/09/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND In patients with ST-segment-elevation myocardial infarction complicated by cardiogenic shock, primary percutaneous coronary intervention (pPCI) is the preferred revascularization option. Little is known about the efficacy and safety of a pharmacoinvasive approach for patients with cardiogenic shock presenting to a non-PCI hospital with prolonged interhospital transport times. METHODS In a retrospective analysis of geographically extensive ST-segment-elevation myocardial infarction network (2006-2021), 426 patients with cardiogenic shock and ST-segment-elevation myocardial infarction presented to a non-PCI-capable hospital and underwent reperfusion therapy (53.8% pharmacoinvasive and 46.2% pPCI). The primary clinical outcome was a composite of in-hospital mortality, renal failure requiring dialysis, cardiac arrest, or mechanical circulatory support, and the primary safety outcome was major bleeding defined as an intracranial hemorrhage or bleeding that required transfusion was compared in an inverse probability weighted model. The electrocardiographic reperfusion outcome of interest was the worst residual ST-segment-elevation. RESULTS Patients with pharmacoinvasive treatment had longer median interhospital transport (3 hours versus 1 hour) and shorter median symptom-onset-to-reperfusion (125 minute-to-needle versus 419 minute-to-balloon) times. ST-segment resolution ≥50% on the postfibrinolysis ECG was 56.6%. Postcatheterization, worst lead residual ST-segment-elevation <1 mm (57.3% versus 46.3%; P=0.01) was higher in the pharmacoinvasive compared with the pPCI cohort, but no differences were observed in the worst lead ST-segment-elevation resolution ≥50% (77.4% versus 81.8%; P=0.57). The primary clinical end point was lower in the pharmacoinvasive cohort (35.2% versus 57.0%; inverse probability weighted odds ratio, 0.44 [95% CI, 0.26-0.72]; P<0.01) compared with patients who received pPCI. An interaction between interhospital transfer time and reperfusion strategy with all-cause mortality was observed, favoring a pharmacoinvasive approach with transfer times >60 minutes. The incidence of the primary safety outcome was 10.1% in the pharmacoinvasive arm versus 18.7% in pPCI (adjusted odds ratio, 0.41 [95% CI, 0.14-1.09]; P=0.08). CONCLUSIONS In patients with ST-segment-elevation myocardial infarction presenting with cardiogenic shock and prolonged interhospital transport times, a pharmacoinvasive approach was associated with improved electrocardiographic reperfusion and a lower rate of death, dialysis, or mechanical circulatory support without an increase in major bleeding.
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Affiliation(s)
- Sean van Diepen
- Department of Critical Care (S.v.D., J.M.S.), University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Janek M Senaratne
- Department of Critical Care (S.v.D., J.M.S.), University of Alberta, Edmonton, Canada
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | | | - Debraj Das
- CK Hui Heart Center, Edmonton, Alberta, Canada (B.D.T., D.D.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Germany (H.T.)
| | - Timothy D Henry
- Carl and Edyth Lindner Research Center at the Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Kevin R Bainey
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
| | - Robert C Welsh
- Division of Cardiology, Department of Medicine (S.v.D., J.M.S., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
- Canadian VIGOUR Center (S.v.D., Y.Z., K.R.B., R.C.W.), University of Alberta, Edmonton, Canada
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Ma B, James MT, Javaheri PA, Kruger D, Graham MM, Har BJ, Tyrrell BD, Heavener S, Puzey C, Benterud E. Change Management Accompanying Implementation of Decision Support for Prevention of Acute Kidney Injury in Cardiac Catheterization Units: Program Report. Can J Kidney Health Dis 2023; 10:20543581231206127. [PMID: 37867500 PMCID: PMC10588412 DOI: 10.1177/20543581231206127] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/26/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose of program Different models exist to guide successful implementation of electronic health tools into clinical practice. The Contrast Reducing Injury Sustained by Kidneys (Contrast RISK) initiative introduced an electronic decision support tool with physician audit and feedback into all of the cardiac catheterization facilities in Alberta, Canada, with the goal of preventing contrast-associated acute kidney injury (CA-AKI) following coronary angiography and intervention. This report describes the change management approaches used by the initiative and end-user's feedback on these processes. Sources of information and methods The Canada Health Infoway Change Management model was used to address 6 activities relevant to project implementation: governance and leadership, stakeholder engagement, communications, workflow analysis and integration, training and education, and monitoring and evaluation. Health care providers and invasive cardiologists from all sites completed preimplementation, usability, and postimplementation surveys to assess integration and change success. Key findings Prior to implementation, 67% of health providers were less than satisfied with processes to determine appropriate contrast dye volumes, 47% were less than satisfied with processes for administering adequate intravenous fluids, and 68% were less than satisfied with processes to ensure follow-up of high-risk patients. 48% of invasive cardiologists were less than satisfied with preprocedural identification of patients at risk of acute kidney injury (AKI). Following implementation, there were significant increases among health providers in the odds of satisfaction with processes for identifying those at high risk of AKI (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.36-6.66, P = .007), quantifying the appropriate level of contrast dye for each patient (OR 6.98, 95% CI 3.06-15.91, P < .001), determining the optimal amount of IV fluid for each patient (OR 1.86, 95% CI 0.88-3.91, P = .102), and following up of kidney function of high risk patients (OR 5.49, 95%CI 2.45-12.30, P < .001). There were also significant increases among physicians in the odds of satisfaction with processes for identifying those at high risk of AKI (OR 19.53, 95% CI 3.21-118.76, P = .001), quantifying the appropriate level of contrast dye for each patient (OR 26.35, 95% CI 4.28-162.27, P < .001), and for following-up kidney function of high-risk patients (OR 7.72, 95% CI 1.62-36.84.30, P = .010). Eighty-nine percent of staff perceived the initiative as being successful in changing clinical practices to reduce the risk of CA-AKI. Physicians uniformly agreed that the system was well-integrated into existing workflows, while 42% of health providers also agreed. Implications The Canada Health Infoway Change Management model was an effective framework for guiding implementation of an electronic decision support tool and audit and feedback intervention to improve processes for AKI prevention within cardiac catheterization units.
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Affiliation(s)
- Bryan Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, AB, Canada
- O’Brien Institute of Public Health, University of Calgary, AB, Canada
| | - Pantea A. Javaheri
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Denise Kruger
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michelle M. Graham
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Bryan J. Har
- Libin Cardiovascular Institute, University of Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Benjamin D. Tyrrell
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Shane Heavener
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Clare Puzey
- Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Eleanor Benterud
- Department of Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
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EL-Andari R, Bozso SJ, Kang JJH, Baghaffar A, Berube J, Moon MC, Tyrrell BD, Mathew A, Welsh RC, Nagendran J. Transaxillary Transcatheter Aortic Valve Replacement in a Patient with Previous Aortic Valve Sparing Root Replacement: A Case Report. CJC Open 2022; 5:233-236. [PMID: 37013078 PMCID: PMC10066435 DOI: 10.1016/j.cjco.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
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James MT, Har BJ, Tyrrell BD, Faris PD, Tan Z, Spertus JA, Wilton SB, Ghali WA, Knudtson ML, Sajobi TT, Pannu NI, Klarenbach SW, Graham MM. Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography: A Randomized Clinical Trial. JAMA 2022; 328:839-849. [PMID: 36066520 PMCID: PMC9449791 DOI: 10.1001/jama.2022.13382] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Contrast-associated acute kidney injury (AKI) is a common complication of coronary angiography and percutaneous coronary intervention (PCI) that has been associated with high costs and adverse long-term outcomes. OBJECTIVE To determine whether a multifaceted intervention is effective for the prevention of AKI after coronary angiography or PCI. DESIGN, SETTING, AND PARTICIPANTS A stepped-wedge, cluster randomized clinical trial was conducted in Alberta, Canada, that included all invasive cardiologists at 3 cardiac catheterization laboratories who were randomized to various start dates for the intervention between January 2018 and September 2019. Eligible patients were aged 18 years or older who underwent nonemergency coronary angiography, PCI, or both; who were not undergoing dialysis; and who had a predicted AKI risk of greater than 5%. Thirty-four physicians performed 7820 procedures among 7106 patients who met the inclusion criteria. Participant follow-up ended in November 2020. INTERVENTIONS During the intervention period, cardiologists received educational outreach, computerized clinical decision support on contrast volume and hemodynamic-guided intravenous fluid targets, and audit and feedback. During the control (preintervention) period, cardiologists provided usual care and did not receive the intervention. MAIN OUTCOMES AND MEASURES The primary outcome was AKI. There were 12 secondary outcomes, including contrast volume, intravenous fluid administration, and major adverse cardiovascular and kidney events. The analyses were conducted using time-adjusted models. RESULTS Of the 34 participating cardiologists who were divided into 8 clusters by practice group and center, the intervention group included 31 who performed 4327 procedures among 4032 patients (mean age, 70.3 [SD, 10.7] years; 1384 were women [32.0%]) and the control group included 34 who performed 3493 procedures among 3251 patients (mean age, 70.2 [SD, 10.8] years; 1151 were women [33.0%]). The incidence of AKI was 7.2% (310 events after 4327 procedures) during the intervention period and 8.6% (299 events after 3493 procedures) during the control period (between-group difference, -2.3% [95% CI, -0.6% to -4.1%]; odds ratio [OR], 0.72 [95% CI, 0.56 to 0.93]; P = .01). Of 12 prespecified secondary outcomes, 8 showed no significant difference. The proportion of procedures in which excessive contrast volumes were used was reduced to 38.1% during the intervention period from 51.7% during the control period (between-group difference, -12.0% [95% CI, -14.4% to -9.4%]; OR, 0.77 [95% CI, 0.65 to 0.90]; P = .002). The proportion of procedures in eligible patients in whom insufficient intravenous fluid was given was reduced to 60.8% during the intervention period from 75.1% during the control period (between-group difference, -15.8% [95% CI, -19.7% to -12.0%]; OR, 0.68 [95% CI, 0.53 to 0.87]; P = .002). There were no significant between-group differences in major adverse cardiovascular events or major adverse kidney events. CONCLUSIONS AND RELEVANCE Among cardiologists randomized to an intervention including clinical decision support with audit and feedback, patients undergoing coronary procedures during the intervention period were less likely to develop AKI compared with those treated during the control period, with a time-adjusted absolute risk reduction of 2.3%. Whether this intervention would show efficacy outside this study setting requires further investigation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03453996.
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Affiliation(s)
- Matthew T. James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Bryan J. Har
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin D. Tyrrell
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- CK Hui Heart Centre, University of Alberta, Edmonton, Canada
| | | | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John A. Spertus
- Departments of Biomedical and Health Informatics, University of Missouri, Kansas City
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Stephen B. Wilton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A. Ghali
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Merril L. Knudtson
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T. Sajobi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Neesh I. Pannu
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Scott W. Klarenbach
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle M. Graham
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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Welsh RC, Shavadia JS, Zheng Y, Tyrrell BD, Leung R, Bainey KR. Ticagrelor or clopidogrel dual antiplatelet therapy following a pharmacoinvasive strategy in ST-segment elevation myocardial infarction. Clin Cardiol 2021; 44:1543-1550. [PMID: 34405422 PMCID: PMC8571547 DOI: 10.1002/clc.23716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 01/30/2023] Open
Abstract
Objectives To describe and evaluate outcomes in STEMI patients sustained on clopidogrel compared to those switched to ticagrelor following fibrinolysis. Background World‐wide, many STEMI patients cannot achieve timely PCI and therefore require fibrinolysis. Although comparable 30‐day and 1‐year safety was shown with clopidogrel or ticagrelor in the TREAT study, there is paucity of long‐term outcomes in pharmacoinvasive treated STEMI. Methods We conducted an observational cohort study evaluating consecutive pharmacoinvasive STEMI patients treated in a network, comparing those switched to ticagrelor to those sustained on clopidogrel. The primary efficacy composite was one‐year all‐cause death, recurrent myocardial infarction, and stroke with major bleeding and intracranial hemorrhage (ICH) as the safety outcomes. Multivariable Cox regression model was used to examine the association between P2Y12 inhibitor and outcomes with inverse probability weighting. Results Of 1426 pharmacoinvasive STEMI patients, 28% (n = 396) were converted to ticagrelor at a mean of 9.9 h after fibrinolysis with comparable GRACE Risk Scores (median; 158 vs 157, p0.352). The primary composite occurred in 3.5% of ticagrelor and 7.0% of clopidogrel treated patients (p0.014). Following adjustment, ticagrelor was associated with a 54% lower composite outcome (adjusted HR 0.46, 95% confidence interval 0.26–0.84). Major bleeding 6.3% vs 6.1% (NS) and ICH 0.0% vs 0.2% (NS) were similar. Conclusions In a prospective STEMI cohort, switching to ticagrelor compared with sustaining clopidogrel following fibrinolysis pharmacoinvasive reperfusion reduced recurrent ischemic events at 1‐year with no differences in major bleeding or ICH. Aligned with randomized data, these findings provide support to switch pharmaco‐invasively treated STEMI patients.
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Affiliation(s)
- Robert C Welsh
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Cardiac Sciences, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Jay S Shavadia
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Cardiac Sciences, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | | | - Raymond Leung
- Cardiology, CK Hui Heart Centre, Edmonton, Alberta, Canada
| | - Kevin R Bainey
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Cardiac Sciences, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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Bainey KR, Armstrong PW, Zheng Y, Brass N, Tyrrell BD, Leung R, Westerhout CM, Welsh RC. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction in Clinical Practice: Insights From the Vital Heart Response Registry. Circ Cardiovasc Interv 2019; 12:e008059. [PMID: 31607152 DOI: 10.1161/circinterventions.119.008059] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent clinical trial data support a pharmacoinvasive strategy as an alternative to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction. We evaluated whether this is true in a real-world prehospital ST-segment elevation myocardial infarction network using ECG assessment of reperfusion coupled with clinical outcomes within 1 year. METHODS Of the 5583 ST-segment elevation myocardial infarction patients in the Alberta Vital Heart Response Program (Cohort 1 [2006-2011]: n=3593; Cohort 2 [2013-2016]: n=1990), we studied 3287 patients who received a pharmacoinvasive strategy with tenecteplase (April 2013: half-dose tenecteplase was employed in prehospital patients ≥75 years) or pPCI. ECGs were analyzed within a core laboratory; sum ST-segment deviation resolution ≥50% was defined as successful reperfusion. The primary composite was all-cause death, congestive heart failure, cardiogenic shock, and recurrent myocardial infarction within 1 year. RESULTS The pharmacoinvasive approach was administered in 1805 patients (54.9%), (493 [27.3%] underwent rescue/urgent percutaneous coronary intervention and 1312 [72.7%] had scheduled angiography); pPCI was performed in 1482 patients (45.1%). There was greater ST-segment resolution post-catheterization/percutaneous coronary intervention with a pharmacoinvasive strategy versus pPCI (75.8% versus 64.3%, IP-weighted odds ratio, 1.59; 95% CI, 1.33-1.90; P<0.001). The primary composite was significantly lower with a pharmacoinvasive approach (16.3% versus 23.1%, IP-weighted hazard ratio, 0.84; 95% CI, 0.72-0.99; P=0.033). Major bleeding and intracranial hemorrhage were similar between a pharmacoinvasive strategy and pPCI (7.6% versus 7.5%, P=0.867; 0.6% versus 0.6%; P=0.841, respectively). In the 82 patients ≥75 years with a prehospital pharmacoinvasive strategy, similar ST-segment resolution and rescue rates were observed with full-dose versus half-dose tenecteplase (75.8% versus 88.9%, P=0.259; 31.0% versus 29.2%, P=0.867) with no difference in the primary composite (31.0% versus 25.0%, P=0.585). CONCLUSIONS In this large Canadian ST-segment elevation myocardial infarction registry, a pharmacoinvasive strategy was associated with improved ST-segment resolution and enhanced outcomes within 1 year compared with pPCI. Our findings support the application of a selective pharmacoinvasive reperfusion strategy when delay to pPCI exists.
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Affiliation(s)
- Kevin R Bainey
- Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada.,Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.)
| | - Paul W Armstrong
- Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada.,Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada
| | - Neil Brass
- Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada.,CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)
| | - Benjamin D Tyrrell
- Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada.,CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)
| | - Raymond Leung
- Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada.,CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)
| | - Cynthia M Westerhout
- Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada
| | - Robert C Welsh
- Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada.,Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.)
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Zheng Y, Bainey KR, Tyrrell BD, Brass N, Armstrong PW, Welsh RC. Relationships Between Baseline Q Waves, Time From Symptom Onset, and Clinical Outcomes in ST-Segment–Elevation Myocardial Infarction Patients. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005399. [DOI: 10.1161/circinterventions.117.005399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Yinggan Zheng
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
| | - Kevin R. Bainey
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
| | - Benjamin D. Tyrrell
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
| | - Neil Brass
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
| | - Paul W. Armstrong
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
| | - Robert C. Welsh
- From the Canadian VIGOUR Centre (Y.Z., K.R.B., P.W.A., R.C.W.) and Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry (K.R.B., B.D.T., N.B., P.W.A., R.C.W.), University of Alberta, Edmonton, Canada; Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.); and CK Hui Heart Centre, Edmonton, Alberta, Canada (B.D.T., N.B.)
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Luc JGY, Shanks M, Tyrrell BD, Welsh RC, Butler CR, Meyer SR. Transcatheter Valve-in-Valve: A Cautionary Tale. Ann Thorac Surg 2016; 102:e211-e213. [PMID: 27549545 DOI: 10.1016/j.athoracsur.2016.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) by valve-in-valve (VIV) implantation is an alternative treatment for high-risk patients with a degenerating aortic bioprosthesis. We present a case of transapical TAVR VIV with a 29-mm Edwards SAPIEN XT (ESV) (Edwards Lifesciences, Irvine, CA) into a 29-mm Medtronic Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, MN) in which unanticipated dilatation of the Freestyle bioprosthesis resulted in intraprocedural embolization of the TAVR valve, necessitating urgent conversion to a conventional surgical aortic valve replacement (AVR). Our experience suggests that TAVR VIV with the 29-mm ESV in the setting of a degenerated 29-mm Freestyle stentless bioprosthesis must be undertaken with caution.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Miriam Shanks
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin D Tyrrell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; CK Hui Heart Centre, Edmonton, Alberta, Canada
| | - Robert C Welsh
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
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Meyer SR, Shanks M, Tyrrell BD, MacArthur RGG, Taylor DA, Welsh S, Paterson C, Welsh RC. Outcomes of consecutive patients referred for consideration for transcatheter aortic valve implantation from an encompassing health-care region. Am J Cardiol 2013; 112:1450-4. [PMID: 23972344 DOI: 10.1016/j.amjcard.2013.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
Procedural outcomes for transcatheter aortic valve implantation (TAVI) are well described. However, limited information exists regarding patient screening and selection. Thus, the purpose of the study was to review consecutive patients referred for TAVI from an inclusive-defined population. The Mazankowski Alberta Heart Institute TAVI program has maintained a prospective database on all referred patients. Patients are reviewed in outpatient clinic attended by a nurse, cardiologist, cardiac surgeon, and administrative assistant. After workup is complete, a TAVI Heart Team conference occurs to accept or reject each patient. Since November 2009, 276 patients (145 men and 131 women) have been referred with a steady increase in the number of referrals annually. Mean age was 82.2 years (men 81.6 and women 82.8), with 13% aged <70 years. Mean EuroSCORE was 13.8 and mean STS score was 5.7. Of the referred patients, 34% received TAVI, 17% were rejected, 12% underwent open AVR, 10% refused TAVI, and 27% are currently being assessed or followed. There were no differences in the mean EuroSCORE (13.4 vs 14.3; p = 0.64) or STS scores (5.2 vs 6.4; p = 0.13) of those accepted for TAVI versus those who were not. In conclusion, a team-based approach to assess this complex patient population is essential to ensure efficient and comprehensive evaluation, in turn determining appropriate care allocation. With expansion of clinical experience and the evidence supporting TAVI, the Heart Teams defined to assess this patient population will be burdened with increased clinical commitment and require appropriate support.
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Affiliation(s)
- Steven R Meyer
- Division of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
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Iida R, Welsh RC, Meyer SR, Tyrrell BD, Taylor DA, Shanks M. Pre-Dismissal Surveillance Echocardiography Second Day After TAVR. JACC Cardiovasc Imaging 2012; 5:1182-4. [DOI: 10.1016/j.jcmg.2012.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 10/27/2022]
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