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Hu J, Murugiah K, Xin X, Sawano M, Lu Y, Wilson FP, Masoudi FA, Messenger JC, Krumholz HM, Huang C. Heterogeneity in the Prognosis of Acute Kidney Injury Following Percutaneous Coronary Intervention. J Am Heart Assoc 2024; 13:e033649. [PMID: 38390832 PMCID: PMC10944032 DOI: 10.1161/jaha.123.033649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Jiun‐Ruey Hu
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Karthik Murugiah
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Xin Xin
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
| | - Mitsuaki Sawano
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
| | - Yuan Lu
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
| | - F. Perry Wilson
- Section of Nephrology, Department of MedicineYale School of MedicineNew HavenCTUSA
| | - Frederick A. Masoudi
- Ascension HealthSt. LouisMOUSA
- Division of Cardiology, Department of MedicineUniversity of Texas at Austin Dell Medical SchoolAustinTXUSA
| | - John C. Messenger
- Division of Cardiology, Department of MedicineUniversity of Colorado School of MedicineAuroraCOUSA
| | - Harlan M. Krumholz
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Chenxi Huang
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
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2
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Price AL, Amin AP, Rogers S, Messenger JC, Moussa ID, Miller JM, Jennings J, Masoudi FA, Abbott JD, Young R, Wojdyla DM, Rao SV. Implementation of a Multidimensional Strategy to Reduce Post-PCI Bleeding Risk. Circ Cardiovasc Interv 2024; 17:e013003. [PMID: 38410946 PMCID: PMC10942247 DOI: 10.1161/circinterventions.123.013003] [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: 02/22/2023] [Accepted: 12/14/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND The American College of Cardiology Reduce the Risk: PCI Bleed Campaign was a hospital-based quality improvement campaign designed to reduce post-percutaneous coronary intervention (PCI) bleeding events. The aim of the campaign was to provide actionable evidence-based tools for participants to review, adapt, and adopt, depending upon hospital resources and engagement. METHODS We used data from 8 757 737 procedures in the National Cardiovascular Data Registry between 2015 and 2021 to compare patient and hospital characteristics and bleeding outcomes among campaign participants (n=195 hospitals) and noncampaign participants (n=1384). Post-PCI bleeding risk was compared before and after campaign participation. Multivariable hierarchical logistic regression was used to determine the adjusted association between campaign participation and post-PCI bleeding events. Prespecified subgroups were examined. RESULTS Campaign hospitals were more often higher volume teaching facilities located in urban or suburban locations. After adjustment, campaign participation was associated with a significant reduction in the rate of bleeding (bleeding: adjusted odds ratio, 0.61 [95% CI, 0.53-0.71]). Campaign hospitals had a greater decrease in bleeding events than noncampaign hospitals. In a subgroup analysis, the reduction in bleeding was noted in non-ST-segment-elevation acute coronary syndrome and ST-segment-elevation myocardial infarction patients, but no significant reduction was seen in patients without acute coronary syndrome. CONCLUSIONS Participation in the American College of Cardiology Reduce the Risk: PCI Bleed Campaign was associated with a significant reduction in post-PCI bleeding. Our results underscore that national quality improvement efforts can be associated with a significant impact on PCI outcomes.
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Affiliation(s)
| | - Amit P. Amin
- Rush University Medical Center, Chicago, IL (A.P.A.)
| | - Susan Rogers
- American College of Cardiology, Washington DC (S.R.)
| | | | - Issam D. Moussa
- Carle Heart & Vascular Institute, Carle Illinois College of Medicine, Urbana (I.D.M.)
| | | | | | | | - J. Dawn Abbott
- Warren Alpert Medical School of Brown University, Brown University, Lifespan Cardiovascular Institute, Providence, RI (J.D.A.)
| | - Rebecca Young
- Duke Clinical Research Institute, Durham, NC (R.Y., D.M.W.)
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3
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Hennessey B, Danenberg H, De Vroey F, Kirtane AJ, Parikh M, Karmpaliotis D, Messenger JC, Strobel A, Curcio A, van Mourik MS, Eshuis P, Escaned J. Dynamic Coronary Roadmap versus standard angiography for percutaneous coronary intervention: the randomised, multicentre DCR4Contrast trial. EUROINTERVENTION 2024; 20:e198-e206. [PMID: 38343370 PMCID: PMC10851082 DOI: 10.4244/eij-d-23-00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/08/2023] [Accepted: 10/24/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Decreasing the amount of iodinated contrast is an important safety aspect of percutaneous coronary interventions (PCI), particularly in patients with a high risk of contrast-induced acute kidney injury (CI-AKI). Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially limiting the need for contrast during PCI. AIMS This study investigates the contrast-sparing potential of DCR in PCI, compared to standard angiographic guidance. METHODS The Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) trial is a multicentre, international, prospective, unblinded, stratified 1:1 randomised controlled trial. Patients were randomised to either DCR-guided PCI or to conventional angiography-guided PCI. The primary endpoint was the total volume of iodinated contrast administered, and the secondary endpoint was the number of cineangiography runs during PCI. RESULTS The study population included 356 randomised patients (179 in DCR and 177 in control groups, respectively). There were no differences in patient demographics, angiographic characteristics or estimated glomerular filtration rate (eGFR) between the two groups. The total contrast volume used during PCI was significantly lower with DCR guidance compared with conventional angiographic guidance (64.6±44.4 ml vs 90.8±55.4 ml, respectively; p<0.001). The total number of cineangiography runs was also significantly reduced in the DCR group (8.7±4.7 vs 11.7±7.6 in the control group; p<0.001). CONCLUSIONS Compared to conventional angiography-guided PCI, DCR guidance was associated with a significant reduction in both contrast volume and the number of cineangiography runs during PCI. (ClinicalTrials.gov: NCT04085614).
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
- Department of Cardiology, Blackrock Clinic, Dublin, Ireland
| | - Haim Danenberg
- Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Interventional Cardiology Division, Wolfson Medical Center, Holon, Israel
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Ajay J Kirtane
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
| | - Manish Parikh
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Dimitrios Karmpaliotis
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA and the Cardiovascular Research Foundation, New York, NY, USA
- Division of Cardiology, Morristown Medical Center, Morristown, NJ, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Aaron Strobel
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Baptist Health Heart Institute, Little Rock, AK, USA
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | | | | | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
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Ismayl M, Hussain Y, Aboeata A, Walters RW, Naidu SS, Messenger JC, Basir MB, Rao SV, Goldsweig AM, Altin SE. Pulmonary Artery Catheter Use and Outcomes in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock Treated With Impella (a Nationwide Analysis from the United States). Am J Cardiol 2023; 203:304-314. [PMID: 37517125 DOI: 10.1016/j.amjcard.2023.06.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 04/15/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
The role of continuous hemodynamic assessment with pulmonary artery (PA) catheter placement in cardiogenic shock (CS) remains debated. We aimed to assess the association between PA catheter placement and clinical outcomes in patients with CS secondary to ST-elevation myocardial infarction (STEMI) treated with an intravascular microaxial flow pump. We identified patients hospitalized with STEMI complicated by CS on mechanical circulatory support with an intravascular microaxial flow pump (Impella, Abiomed, Danvers, Massachusetts) using the National Inpatient Sample database and compared the outcomes in those treated with and without PA catheters. The primary outcome was in-hospital mortality. The secondary outcomes included in-hospital complications, hospital length of stay, inpatient costs, and temporal trends. The total cohort included 14,635 hospitalizations for STEMI complicated by CS treated with Impella between 2016 and 2020, of whom 5,505 (37.6%) received PA catheters. Over the study period, the use of PA catheters increased significantly from 25.9% to 41.8% (ptrend <0.01). Similarly, the use of Impella increased from 9.9% to 18.9% (ptrend <0.01). After adjustment for baseline characteristics using a multivariate logistic regression analysis, PA catheter use was associated with lower in-hospital mortality (adjusted odds ratio 0.80, 95% confidence interval 0.67 to 0.96, p = 0.01) and similar cardiovascular, neurologic, renal, and hematologic complications; length of stay; and inpatient costs compared with no PA catheter use. In conclusion, PA catheter use in patients with STEMI complicated by CS treated with Impella is associated with reduced in-hospital mortality and similar complication rates. Given the mortality benefit, further research is necessary to optimize PA catheter use in patients with STEMI with CS.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota.
| | - Yasin Hussain
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ahmed Aboeata
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska
| | - Srihari S Naidu
- Department of Cardiovascular Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - John C Messenger
- Department of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mir B Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Sunil V Rao
- Department of Cardiovascular Medicine, NYU Langone Health System, New York, New York
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, Massachusetts
| | - S Elissa Altin
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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5
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Hennessey B, Messenger JC, Kirtane AJ, Parikh M, Danenberg H, De Vroey F, Curcio A, Eshuis P, Escaned J. Rationale and design of the Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) in PCI randomized controlled trial. Am Heart J 2023; 263:151-158. [PMID: 37040861 DOI: 10.1016/j.ahj.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The clinical and anatomic complexity of patients undergoing percutaneous coronary interventions (PCI) has increased significantly over the past 2 decades. Contrast induced nephropathy (CIN) significantly impacts prognosis after PCI, therefore minimizing the risk of CIN is important in improving clinical outcomes. Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool which may decrease CIN by projecting a motion-compensated virtual coronary roadmap overlay on fluoroscopy, potentially reducing iodinated contrast volume during PCI. STUDY DESIGN AND OBJECTIVES The Dynamic Coronary Roadmap for Contrast Reduction trial (DCR4Contrast) is a multi-center, prospective, unblinded, stratified 1:1 randomized controlled trial investigating if DCR use reduces the total contrast volume administered during PCI compared to PCI performed without DCR guidance. DCR4Contrast aims to recruit 394 patients undergoing PCI. The primary end point is the total undiluted iodinated contrast volume administered during the PCI, performed with or without DCR. As of November 14, 2022, 346 subjects have been enrolled. CONCLUSIONS The DCR4Contrast study will investigate the potential contrast-sparing effect of the DCR navigation support tool in patients undergoing PCI. By reducing iodinated contrast administration, DCR has the potential to contribute to reduced risk of CIN and thus increase PCI safety. CLINICAL TRIAL REGISTRATION URL https://clinicaltrials.gov/ct2/show/NCT04085614.
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - John C Messenger
- Division of Cardiology, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Ajay J Kirtane
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Manish Parikh
- Division of Cardiology, New York-Presbyterian/Brooklyn Methodist Hospital, New York, NY
| | - Haim Danenberg
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Interventional Cardiology Division, Wolfson Medical Centre Holon, Holon, Israel
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Alejandro Curcio
- Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain.
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6
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Boulos PK, Freeman SV, Henry TD, Mahmud E, Messenger JC. Interaction of COVID-19 With Common Cardiovascular Disorders. Circ Res 2023; 132:1259-1271. [PMID: 37167359 PMCID: PMC10171313 DOI: 10.1161/circresaha.122.321952] [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] [Indexed: 05/13/2023]
Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.
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Affiliation(s)
- Peter K. Boulos
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Scott V. Freeman
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (E.M.)
| | - John C. Messenger
- University of Colorado School of Medicine, Division of Cardiology, Aurora (P.K.B., S.V.F., J.C.M.)
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7
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Huang C, Murugiah K, Li X, Masoudi FA, Messenger JC, Williams KA, Mortazavi BJ, Krumholz HM. Effect of the New Glomerular Filtration Rate Estimation Equation on Risk Predicting Models for Acute Kidney Injury After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2023; 16:e012831. [PMID: 37009734 PMCID: PMC10622038 DOI: 10.1161/circinterventions.122.012831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xumin Li
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Frederick A. Masoudi
- Ascension Health, St. Louis, Missouri
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kim A. Williams
- Department of Internal Medicine, University of Louisville, Louisville, Kentucky
| | - Bobak J. Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station, Texas
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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8
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McIlvennan CK, Urra M, Helmkamp L, Messenger JC, Raymer D, Ream KS, Oldemeyer JB, Ambardekar AV, Barnes K, Allen LA. Magnitude of troponin elevation in patients with biomarker evidence of myocardial injury: relative frequency and outcomes in a cohort study across a large healthcare system. BMC Cardiovasc Disord 2023; 23:151. [PMID: 36959555 PMCID: PMC10037877 DOI: 10.1186/s12872-023-03168-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Serum troponin levels correlate with the extent of myocyte necrosis in acute myocardial infarction (AMI) and predict adverse outcomes. However, thresholds of cardiac troponin elevation that could portend to poor outcomes have not been established. METHODS In this cohort study, we characterized all cardiac troponin elevations > 0.04 ng/mL (upper limit of normal [ULN]) from patients hospitalized with an ICD-9/10 diagnosis of AMI across our health system from 2012-2019. We grouped events into exponential categories of peak cardiac troponin and evaluated the association of these troponin categories with all-cause mortality, heart transplants, or durable left ventricular assist devices (LVAD). Patients with cardiac troponin > 10,000 × ULN were manually chart reviewed and described. RESULTS There were 18,194 AMI hospitalizations with elevated cardiac troponin. Peak troponin was 1-10 × ULN in 21.1%, 10-100 × ULN in 34.8%, 100-1,000 × ULN in 30.1%, 1,000-10,000 × ULN in 13.1%, and > 10,000 × ULN in 0.9% of patients. One-year mortality was 17-21% across groups, except in > 10,000 × ULN group where it was 33% (adjusted hazard ratio (99%CI) for > 10,000 × ULN group compared to all others: 1.86 (1.21, 2.86)). Hazards of one-year transplant and MCS were also significantly elevated in the > 10,000 × ULN group. CONCLUSIONS Elevation in cardiac troponin levels post AMI that are > 10,000 × ULN was rare but identified patients at particularly high risk of adverse events. These patients may benefit from clarification of goals of care and early referral for advanced heart failure therapies. These data have implications for conversion to newer high-sensitivity cardiac troponin assays whose maximum assay limit is often lower than traditional assays.
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Affiliation(s)
- Colleen K McIlvennan
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Manuel Urra
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
| | - Laura Helmkamp
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John C Messenger
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
| | - David Raymer
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
| | - Karen S Ream
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
| | | | - Amrut V Ambardekar
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
| | - Kathleen Barnes
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA
- Colorado Center for Personalized Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Larry A Allen
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17 Avenue, B130, Aurora, CO, 80045, USA.
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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9
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Altman NL, Berning AA, Saxon CE, Adamek KE, Wagner JA, Slavov D, Quaife RA, Gill EA, Minobe WA, Jonas ER, Carroll IA, Huebler SP, Raines J, Messenger JC, Ambardekar AV, Mestroni L, Rosenberg RM, Rove J, Campbell TB, Bristow MR. Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination. JACC Basic Transl Sci 2023; 8:124-137. [PMID: 36281440 PMCID: PMC9581498 DOI: 10.1016/j.jacbts.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.
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Key Words
- ACE, angiotensin I–converting enzyme gene
- ACE2, angiotensin-converting enzyme 2 gene
- AGT, angiotensinogen gene
- AGTR1, angiotensin II receptor type 1 gene
- ANG II, angiotensin II
- BNP, B-type natriuretic peptide
- CMR, cardiac magnetic resonance
- COVID-19
- EM, electron microscopy
- F3, coagulation factor III (tissue factor) gene
- ITGA5, integrin subunit alpha 5 gene
- IVS, interventricular septum
- LGE, late gadolinium enhancement
- LM, light microscopy
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NDC, nonischemic dilated cardiomyopathy
- NPPB, natriuretic peptide B gene
- RV, right ventricular
- S, SARS-CoV-2 Spike
- TnI, troponin I
- gene expression
- mRNA vaccines
- myocardial injury
- myocarditis
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Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amber A. Berning
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara E. Saxon
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kylie E. Adamek
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica A. Wagner
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dobromir Slavov
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward A. Gill
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wayne A. Minobe
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric R. Jonas
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Joshua Raines
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel M. Rosenberg
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Rove
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas B. Campbell
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- ARCA Biopharma, Westminster, Colorado, USA
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Ahsan MJ, Ahmad S, Latif A, Lateef N, Ahsan MZ, Abusnina W, Nathan S, Altin SE, Kolte DS, Messenger JC, Tannenbaum M, Goldsweig AM. Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis. European Heart Journal - Quality of Care and Clinical Outcomes 2022; 8:640-650. [PMID: 35460230 PMCID: PMC9442849 DOI: 10.1093/ehjqcco/qcac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI), transradial access (TRA) for percutaneous coronary intervention (PCI) is associated with less bleeding and mortality than transfemoral access (TFA). However, patients in cardiogenic shock (CS) are more often treated via TFA. The aim of this meta-analysis is to compare the safety and efficacy of TRA vs. TFA in CS. METHODS Systematic review was performed querying PubMed, Google Scholar, Cochrane, and clinicaltrials.gov for studies comparing TRA to TFA in PCI for CS. Outcomes included in-hospital, 30-day and ≥1-year mortality, major and access site bleeding, TIMI3 (thrombolytics in myocardial infarction) flow, procedural success, fluoroscopy time, and contrast volume. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. RESULTS Six prospective and eight retrospective studies (TRA, n = 8032; TFA, n = 23 031) were identified. TRA was associated with lower in-hospital (RR 0.59, 95% CI 0.52-0.66, P < 0.0001), 30-day and ≥1-year mortality, as well as less in-hospital major (RR 0.41, 0.31-0.56, P < 0.001) and access site bleeding (RR 0.42, 0.23-0.77, P = 0.005). There were no statistically significant differences in post-PCI coronary flow grade, procedural success, fluoroscopy time, and contrast volume between TRA vs. TFA. CONCLUSIONS In PCI for STEMI with CS, TRA is associated with significantly lower mortality and bleeding complications than TFA while achieving similar TIMI3 flow and procedural success rates.
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Affiliation(s)
| | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Azka Latif
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Waiel Abusnina
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, USA
| | - Sandeep Nathan
- Division of Cardiovascular Medicine, University of Chicago, Chicago, IL, USA
| | - S Elissa Altin
- Division of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Dhaval S Kolte
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John C Messenger
- Division of Cardiology Medicine, University of Colorado, Aurora, CO, USA
| | - Mark Tannenbaum
- Division of Cardiovascular Medicine, Iowa Heart Center, Des Moines, IA, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Valle JA, Fullerton D, Cleveland J, Messenger JC, Carroll JD. Reply: Rational Dispersion of TAVR: The Role of Training Centers. J Am Coll Cardiol 2022; 79:e187. [PMID: 35210042 DOI: 10.1016/j.jacc.2021.12.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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12
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Castro-Dominguez YS, Curtis JP, Masoudi FA, Wang Y, Messenger JC, Desai NR, Slattery LE, Dehmer GJ, Minges KE. Hospital Characteristics and Early Enrollment Trends in the American College of Cardiology Voluntary Public Reporting Program. JAMA Netw Open 2022; 5:e2147903. [PMID: 35142829 PMCID: PMC8832180 DOI: 10.1001/jamanetworkopen.2021.47903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Limited data exist regarding the characteristics of hospitals that do and do not participate in voluntary public reporting programs. OBJECTIVE To describe hospital characteristics and trends associated with early participation in the American College of Cardiology (ACC) voluntary reporting program for cardiac catheterization-percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed enrollment trends and characteristics of hospitals that did and did not participate in the ACC voluntary public reporting program. All hospitals reporting procedure data to the National Cardiovascular Data Registry (NCDR) CathPCI or ICD registries that were eligible for the public reporting program from July 2014 (ie, program launch date) to May 2017 were included. Stepwise logistic regression was used to identify hospital characteristics associated with voluntary participation. Enrollment trends were evaluated considering the date US News & World Report (USNWR) announced that it would credit participating hospitals. Data analysis was performed from March 2017 to January 2018. MAIN OUTCOMES AND MEASURES Hospital characteristics and participation in the public reporting program. RESULTS By May 2017, 561 of 1747 eligible hospitals (32.1%) had opted to participate in the program. Enrollment increased from 240 to 376 hospitals (56.7%) 1 month after the USNWR announcement that program participation would be considered as a component of national hospital rankings. Compared with hospitals that did not enroll, program participants had increased median (IQR) procedural volumes for PCI (481 [280-764] procedures vs 332 [186-569] procedures; P < .001) and ICD (114 [56-220] procedures vs 62 [25-124] procedures; P < .001). Compared with nonparticipating hospitals, an increased mean (SD) proportion of participating hospitals adhered to composite discharge medications after PCI (0.96 [0.03] vs 0.92 [0.07]; P < .001) and ICD (0.88 [0.10] vs 0.81 [0.12]; P < .001). Hospital factors associated with enrollment included participation in 5 or more NCDR registries (odds ratio [OR],1.98; 95% CI, 1.24-3.19; P = .005), membership in a larger hospital system (ie, 3-20 hospitals vs ≤2 hospitals in the system: OR, 2.29; 95% CI, 1.65-3.17; P = .001), participation in an NCDR pilot public reporting program of PCI 30-day readmissions (OR, 2.93; 95% CI, 2.19-3.91; P < .001), university affiliation (vs government affiliation: OR, 3.85, 95% CI, 1.03-14.29; P = .045; vs private affiliation: OR, 2.22; 95% CI, 1.35-3.57; P < .001), Midwest location (vs South: OR, 1.47; 95% CI, 1.06-2.08; P = .02), and increased comprehensive quality ranking (4 vs 1-2 performance stars in CathPCI: OR, 8.08; 95% CI, 5.07-12.87; P < .001; 4 vs 1 performance star in ICD: OR, 2.26; 95% CI, 1.48-3.44; P < .001) (C statistic = 0.829). CONCLUSIONS AND RELEVANCE This study found that one-third of eligible hospitals participated in the ACC voluntary public reporting program and that enrollment increased after the announcement that program participation would be considered by USNWR for hospital rankings. Several hospital characteristics, experience with public reporting, and quality of care were associated with increased odds of participation.
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Affiliation(s)
- Yulanka S. Castro-Dominguez
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - John C. Messenger
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Lara E. Slattery
- American College of Cardiology, Washington, District of Columbia
| | - Gregory J. Dehmer
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Karl E. Minges
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Health Administration and Policy, University of New Haven, West Haven, Connecticut
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13
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Bricker RS, Cleveland JC, Messenger JC. Mechanical Complications of Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:465-480. [PMID: 34593110 DOI: 10.1016/j.iccl.2021.06.007] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical complications after transcatheter aortic valve replacement are fortunately rare with the current generation of devices. Unfortunately, life-threatening complications will occur and it is the responsibility of operators to be familiar with strategies to prevent and manage these challenging scenarios. Because these cases will not occur often, it is important for us to highlight and talk about those that do occur, to learn best practices in how to manage and prevent them going forward. We can learn much from each other's good crash landings.
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, Aurora, CO 80045, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA.
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14
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Bricker RS, Quaife RA, Chen SYJ, Messenger JC, Hammers J, Carroll JD. Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy. JACC Case Rep 2021; 3:1258-1263. [PMID: 34471874 PMCID: PMC8387808 DOI: 10.1016/j.jaccas.2021.05.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
This paper describes the case of a patient who developed refractory heart failure due to a fistula from the left ventricle to the coronary sinus that was unintentionally created after a surgical myectomy and mitral valve replacement. Advanced image guidance with a pre-procedure 3-dimensional physical model and intraprocedure echocardiography fusion facilitated transcatheter plugging of the shunt with symptom resolution. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert A Quaife
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shiuh-Yung J Chen
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - John D Carroll
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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15
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Naidu SS, Baron SJ, Eng MH, Sathanandam SK, Zidar DA, Feldman DN, Ing FF, Latif F, Lim MJ, Henry TD, Rao SV, Dangas GD, Hermiller JB, Daggubati R, Shah B, Ang L, Aronow HD, Banerjee S, Box LC, Caputo RP, Cohen MG, Coylewright M, Duffy PL, Goldsweig AM, Hagler DJ, Hawkins BM, Hijazi ZM, Jayasuriya S, Justino H, Klein AJ, Kliger C, Li J, Mahmud E, Messenger JC, Morray BH, Parikh SA, Reilly J, Secemsky E, Shishehbor MH, Szerlip M, Yakubov SJ, Grines CL, Alvarez-Breckenridge J, Baird C, Baker D, Berry C, Bhattacharya M, Bilazarian S, Bowen R, Brounstein K, Cameron C, Cavalcante R, Culbertson C, Diaz P, Emanuele S, Evans E, Fletcher R, Fortune T, Gaiha P, Govender D, Gutfinger D, Haggstrom K, Herzog A, Hite D, Kalich B, Kirkland A, Kohler T, Laurisden H, Livolsi K, Lombardi L, Lowe S, Marhenke K, Meikle J, Moat N, Mueller M, Patarca R, Popma J, Rangwala N, Simonton C, Stokes J, Taber M, Tieche C, Venditto J, West NEJ, Zinn L. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions (SCAI) 2021 think tank. Catheter Cardiovasc Interv 2021; 98:904-913. [PMID: 34398509 DOI: 10.1002/ccd.29898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023]
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community annually for high-level field-wide discussions. The 2021 Think Tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease. Each session was moderated by a senior content expert and co-moderated by a member of SCAI's Emerging Leader Mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialog from a broader base, and thereby aid SCAI, the industry community and external stakeholders in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suzanne J Baron
- Division of Cardiology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Shyam K Sathanandam
- Department of Cardiology, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - David A Zidar
- Department of Cardiology, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Dmitriy N Feldman
- Department of Cardiology, Weill Cornell Medical Center, New York, USA
| | - Frank F Ing
- Department of Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Faisal Latif
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Michael J Lim
- Department of Cardiology, St. Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Timothy D Henry
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sunil V Rao
- Department of Cardiology, Duke University Health System, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, USA
| | - James B Hermiller
- Department of Cardiology, Ascension St. Vincent Cardiovascular Research Institute, Carmel, Indiana, USA
| | - Ramesh Daggubati
- Department of Cardiology, The West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Binita Shah
- Department of Cardiology, NYU Grossman School of Medicine, New York, USA
| | - Lawrence Ang
- Division of Cardiovascular Medicine, The University of California, San Diego, California, USA
| | - Herbert D Aronow
- Department of Cardiology, Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Subhash Banerjee
- Department of Cardiology, Dallas Veterans Affairs Medical Center, Dallas, Texas, USA
| | - Lyndon C Box
- Department of Cardiology, West Valley Medical Center, Caldwell, Idaho, USA
| | - Ronald P Caputo
- Department of Cardiology, Levine Heart and Wellness, Naples, Florida, USA
| | - Mauricio G Cohen
- Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan Coylewright
- Department of Cardiology, Erlanger Health System, Chattanooga, Tennessee, USA
| | - Peter L Duffy
- Department of Cardiology, West Florida Hospital, Pensacola, Florida, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Donald J Hagler
- Division of Pediatric Cardiology and Department of Cardiovascular Diseases, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Beau M Hawkins
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Ziyad M Hijazi
- Cardiology, Weill Cornell Medical College, New York, USA.,Sidra Medicine, Doha, Qatar
| | - Sasanka Jayasuriya
- Cardiology, Ascension Columbia St. Mary's Hospital Milwaukee, Milwaukee, Wisconsin, USA
| | - Henri Justino
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Andrew J Klein
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Chad Kliger
- Department of Medicine, Division of Cardiovascular Medicine, Northwell Health Lenox Hill Hospital, New York, USA
| | - Jun Li
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ehtisham Mahmud
- Coronary Care Unit, University of California, San Diego, California, USA
| | - John C Messenger
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, USA
| | - John Reilly
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Eric Secemsky
- Department of Internal Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular Institute, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Molly Szerlip
- Division of Cardiology, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas, USA
| | - Steven J Yakubov
- Department of Cardiology, OhioHealth Heart & Vascular Physicians, Columbus, Ohio, USA
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
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- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - David Baker
- Philips Healthcare, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Erin Evans
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - Priya Gaiha
- Siemens Medical Solutions USA, Malvern, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neil Moat
- Abbott, Santa Clara, California, USA
| | | | | | | | | | | | - Jerry Stokes
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
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Abstract
PURPOSE OF REVIEW Given the low occurrence of clinically important paravalvular leak (PVL), there are no large registries or trials in this space to investigate management strategies. This review integrates newer evidence, particularly in imaging guidance for these complex procedures, novel techniques and approaches that our group has taken, as well as approaches to more complex PVL plugging reported in case reports. RECENT FINDINGS Perhaps the largest area of growth in the management of PVL is the use of advanced imaging in both pre-procedure evaluation and intra-procedural guidance with gated cardiac CT, 3D TEE, and fluoroscopy fusion technologies. Outside the USA, a new device, the Occlutech PLD, has become available with early data indicating high success rates. There remains little randomized data to support the efficacy of percutaneous PVL closure. Gated cardiac CT has become key to the pre-procedure evaluation for transcatheter closure as it allows for increased procedural efficiency and more accurate pre-procedure planning, particularly when combined with 3D printing. Intra-procedural TEE-fluoro fusion allows for more rapid crossing of defects by providing a visual target for interventionalists. The advent of purpose-built devices for PVL closure may further increase the efficacy and efficiency of percutaneous closure, but significant barriers remain for approval of these devices in the USA.
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Affiliation(s)
- Aken Desai
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA.
| | - John C Messenger
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - Robert Quaife
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - John Carroll
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
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Manly DA, Karrowni W, Rymer JA, Kaltenbach LA, Swaminathan RV, Messenger JC, Abbott JD, Seto A, Panetta C, Brilakis E, Nikolakopoulos I, Gilchrist IC, Kaul P, Dakik H, Rao SV. Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach. JACC Cardiovasc Interv 2021; 14:907-916. [PMID: 33812824 DOI: 10.1016/j.jcin.2021.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 08/27/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach. BACKGROUND There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI. METHODS Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access. RESULTS The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG. CONCLUSIONS The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.
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Affiliation(s)
- David A Manly
- Prisma Health-Upstate, Greenville Memorial Medical Campus, Greenville, South Carolina, USA
| | - Wassef Karrowni
- St. Luke's Hospital-Unity Point Health, Cedar Rapids, Iowa, USA
| | | | | | | | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - J Dawn Abbott
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Arnold Seto
- University of California-Irvine, Irvine, California, USA
| | | | | | | | - Ian C Gilchrist
- Penn State Heart and Vascular Institute, Hershey, Pennsylvania, USA
| | | | - Habib Dakik
- American University of Beirut, Beirut, Lebanon
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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18
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Levy AE, Hammes A, Anoff DL, Raines JD, Beck NM, Rudofker EW, Marshall KJ, Nensel JD, Messenger JC, Masoudi FA, Pierce RG, Allen LA, Ream KS, Ho PM. Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System. Circ Cardiovasc Qual Outcomes 2021; 14:e006570. [PMID: 33653116 DOI: 10.1161/circoutcomes.120.006570] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses International Classification of Diseases, Tenth Revision (ICD-10) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known. METHODS In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal ICD-10 diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission. RESULTS One thousand nine hundred thirty-five patients were included in the ICD-10 cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years, P<0.001), more often female (48% versus 30%, P<0.001), and had higher rates of heart failure (52% versus 33%, P<0.001) and kidney disease (42% versus 25%, P<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%, P<0.001), 1-year mortality (21% versus 8%, P<0.001), and 90-day readmission (26% versus 19%, P=0.006) than the ICD-10 cohort. Two observations help explain these differences: 61% of ICD-10 cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the ICD-10 cohort (78%). CONCLUSIONS The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on ICD-10 codes to define AMI cohorts would better represent type 1 myocardial infarction patients.
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Affiliation(s)
- Andrew E Levy
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora.,Division of Cardiology, Denver Health and Hospital Authority, CO (A.E.L.)
| | - Andrew Hammes
- Division of Biostatistics and Informatics, Colorado School of Public Health, Aurora (A.H.)
| | - Debra L Anoff
- Division of Hospital Medicine (D.L.A.), University of Colorado Anschutz Medical Campus, Aurora
| | - Joshua D Raines
- Department of Medicine (J.D.R., N.M.B., E.W.R., P.M.H.), University of Colorado Anschutz Medical Campus, Aurora
| | - Natalie M Beck
- Department of Medicine (J.D.R., N.M.B., E.W.R., P.M.H.), University of Colorado Anschutz Medical Campus, Aurora
| | - Eric W Rudofker
- Department of Medicine (J.D.R., N.M.B., E.W.R., P.M.H.), University of Colorado Anschutz Medical Campus, Aurora
| | - Kimberly J Marshall
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - Jessica D Nensel
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - John C Messenger
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - Frederick A Masoudi
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - Read G Pierce
- Department of Medicine, Dell Medical School, Austin, TX (R.G.P.)
| | - Larry A Allen
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - Karen S Ream
- Division of Cardiology (A.E.L., K.J.M., J.D.N., J.C.M., F.A.M., L.A.A., K.S.R.), University of Colorado Anschutz Medical Campus, Aurora
| | - P Michael Ho
- Department of Medicine (J.D.R., N.M.B., E.W.R., P.M.H.), University of Colorado Anschutz Medical Campus, Aurora.,Cardiovascular Medicine, VA Eastern Colorado Healthcare System, Denver, CO (P.M.H.)
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Dhruva SS, Ross JS, Mortazavi BJ, Hurley NC, Krumholz HM, Curtis JP, Berkowitz AP, Masoudi FA, Messenger JC, Parzynski CS, Ngufor CG, Girotra S, Amin AP, Shah ND, Desai NR. Use of Mechanical Circulatory Support Devices Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA Netw Open 2021; 4:e2037748. [PMID: 33616664 PMCID: PMC7900859 DOI: 10.1001/jamanetworkopen.2020.37748] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Mechanical circulatory support (MCS) devices, including intravascular microaxial left ventricular assist devices (LVADs) and intra-aortic balloon pumps (IABPs), are used in patients who undergo percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock despite limited evidence of their clinical benefit. OBJECTIVE To examine trends in the use of MCS devices among patients who underwent PCI for AMI with cardiogenic shock, hospital-level use variation, and factors associated with use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the CathPCI and Chest Pain-MI Registries of the American College of Cardiology National Cardiovascular Data Registry. Patients who underwent PCI for AMI complicated by cardiogenic shock between October 1, 2015, and December 31, 2017, were identified from both registries. Data were analyzed from October 2018 to August 2020. EXPOSURES Therapies to provide hemodynamic support were categorized as intravascular microaxial LVAD, IABP, TandemHeart, extracorporeal membrane oxygenation, LVAD, other devices, combined IABP and intravascular microaxial LVAD, combined IABP and other device (defined as TandemHeart, extracorporeal membrane oxygenation, LVAD, or another MCS device), or medical therapy only. MAIN OUTCOMES AND MEASURES Use of MCS devices overall and specific MCS devices, including intravascular microaxial LVAD, at both patient and hospital levels and variables associated with use. RESULTS Among the 28 304 patients included in the study, the mean (SD) age was 65.4 (12.6) years and 18 968 were men (67.0%). The overall MCS device use was constant from the fourth quarter of 2015 to the fourth quarter of 2017, although use of intravascular microaxial LVADs significantly increased (from 4.1% to 9.8%; P < .001), whereas use of IABPs significantly decreased (from 34.8% to 30.0%; P < .001). A significant hospital-level variation in MCS device use was found. The median (interquartile range [IQR]) proportion of patients who received MCS devices was 42% (30%-54%), and the median proportion of patients who received intravascular microaxial LVADs was 1% (0%-10%). In multivariable analyses, cardiac arrest at first medical contact or during hospitalization (odds ratio [OR], 1.82; 95% CI, 1.58-2.09) and severe left main and/or proximal left anterior descending coronary artery stenosis (OR, 1.36; 95% CI, 1.20-1.54) were patient characteristics that were associated with higher odds of receiving intravascular microaxial LVADs only compared with IABPs only. CONCLUSIONS AND RELEVANCE This study found that, among patients who underwent PCI for AMI complicated by cardiogenic shock, overall use of MCS devices was constant, and a 2.5-fold increase in intravascular microaxial LVAD use was found along with a corresponding decrease in IABP use and a significant hospital-level variation in MCS device use. These trends were observed despite limited clinical trial evidence of improved outcomes associated with device use.
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Affiliation(s)
- Sanket S. Dhruva
- University of California, San Francisco School of Medicine, San Francisco
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Bobak J. Mortazavi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Computer Science and Engineering, Texas A&M University, College Station
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nathan C. Hurley
- Department of Computer Science and Engineering, Texas A&M University, College Station
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alyssa P. Berkowitz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - John C. Messenger
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Craig S. Parzynski
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Che G. Ngufor
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Saket Girotra
- Division of Cardiovascular Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
| | - Amit P. Amin
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri
| | - Nilay D. Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy Research, Mayo Clinic, Rochester, Minnesota
| | - Nihar R. Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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20
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Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, Mattu A, Kirtane AJ, Jauhar R, Meraj P, Rokos IC, Rumsfeld JS, Henry TD. Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). J Am Coll Cardiol 2020; 76:1375-1384. [PMID: 32330544 PMCID: PMC7173829 DOI: 10.1016/j.jacc.2020.04.039] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.
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Affiliation(s)
- Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California-San Diego, La Jolla, California.
| | | | | | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina
| | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia
| | - Amal Mattu
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Ajay J Kirtane
- Columbia University Medical Center, Center for Interventional Vascular Therapy, New York, New York
| | | | - Perwaiz Meraj
- Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | | | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
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21
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Rymer JA, Kaltenbach LA, Doll JA, Messenger JC, Peterson ED, Wang TY. Safety of Dual-Antiplatelet Therapy After Myocardial Infarction Among Patients With Chronic Kidney Disease. J Am Heart Assoc 2020; 8:e012236. [PMID: 31070112 PMCID: PMC6585341 DOI: 10.1161/jaha.119.012236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 12/18/2022]
Abstract
Background Although recommended in the guidelines, the safety of chronic P2Y12 inhibitor therapy in patients with chronic kidney disease ( CKD ) after an acute myocardial infarction ( MI ) is not well studied. Methods and Results The TRANSLATE -ACS (Treatment with ADP Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study included 11 108 MI patients treated with percutaneous coronary intervention and discharged alive on a P2Y12 inhibitor from 233 US hospitals. We compared rates of GUSTO (Global Use of Strategies to Open Occluded Arteries) severe/moderate bleeding and premature discontinuation of P2Y12 inhibitor by 1 year after MI among patients with varying CKD severity. The majority of MI patients treated with percutaneous coronary intervention had CKD : 42% had stage 2 (mild), 27% had stage 3 (moderate), and 4% had stage ≥4 (severe/end stage). Higher potency P2Y12 inhibitors (prasugrel or ticagrelor) were prescribed at discharge in 39%, 35%, 23%, and 15% ( P<0.01) of patients with stages 1, 2, 3, and ≥4, respectively. One-year GUSTO severe/moderate bleeding rates were higher with each stage of CKD : 1% in patients with CKD stage 1 or no CKD , 2% with an adjusted hazard ratio of 1.61 (95% CI, 1.05-2.35) for CKD stage 2, 4% with an adjusted hazard ratio of 1.92 (95% CI, 1.21-3.02) for CKD stage 3, and 10% with an adjusted hazard ratio of 2.44 (95% CI, 1.40-4.23) for patients with CKD stage ≥4. By 1 year after MI , 16% of patients overall had prematurely discontinued P2Y12 inhibitor therapy; however, this rate was not largely affected by CKD stage. Premature P2Y12 inhibitor-discontinuation rates were higher for patients discharged on higher potency P2Y12 inhibitors in patients with CKD stage ≥2 ( P<0.01). Conclusions CKD severity was associated with a higher bleeding risk among those with acute MI treated with a P2Y12 inhibitor. Patients with more advanced CKD were not significantly more likely than those with less advance CKD to prematurely discontinue P2Y12 inhibitor therapy.
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Affiliation(s)
- Jennifer A Rymer
- 1 Department of Medicine Duke University Medical Center Durham NC
| | | | | | - John C Messenger
- 4 Division of Cardiology University of Colorado School of Medicine Aurora CO
| | - Eric D Peterson
- 1 Department of Medicine Duke University Medical Center Durham NC
| | - Tracy Y Wang
- 1 Department of Medicine Duke University Medical Center Durham NC
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22
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Damluji AA, Fabbro M, Epstein RH, Rayer S, Wang Y, Moscucci M, Cohen MG, Carroll JD, Messenger JC, Resar JR, Cohen DJ, Sherwood MW, O'Connor CM, Batchelor W. Transcatheter Aortic Valve Replacement in Low-Population Density Areas: Assessing Healthcare Access for Older Adults With Severe Aortic Stenosis. Circ Cardiovasc Qual Outcomes 2020; 13:e006245. [PMID: 32813564 DOI: 10.1161/circoutcomes.119.006245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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 Restricting transcatheter aortic valve replacement (TAVR) to centers based on volume thresholds alone can potentially create unintended disparities in healthcare access. We aimed to compare the influence of population density in state of Florida in regard to access to TAVR, TAVR utilization rates, and in-hospital mortality. METHODS AND RESULTS From 2011 to 2016, we used data from the Agency for Health Care Administration to calculate travel time and distance for each TAVR patient by comparing their home address to their TAVR facility ZIP code. Travel time and distance, TAVR rates, and mortality were compared across categories of low to high population density (population per square miles of land). Of the 6531 patients included, the mean (SD) age was 82 (9) years, 43% were female and 91% were White. Patients residing in the lowest category (<50/square miles) were younger, more likely to be men, and less likely to be a racial minority. Those residing in the lowest category density faced a longer unadjusted driving distances and times to their TAVR center (mean extra distance [miles]=43.5 [95% CI, 35.6-51.4]; P<0.001; mean extra time (minutes)=45.6 [95% CI, 38.3-52.9], P<0.001). This association persisted regardless of the methods used to determine population density. Excluding uninhabitable land, there was a 7-fold difference in TAVR utilization rates in the lowest versus highest population density regions (7 versus 45 per 100 000, P-for-pairwise-comparisons <0.001) and increase in TAVR in-hospital mortality (adjusted OR, 6.13 [95% CI, 1.97-19.1]; P<0.001). CONCLUSIONS Older patients living in rural counties in Florida face (1) significantly longer travel distances and times for TAVR, (2) lower TAVR utilization rates, and (3) higher adjusted TAVR mortality. These findings suggest that there are trade-offs between access to TAVR, its rate of utilization, and procedural mortality, all of which are important considerations when defining institutional and operator requirements for TAVR across the country.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., M.W.S., C.M.O., W.B.).,Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D., J.R.R.)
| | - Michael Fabbro
- Department of Anesthesiology, University of Miami, FL (M.F., R.H.E.)
| | - Richard H Epstein
- Department of Anesthesiology, University of Miami, FL (M.F., R.H.E.)
| | - Stefan Rayer
- Bureau of Economic and Business Research, University of Florida, Gainesville, FL (S.R., Y.W.)
| | - Ying Wang
- Bureau of Economic and Business Research, University of Florida, Gainesville, FL (S.R., Y.W.)
| | | | | | - John D Carroll
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (J.D.C., J.C.M.)
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (J.D.C., J.C.M.)
| | - Jon R Resar
- Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.D., J.R.R.)
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, MO (D.J.C.)
| | - Matthew W Sherwood
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., M.W.S., C.M.O., W.B.)
| | - Christopher M O'Connor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., M.W.S., C.M.O., W.B.)
| | - Wayne Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., M.W.S., C.M.O., W.B.)
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23
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Box LC, Blankenship JC, Henry TD, Messenger JC, Cigarroa JE, Moussa ID, Snyder RW, Duffy PL, Carr JG, Tukaye DN, Ang L, Shah B, Rao SV, Mahmud E. SCAI
position statement on the performance of percutaneous coronary intervention in ambulatory surgical centers. Catheter Cardiovasc Interv 2020; 96:862-870. [DOI: 10.1002/ccd.28991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital Cincinnati Ohio USA
| | | | | | - Issam D. Moussa
- Carle Health System, Carle Illinois College of Medicine Champaign Illinois USA
| | | | - Peter L. Duffy
- Appalachian Regional Healthcare System Boone North Carolina USA
| | - Jeffrey G. Carr
- CardiaStream Tyler Cardiac and Endovascular Center Tyler Texas USA
| | | | - Lawrence Ang
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
| | - Binita Shah
- New York University School of Medicine New York New York USA
| | - Sunil V. Rao
- Duke University Health System Durham North Carolina USA
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
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24
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Lotfi A, Klein LW, Hira RS, Mallidi J, Mehran R, Messenger JC, Pinto DS, Mooney MR, Rab T, Yannopoulos D, van Diepen S. SCAI expert consensus statement on out of hospital cardiac arrest. Catheter Cardiovasc Interv 2020; 96:844-861. [PMID: 32406999 DOI: 10.1002/ccd.28990] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Lloyd W Klein
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Ravi S Hira
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jaya Mallidi
- Santa Rosa Memorial Hospital, St. Joseph Cardiology Medical Group, Santa Rosa, California, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Duane S Pinto
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael R Mooney
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Demetri Yannopoulos
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, University of Alberta, Edmonton, Canada
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25
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Gluckman TJ, Wang L, Spinelli KJ, Petersen JL, Huang P, Amin A, Messenger JC, Rao SV. Differential Use and Impact of Bleeding Avoidance Strategies on Percutaneous Coronary Intervention-Related Bleeding Stratified by Predicted Risk. Circ Cardiovasc Interv 2020; 13:e008702. [PMID: 32527190 DOI: 10.1161/circinterventions.119.008702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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 Procedural anticoagulation with bivalirudin (BIV), trans-radial intervention (TRI), and use of a vascular closure device (VCD) are thought to mitigate percutaneous coronary intervention (PCI)-related bleeding. We compared the impact of these bleeding avoidance strategies (BAS) for PCIs stratified by bleeding risk. METHODS We performed a retrospective cohort analysis of PCIs from 18 facilities within one health care system from 2009Q3 to 2017Q4. Bleeding risk was assessed per the National Cardiovascular Data Registry CathPCI bleeding model, with procedures stratified into 6 categories (first, second, third quartiles, 75th-90th, 90th-97.5th, and top 2.5th percentiles). Regression models were used to assess the impact of BAS on bleeding outcome. RESULTS Of 74 953 PCIs, 9.4% used no BAS, 12.0% used BIV alone, 20.8% used TRI alone, 26.8% used VCD alone, 5.4% used TRI+BIV, and 25.6% used VCD+BIV. The crude bleeding rate was 4.4% overall. Only 2 comparisons showed significant trends across all risk strata: VCD+BIV versus no BAS, odds ratio (95% CI) range: first quartile, 0.36 (0.18-0.72) to top 2.5th percentile, 0.50 (0.32-0.78); TRI versus no BAS, odds ratio (95% CI) range: first quartile, 0.15 (0.06-0.38) to top 2.5th percentile, 0.49 (0.28-0.86). TRI had lower odds of bleeding compared with BIV for all risk strata except the top 2.5th percentile. Addition of BIV to TRI did not change the odds of bleeding for any risk strata. Factors potentially limiting use of TRI (renal failure, shock, cardiac arrest, and mechanical circulatory support) were present in ≤10% of procedures below the 90th percentile. CONCLUSIONS Among individual BAS, only TRI had consistently lower odds of bleeding across all risk strata. Factors potentially limiting TRI were found infrequently in procedures below the 90th percentile of bleeding risk. For transfemoral PCI, VCD+BIV had lower odds of bleeding compared with no BAS across all risk strata.
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Affiliation(s)
- Ty J Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon (T.J.G., L.W., K.J.S.)
| | - Lian Wang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon (T.J.G., L.W., K.J.S.)
| | - Kateri J Spinelli
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon (T.J.G., L.W., K.J.S.)
| | - John L Petersen
- Swedish Heart and Vascular Institute, Providence St. Joseph Health, Seattle, WA (J.L.P., P.H.)
| | - Paul Huang
- Swedish Heart and Vascular Institute, Providence St. Joseph Health, Seattle, WA (J.L.P., P.H.)
| | - Amit Amin
- Cardiovascular Division, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO (A.A.)
| | - John C Messenger
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (J.C.M.)
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC (S.V.R.)
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26
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Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, Mattu A, Kirtane AJ, Jauhar R, Meraj P, Rokos IC, Rumsfeld JS, Henry TD. Management of acute myocardial infarction during the COVID-19 pandemic: A Consensus Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). Catheter Cardiovasc Interv 2020; 96:336-345. [PMID: 32311816 DOI: 10.1002/ccd.28946] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [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] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/03/2023]
Abstract
The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on (a) varied clinical presentations; (b) appropriate personal protection equipment (PPE) for health care workers; (c) the roles of the emergency department, emergency medical system, and the cardiac catheterization laboratory (CCL); and (4) regional STEMI systems of care. During the COVID-19 pandemic, primary percutaneous coronary intervention (PCI) remains the standard of care for STEMI patients at PCI-capable hospitals when it can be provided in a timely manner, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI-capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.
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Affiliation(s)
- Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
| | | | | | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina
| | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia
| | - Amal Mattu
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Ajay J Kirtane
- Columbia University Medical Center, Center for Interventional Vascular Therapy, New York, New York
| | | | - Perwaiz Meraj
- Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | | | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
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Rymer JA, Kaltenbach LA, Kochar A, Hess CN, Gilchrist IC, Messenger JC, Harrington RA, Jolly SS, Jacobs AK, Abbott JD, Wojdyla DM, Krucoff MW, Rao SV. Comparison of Rates of Bleeding and Vascular Complications Before, During, and After Trial Enrollment in the SAFE-PCI Trial for Women. Circ Cardiovasc Interv 2020; 12:e007086. [PMID: 31014090 DOI: 10.1161/circinterventions.118.007086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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 SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women), a randomized controlled trial comparing radial and femoral access in women undergoing cardiac catheterization or percutaneous coronary intervention (PCI), was terminated early for lower than expected event rates. Whether this was because of patient selection or better access site practice among trial patients is unknown. METHODS AND RESULTS SAFE-PCI was conducted within the National Cardiovascular Data Registry CathPCI registry. Using the National Cardiovascular Research Infrastructure Identification, PCI date, and age, patients enrolled in SAFE-PCI were compared with trial-eligible female CathPCI registry patients 1 year before, during, and 1 year after SAFE-PCI enrollment. Patient and procedure characteristics, predicted bleeding and mortality, and post-PCI bleeding were compared between groups. Enrolled SAFE-PCI patients and registry patients from the 3 time periods were linked to Centers for Medicare and Medicaid Services data to compare 30-day death and unplanned revascularization rates. At 54 SAFE-PCI sites, there were 496 SAFE-PCI trial patients with a PCI visit within the CathPCI registry. There were 24 958 registry patients from 1 year before and 1 year after SAFE-PCI enrollment and 15 904 trial-eligible registry patients during trial enrollment. Trial patients were younger, had lower predicted bleeding and mortality, and had lower rates of post-PCI bleeding within 72 hours compared with registry patients. Among 12 212 Centers for Medicare and Medicaid Services-linked patients, there were no significant differences in 30-day death and unplanned revascularization among the 4 groups. CONCLUSIONS Lower predicted risk of bleeding and mortality among SAFE-PCI trial patients compared with registry patients suggests that lower-risk patients were selectively enrolled for the trial. These data demonstrate how registry-based randomized trials may offer methods for enrollment feedback to curb selection bias in recruitment. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01406236.
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Affiliation(s)
- Jennifer A Rymer
- Department of Medicine, Duke University Medical Center, Durham, NC (J.A.R., A.K., M.W.K., S.V.R)
| | - Lisa A Kaltenbach
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W.)
| | - Ajar Kochar
- Department of Medicine, Duke University Medical Center, Durham, NC (J.A.R., A.K., M.W.K., S.V.R)
| | - Connie N Hess
- Division of Cardiology, University of Colorado School of Medicine, Aurora (C.N.H., J.C.M.)
| | - Ian C Gilchrist
- Department of Medicine, Penn State University, Hershey, PA (I.C.G.)
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora (C.N.H., J.C.M.)
| | | | - Sanjit S Jolly
- Department of Medicine, McMaster University, Hamilton, ON (S.S.J.)
| | | | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI (J.D.A.)
| | - Daniel M Wojdyla
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC (L.A.K., D.M.W.)
| | - Mitchell W Krucoff
- Department of Medicine, Duke University Medical Center, Durham, NC (J.A.R., A.K., M.W.K., S.V.R)
| | - Sunil V Rao
- Department of Medicine, Duke University Medical Center, Durham, NC (J.A.R., A.K., M.W.K., S.V.R)
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Dhruva SS, Ross JS, Mortazavi BJ, Hurley NC, Krumholz HM, Curtis JP, Berkowitz A, Masoudi FA, Messenger JC, Parzynski CS, Ngufor C, Girotra S, Amin AP, Shah ND, Desai NR. Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock. JAMA 2020; 323:734-745. [PMID: 32040163 PMCID: PMC7042879 DOI: 10.1001/jama.2020.0254] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with substantial morbidity and mortality. Although intravascular microaxial left ventricular assist devices (LVADs) provide greater hemodynamic support as compared with intra-aortic balloon pumps (IABPs), little is known about clinical outcomes associated with intravascular microaxial LVAD use in clinical practice. OBJECTIVE To examine outcomes among patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by cardiogenic shock treated with mechanical circulatory support (MCS) devices. DESIGN, SETTING, AND PARTICIPANTS A propensity-matched registry-based retrospective cohort study of patients with AMI complicated by cardiogenic shock undergoing PCI between October 1, 2015, and December 31, 2017, who were included in data from hospitals participating in the CathPCI and the Chest Pain-MI registries, both part of the American College of Cardiology's National Cardiovascular Data Registry. Patients receiving an intravascular microaxial LVAD were matched with those receiving IABP on demographics, clinical history, presentation, infarct location, coronary anatomy, and clinical laboratory data, with final follow-up through December 31, 2017. EXPOSURES Hemodynamic support, categorized as intravascular microaxial LVAD use only, IABP only, other (such as use of a percutaneous extracorporeal ventricular assist system, extracorporeal membrane oxygenation, or a combination of MCS device use), or medical therapy only. MAIN OUTCOMES AND MEASURES The primary outcomes were in-hospital mortality and in-hospital major bleeding. RESULTS Among 28 304 patients undergoing PCI for AMI complicated by cardiogenic shock, the mean (SD) age was 65.0 (12.6) years, 67.0% were men, 81.3% had an ST-elevation myocardial infarction, and 43.3% had cardiac arrest. Over the study period among patients with AMI, an intravascular microaxial LVAD was used in 6.2% of patients, and IABP was used in 29.9%. Among 1680 propensity-matched pairs, there was a significantly higher risk of in-hospital death associated with use of an intravascular microaxial LVAD (45.0%) vs with an IABP (34.1% [absolute risk difference, 10.9 percentage points {95% CI, 7.6-14.2}; P < .001) and also higher risk of in-hospital major bleeding (intravascular microaxial LVAD [31.3%] vs IABP [16.0%]; absolute risk difference, 15.4 percentage points [95% CI, 12.5-18.2]; P < .001). These associations were consistent regardless of whether patients received a device before or after initiation of PCI. CONCLUSIONS AND RELEVANCE Among patients undergoing PCI for AMI complicated by cardiogenic shock from 2015 to 2017, use of an intravascular microaxial LVAD compared with IABP was associated with higher adjusted risk of in-hospital death and major bleeding complications, although study interpretation is limited by the observational design. Further research may be needed to understand optimal device choice for these patients.
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Affiliation(s)
- Sanket S. Dhruva
- University of California, San Francisco School of Medicine, San Francisco
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Bobak J. Mortazavi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Computer Science and Engineering, Texas A&M University, College Station
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nathan C. Hurley
- Department of Computer Science and Engineering, Texas A&M University, College Station
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alyssa Berkowitz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Frederick A. Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - John C. Messenger
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Craig S. Parzynski
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Che Ngufor
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Saket Girotra
- Division of Cardiovascular Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Amit P. Amin
- Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nilay D. Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy Research, Mayo Clinic, Rochester, Minnesota
| | - Nihar R. Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Szerlip M, Feldman DN, Aronow HD, Blankenship JC, Choi JW, Elgendy IY, Elmariah S, Garcia S, Goldstein BH, Herrmann H, Hira RS, Jaff MR, Kalra A, Kaluski E, Kavinsky CJ, Kolansky DM, Kong DF, Messenger JC, Mukherjee D, Patel RAG, Piana R, Senerth E, Shishehbor M, Singh G, Singh V, Yadav PK, Cox D. SCAI publications committee manual of standard operating procedures. Catheter Cardiovasc Interv 2020; 96:145-155. [DOI: 10.1002/ccd.28754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | - Dmitriy N. Feldman
- Weill Cornell Medical CollegeDivision of Cardiology, New York Presbyterian Hospital New York New York
| | - Herbert D. Aronow
- Cardiovascular Institute/Brown Medical School Providence Rhode Island
| | - James C. Blankenship
- Geisinger Health System, Cardiovascular Center for Clinical Research Danville Pennsylvania
| | - James W. Choi
- Baylor Scott & White Heart and Vascular Hospital Dallas Texas
| | - Islam Y. Elgendy
- Massachusetts General Hospital, Division of Cardiology Boston Massachusetts
| | - Sammy Elmariah
- Baylor Scott & White Heart and Vascular Hospital Dallas Texas
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis Minnesota
| | - Bryan H. Goldstein
- UPMC Children's Hospital of Pittsburgh, Pediatric Cardiology Pittsburgh PA
| | - Howard Herrmann
- University of Pennsylvania Health System, Cardiovascular Division Philadelphia Pennsylvania
| | - Ravi S. Hira
- University of Washington, Division of Cardiology Seattle Washington
| | | | - Ankur Kalra
- Department of Cardiovascular MedicineHeart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Edo Kaluski
- Robert Packer Hospital, Division of CardiologyGuthrie Health System Sayre Pennsylvania
| | | | - Daniel M. Kolansky
- University of Pennsylvania Health System, Cardiovascular Division Philadelphia Pennsylvania
| | - David F. Kong
- Duke University Medical Center Durham North Carolina
| | - John C. Messenger
- University of Colorado, Department of Medicine, Division of Cardiology Aurora Colorado
| | | | | | - Robert Piana
- Vanderbilt Heart and Vascular Institute Nashville Tennessee
| | - Emily Senerth
- Society for Cardiovascular Angiography & Interventions Washington District of Columbia
| | | | - Gagan Singh
- UC Davis Medical Center, Department of Internal Medicine Sacramento California
| | - Vikas Singh
- University of Louisville School of Medicine, Cardiovascular Medicine Louisville Kentucky
| | - Pradeep K. Yadav
- Milton S. Hershey Medical CenterPenn State University Hershey Pennsylvania
| | - David Cox
- Cardiovascular Associates of Alabama Birmingham Alabama
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30
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Valle JA, Tamez H, Abbott JD, Moussa ID, Messenger JC, Waldo SW, Kennedy KF, Masoudi FA, Yeh RW. Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative. JAMA Cardiol 2020; 4:100-109. [PMID: 30601910 DOI: 10.1001/jamacardio.2018.4376] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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] [Indexed: 11/14/2022]
Abstract
Importance Recent data support percutaneous revascularization as an alternative to coronary artery bypass grafting in unprotected left main (ULM) coronary lesions. However, the relevance of these trials to current practice is unclear, as patterns and outcomes of ULM percutaneous coronary intervention (PCI) in contemporary US clinical practice are not well studied. Objective To define the current practice of ULM PCI and its outcomes and compare these with findings reported in clinical trials. Design, Setting, and Participants This cross-sectional multicenter analysis included data collected from 1662 institutions participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between April 2009 and July 2016. Data were collected from 33 128 patients undergoing ULM PCI and 3 309 034 patients undergoing all other PCI. Data were analyzed from June 2017 to May 2018. Main Outcomes and Measures Patient and procedural characteristics and their temporal trends were compared between ULM PCI and all other PCI. In-hospital major adverse clinical events (ie, death, myocardial infarction, stroke, and emergent coronary artery bypass grafting) were compared using hierarchical logistic regression. Characteristics and outcomes were also compared against clinical trial cohorts. Results Of the 3 342 162 included patients, 2 223 570 (66.5%) were male, and the mean (SD) age was 64.2 (12.1) years. Unprotected left main PCI represented 1.0% (33 128 of 3 342 162) of all procedures, modestly increasing from 0.7% to 1.3% over time. The mean (SD) annualized ULM PCI volume was 0.5 (1.5) procedures for operators and 3.2 (6.1) procedures for facilities, with only 1808 of 10 971 operators (16.5%) and 892 of 1662 facilities (53.7%) performing an average of 1 or more ULM PCI annually. After adjustment, major adverse clinical events occurred more frequently with ULM PCI compared with all other PCI (odds ratio, 1.46; 95% CI, 1.39-1.53). Compared with clinical trial populations, patients in the CathPCI Registry were older with more comorbid conditions, and adverse events were more frequent. Conclusions and Relevance Use of ULM PCI has increased over time, but overall use remains low. These findings suggest that ULM PCI occurs infrequently in the United States and in an older and more comorbid population than that seen in clinical trials.
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Affiliation(s)
- Javier A Valle
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | - Hector Tamez
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - J Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Issam D Moussa
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Stephen W Waldo
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado.,University of Colorado School of Medicine, Aurora
| | | | | | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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31
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Jone PN, Haak A, Ross M, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Congenital and Structural Heart Disease Interventions Using Echocardiography-Fluoroscopy Fusion Imaging. J Am Soc Echocardiogr 2019; 32:1495-1504. [DOI: 10.1016/j.echo.2019.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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32
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Zipse MM, Messenger JC, Carroll JD, Seres T. Percutaneous repair of right ventricular perforation with Amplatzer septal defect occlusion device. Eur Heart J 2019; 39:817. [PMID: 28025192 DOI: 10.1093/eurheartj/ehw514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/25/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew M Zipse
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - John C Messenger
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - John D Carroll
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
| | - Tamas Seres
- Section of Cardiac Electrophysiology, Section of Interventional Cardiology, and Department of Anesthesiology, University of Colorado, Denver, 12605 E. 16th Ave., Mailstop B136, Aurora, CO 80045, USA
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33
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Fanaroff AC, Zakroysky P, Wojdyla D, Kaltenbach LA, Sherwood MW, Roe MT, Wang TY, Peterson ED, Gurm HS, Cohen MG, Messenger JC, Rao SV. Relationship Between Operator Volume and Long-Term Outcomes After Percutaneous Coronary Intervention. Circulation 2019; 139:458-472. [PMID: 30586696 DOI: 10.1161/circulationaha.117.033325] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 01/18/2023]
Abstract
BACKGROUND Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer-term outcomes is unknown. METHODS Using the National Cardiovascular Data Registry CathPCI registry data linked with Medicare claims data, we examined the association between operator PCI volume and long-term outcomes among patients ≥65 years of age. Operators were stratified by average annual PCI volume (counting PCIs performed in patients of all ages): low- (<50 PCIs), intermediate- (50-100), and high- (>100) volume operators. One-year unadjusted rates of death and major adverse coronary events (MACEs; defined as death, readmission for myocardial infarction, or unplanned coronary revascularization) were calculated with Kaplan-Meier methods. The proportional hazards assumption was not met, and risk-adjusted associations between operator volume and outcomes were calculated separately from the time of PCI to hospital discharge and from hospital discharge to 1-year follow-up. RESULTS Between July 1, 2009, and December 31, 2014, 723 644 PCI procedures were performed by 8936 operators: 2553 high-, 2878 intermediate-, and 3505 low-volume operators. Compared with high- and intermediate-volume operators, low-volume operators more often performed emergency PCI, and their patients had fewer cardiovascular comorbidities. Over 1-year follow-up, 15.9% of patients treated by low-volume operators had a MACE compared with 16.9% of patients treated by high-volume operators ( P=0.004). After multivariable adjustment, intermediate- and high-volume operators had a significantly lower rate of in-hospital death than low-volume operators (odds ratio, 0.91; 95% CI, 0.86-0.96 for intermediate versus low; odds ratio, 0.79; 95% CI, 0.75-0.83 for high versus low). There were no significant differences in rates of MACEs, death, myocardial infarction, or unplanned revascularization between operator cohorts from hospital discharge to 1-year follow-up (adjusted hazard ratio for MACEs, 0.99; 95% CI, 0.96-1.01 for intermediate versus low; hazard ratio, 1.01; 95% CI, 0.99-1.04 for high versus low). CONCLUSIONS Unadjusted 1-year outcomes after PCI were worse for older adults treated by operators with higher annual volume; however, patients treated by these operators had more cardiovascular comorbidities. After risk adjustment, higher operator volume was associated with lower in-hospital mortality and no difference in postdischarge MACEs.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Pearl Zakroysky
- Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Daniel Wojdyla
- Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Lisa A Kaltenbach
- Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Matthew W Sherwood
- Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Matthew T Roe
- Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Tracy Y Wang
- Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Eric D Peterson
- Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
| | - Hitinder S Gurm
- Division of Cardiology, University of Michigan, Ann Arbor (H.S.G.)
| | | | | | - Sunil V Rao
- Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.,Duke Clinical Research Institute (A.C.F., P.Z., D.W., L.A.K., M.W.S., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC
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Messenger JC. The Veterans Affairs Transcatheter Aortic Valve Experience: Putting the CART Before the Horse! JACC Cardiovasc Interv 2019; 12:2195-2197. [PMID: 31473242 DOI: 10.1016/j.jcin.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
Affiliation(s)
- John C Messenger
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
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35
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Naidu SS, Daniels MJ, Elmariah S, Garcia S, Klein AJ, Feldman DN, Ing FF, Kavinsky CJ, Devireddy C, Mahmud E, Grines CL, Henry TD, Duffy PL, Amin ZC, Aronow HD, Banerjee S, Brilakis ES, Herrmann HC, Hijazi ZM, Jaffer FA, Latif F, Messenger JC, Parikh SA, Poulin M, Reilly JP, Rosenfield K, Szerlip M, Vincent RN, Cox DA, Baker D, Bhalla N, Bowen R, Camp C, Govender D, Haggstrom K, Hargus N, Hite D, Meikle J, Mylor B, Pierce V, Prince B, Roach J, Rudy J, Schludi B, Struck J, Tochterman A, Tolve M, William DM, Yowe S. Hot topics in interventional cardiology: Proceedings from the Society for Cardiovascular Angiography and Interventions (SCAI) 2019 Think Tank. Catheter Cardiovasc Interv 2019; 94:598-606. [DOI: 10.1002/ccd.28449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Srihari S. Naidu
- Westchester Medical Center and New York Medical College Valhalla New York
| | | | | | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis Minnesota
| | | | | | | | | | | | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center San Diego California
| | | | | | - Peter L. Duffy
- FirstHealth Cardiology‐Pinehurst Pinehurst North Carolina
| | | | - Herbert D. Aronow
- Cardiovascular Institute/Brown Medical School Providence Rhode Island
| | | | | | | | | | | | - Faisal Latif
- University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | | | | | - Marie‐France Poulin
- Beth Israel Deaconess Medical Center/Harvard Medical School Boston Massachusetts
| | - John P. Reilly
- SUNY Stony Brook University Hospital Southampton New York
| | | | | | | | | | | | | | | | | | | | - Kurt Haggstrom
- Cordis, A Cardinal Health Company Santa Clara California
| | - Nick Hargus
- Cardiovascular Systems, Inc. Saint Paul Minnesota
| | - Denise Hite
- Cordis, A Cardinal Health Company Santa Clara California
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Chau KHY, Kennedy KF, Messenger JC, Garratt KN, Maddox TM, Yeh RW, Kirtane AJ. Uptake of Drug-Eluting Bioresorbable Vascular Scaffolds in Clinical Practice: An NCDR Registry to Practice Project. JAMA Cardiol 2019; 4:564-568. [PMID: 31066860 DOI: 10.1001/jamacardio.2019.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022]
Abstract
Importance Physicians have been criticized for having an overly enthusiastic response to new device approvals, especially for novel technologies. However, to our knowledge, the rates of new product adoption and patterns of new device usage in clinical practice have not been well described. Objective To characterize the patterns of uptake of bioresorbable vascular scaffolds (BVS) within the United States following device approval and to describe changes in response to subsequent releases of data and US Food and Drug Administration (FDA) warnings. Design, Setting, and Participants This analysis of the uptake of BVS between January 2016 and June 2017 used CathPCI Registry data; all percutaneous coronary intervention (PCI) procedures with an implant of either a BVS or conventional stent were included. Data analysis was performed in October 2017. Exposures Implant of BVS. Main Outcomes and Measures The primary outcome was monthly use of BVS in the United States. In addition, the characteristics of patients who received BVS and of hospitals that used BVS were assessed and comparisons of patient characteristics between BVS recipients and patients who were treated contemporaneously with metallic stents were made. Results Of 682 951 procedures, 471 064 (69.0%) were done in men, 587 301 (86.0%) were among white people, and the mean (SD) age of those undergoing procedures with BVS vs conventional stents was 62.6 (11.4) years vs 65.7 (11.9) years. Of these, 4265 procedures (0.6%) used BVS overall (after FDA approval of BVS). Procedures with implants of BVS occurred among patients with fewer comorbidities and lower-acuity presentations compared with procedures with implants of conventional stents. The patient characteristics for BVS use were not dissimilar to the inclusion criteria of the ABSORB III FDA approval trial, with notable differences based on trial eligibility (eg, excluding patients with myocardial infarctions). The maximum monthly use of BVS was 1.25% of all PCI procedures that occurred 90 days after FDA approval, but with site-to-site variability. Declines in use were observed coincident with the scientific presentation of adverse event data as well as FDA warnings. Conclusions and Relevance Most US physicians and hospitals were selective in their use of BVS, primarily using them in patients similar to those in the device's FDA approval trial. In addition, declines in use were evident in the subsequent month following the release of data that reported negative outcomes. These results illustrate an example of an appropriate physician response to adverse data updates and FDA warnings.
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Affiliation(s)
- Katherine Hsin-Yu Chau
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, New York.,Cardiovascular Research Foundation, New York, New York
| | | | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Kirk N Garratt
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Robert W Yeh
- Department of Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ajay J Kirtane
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, New York.,Cardiovascular Research Foundation, New York, New York.,Associate Editor
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Levy AE, Ream KS, Hammes A, Rudofker E, Beck N, Raines JD, Marshall KJ, Nensel JD, Anoff DL, Messenger JC, Masoudi FA, Allen LA, Ho PM. Abstract 20: Are We Ready for High(er) Sensitivity Troponin Assays? The Positive Predictive Value of a Contemporary Troponin Assay for Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
Patients with elevated troponin (cTn) in the absence of Acute Myocardial Infarction (AMI) present a diagnostic dilemma: they at high risk of adverse cardiac events, yet there is little evidence on how they should be managed clinically. In recent years, greater sensitivity of cTn assays and less selective use of cTn in clinical practice have led to a greater number of non-AMI patients with elevated troponin. The exact scope of the problem in routine clinical practice is not known, as published estimates of troponin’s positive predictive value (PPV) for AMI range from 15% to 70%. We sought to define troponin’s PPV for AMI at our institution and examine both process and outcome measures for AMI and non-AMI patients.
Methods:
In a retrospective cohort analysis of patients evaluated at the University of Colorado Hospital, we identified 5,903 hospital encounters between January 1, 2017 and October 6, 2018 in which patients were found to have an elevated serum troponin level (>0.04 ng/mL, Siemens Advia Centaur Tnl-Ultra). We used ICD-10 codes, billing diagnosis related groups (DRGs), or inclusion in the NCDR® ACTION Registry® to identify patients with a diagnosis of AMI. Patients not captured by one of these diagnoses were categorized as non-AMI. We then compared AMI and non-AMI patients according to the primary outcome of 100-day mortality. Secondary outcomes and process measures were also examined.
Results:
Out of 5,903 hospital encounters in which elevated cTn was detected, 730 were associated with any diagnosis of AMI (PPV 12.4%). The PPV was lower for individual AMI diagnosis groups. The primary outcome of 100-day mortality was observed in 10.3% of AMI patients versus 20.5% of non-AMI patients (p < 0.001). AMI patients also had significantly shorter hospitalizations, higher rates of inpatient echocardiography and higher rates of P2Y12 inhibitor therapy (Table 1).
Conclusion:
The PPV of a contemporary troponin assay for AMI was 12.4% in routine clinical practice at a tertiary care academic hospital. Concordant with prior studies, non-AMI patients had worse outcomes. With high-sensitivity troponin (hsTn) assays poised to increase the prevalence of non-AMI troponin elevation, guidance is needed regarding the appropriate use of hsTn as well as the evaluation and treatment of non-ACS patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - P. M Ho
- Univ of Colorado, Aurora, CO
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Levy A, Ream K, Hammes A, Anoff DL, Raines JD, Beck N, Rudofker E, Marshall KJ, Nensel JD, Messenger JC, Masoudi FA, Allen LA, Ho PM. Abstract 243: ICD-10, DRG and ACTION: Poor Agreement Between Diagnoses of Acute Myocardial Infarction Results in Significant Differences in Process and Outcome Measures. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Abstract
Background:
In the Unites States, there are three major approaches to identify patients diagnosed with Acute Myocardial Infarction (AMI). The Center for Medicare and Medicaid Services uses ICD-10 codes (1) for the Value-Based Payments program whereas it uses DRG codes (2) for the Inpatient Prospective Payment System. Hospital administrators, meanwhile, often use the NCDR® ACTION Registry® (3) to examine process and outcome measures for their AMI patients. Understanding which patients are captured by these different classification systems, and whether there is agreement between them, has important implications for hospitals’ efforts to optimize performance measures and payments for AMI.
Methods:
In a retrospective cohort analysis, we examined 730 hospitalizations at the University of Colorado Hospital between January 1, 2017 and October 6, 2018 that were captured by one of the three methods for identifying AMI patients: 1) ICD-10, 2) DRG, or 3) ACTION. Categories were not mutually exclusive. Agreement between DRG, ICD-10 and ACTION diagnoses of AMI was assessed by percentage agreement with the total AMI cohort and dual-comparison kappa statistics. AMI cohorts defined by ICD-10 vs. DRG vs. ACTION were then compared according to the primary outcome of 100-day mortality, as well as secondary outcomes of 30-day readmission, length of stay (LOS), P2Y12 inhibition and rates of inpatient echocardiography.
Results:
Among 730 hospitalizations with at least one diagnosis of AMI, 617 (84.5%) were assigned a primary ICD-10 code for AMI, 227 (31.1%) were assigned a DRG code for AMI, and 479 (65.6%) carried a diagnosis of AMI in ACTION. Only 112 (15.3%) were captured by all 3 diagnosis groups (ICD-10, DRG and ACTION). 159 (21.7%) hospitalizations were captured by both ICD-10 and DRG diagnoses (Kappa -0.143); 425 (58.2%) were included in ICD-10 and ACTION groups (Kappa 0.141); 121 (16.6%) were included in DRG and ACTION groups (Kappa -0.137). Outcomes and process measures as a function of diagnosis category are presented in Figure 1.
Conclusion:
Only about 15% of patients with a diagnosis of AMI were included in all three diagnosis groups (ICD-10, DRG and ACTION). There may be significant between-group differences in outcomes and process measures. These data emphasize the need to harmonize administrative definitions for AMI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - P. M Ho
- Univ of Colorado, Aurora, CO
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Jone PN, Haak A, Petri N, Ross M, Morgan G, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Echocardiography-Fluoroscopy Fusion Imaging for Guidance of Congenital and Structural Heart Disease Interventions. JACC Cardiovasc Imaging 2019; 12:1279-1282. [PMID: 30660524 DOI: 10.1016/j.jcmg.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Nils Petri
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael Ross
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Gareth Morgan
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominik M Wiktor
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Edward Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert A Quaife
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ernesto E Salcedo
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Carroll
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
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Fosbøl EL, Ju C, Anstrom KJ, Zettler ME, Messenger JC, Waksman R, Effron MB, Baker BA, Cohen DJ, Peterson ED, Wang TY. Early Cessation of Adenosine Diphosphate Receptor Inhibitors Among Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention: Insights From the TRANSLATE-ACS Study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome). Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003602. [PMID: 27789517 DOI: 10.1161/circinterventions.115.003602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Received: 12/11/2015] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS We examined 11 858 acute myocardial infarction patients treated with percutaneous coronary intervention discharged alive on ADPri therapy from 233 United States TRANSLATE-ACS study (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) participating hospitals to determine the prevalence of early ADPri cessation (within 1 year), patient-reported reasons for cessation, and associated risk of major adverse cardiovascular events at 1 year. Overall, 2514 (21.2%) of percutaneous coronary intervention-treated patients stopped ADPri by 1 year postmyocardial infarction; the median time from discharge to cessation was 200.5 days (25th, 75th percentiles: 71, 340). Among those with early ADPri cessation, 53.9% received drug-eluting stents and had a median duration of 301 treatment days (25th, 75th percentiles: 137, 353); 33.3% of drug-eluting stent patients stopped treatment within 6 months compared with 64.2% of bare metal stent patients. Those discharged on prasugrel (versus clopidogrel) had a slightly higher likelihood of early ADPri cessation (23.2% versus 21.0%; P=0.03; adjusted hazard ratio, 1.28; 95% confidence interval, 1.17-1.40). Patient-reported reasons for early ADPri cessation included physician-recommended discontinuation (54%), as well as patient self-discontinuation, because of cost (19%), medication side effects (9%), and procedural interruption (10%). Using a time-dependent covariate model, early cessation of ADPri therapy was associated with increased major adverse cardiovascular event (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19-1.65; P<0.0001). CONCLUSIONS One in 5 percutaneous coronary intervention-treated myocardial infarction patients stopped ADPri treatment within 1 year. Early cessation was associated with increased major adverse cardiovascular event risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Affiliation(s)
- Emil L Fosbøl
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.).
| | - Christine Ju
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Kevin J Anstrom
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Marjorie E Zettler
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - John C Messenger
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Ron Waksman
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Mark B Effron
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Brian A Baker
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - David J Cohen
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Eric D Peterson
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
| | - Tracy Y Wang
- From The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Duke Clinical Research Institute, Durham, NC (E.L.F., C.J., K.J.A., E.D.P., T.Y.W.); The Danish Heart Foundation, Copenhagen, Denmark (E.L.F.); Eli Lilly and Company, Indianapolis, IN (M.E.Z., M.B.E.); University of Colorado School of Medicine, Aurora (J.C.M.); Cardiovascular Research Institute, MedStar Washington Hospital Center, Washington, DC (R.W.); John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA (M.B.E.); Daiichi Sankyo, Inc., Parsippany, NJ (B.A.B.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (D.J.C.)
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Valle JA, Kaltenbach LA, Bradley SM, Yeh RW, Rao SV, Gurm HS, Armstrong EJ, Messenger JC, Waldo SW. Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction: Insights From the NCDR CathPCI Registry. JACC Cardiovasc Interv 2017; 10:2242-2254. [PMID: 29102582 DOI: 10.1016/j.jcin.2017.07.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/26/2017] [Accepted: 07/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. BACKGROUND TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes. METHODS The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality. RESULTS Among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = -0.053), whereas TRA use across institutions was associated with reduced mortality (rho = -0.077). CONCLUSIONS Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care.
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Affiliation(s)
- Javier A Valle
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Robert W Yeh
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sunil V Rao
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Section of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - John C Messenger
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen W Waldo
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Section of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
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Valle JA, McCoy LA, Maddox TM, Rumsfeld JS, Ho PM, Casserly IP, Nallamothu BK, Roe MT, Tsai TT, Messenger JC. Longitudinal Risk of Adverse Events in Patients With Acute Kidney Injury After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004439. [PMID: 28404621 DOI: 10.1161/circinterventions.116.004439] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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] [Received: 08/25/2016] [Accepted: 03/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied. METHODS AND RESULTS Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year. AKI was defined using Acute Kidney Injury Network (AKIN) criteria. Adverse events included death, myocardial infarction, bleeding, and recurrent kidney injury. Using Cox methods, we determined the relationship between in-hospital AKI and risk of post-discharge adverse events by AKIN stage. In a cohort of 453 475 elderly patients undergoing PCI, 39 850 developed AKI (8.8% overall; AKIN stage 1, 85.8%; AKIN 2/3, 14.2%). Compared with no AKI, in-hospital AKI was associated with higher post-discharge hazard of death, myocardial infarction, or bleeding (AKIN 1: hazard ratio [HR], 1.53; confidence interval [CI], 1.49-1.56 and AKIN 2/3: HR, 2.13; CI, 2.01-2.26), recurrent AKI (AKIN 1: HR, 1.70; CI, 1.64-1.76; AKIN 2/3: HR, 2.22; CI, 2.04-2.41), and AKI requiring dialysis (AKIN 1: HR, 2.59; CI, 2.29-2.92; AKIN 2/3: HR, 4.73; CI, 3.73-5.99). For each outcome, the highest incidence was within 30 days. CONCLUSIONS Post-PCI AKI is associated with increased risk of death, myocardial infarction, bleeding, and recurrent renal injury after discharge. Post-PCI AKI should be recognized as a significant risk factor not only for in-hospital adverse events but also after hospital discharge.
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Affiliation(s)
- Javier A Valle
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.).
| | - Lisa A McCoy
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas M Maddox
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John S Rumsfeld
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Ivan P Casserly
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Brahmajee K Nallamothu
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Matthew T Roe
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - Thomas T Tsai
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
| | - John C Messenger
- From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.); Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.); Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.); Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.); Division of Cardiology, Duke University, Durham, NC (M.T.R.); and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.)
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Fanaroff AC, Zakroysky P, Dai D, Wojdyla D, Sherwood MW, Roe MT, Wang TY, Peterson ED, Gurm HS, Cohen MG, Messenger JC, Rao SV. Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States. J Am Coll Cardiol 2017; 69:2913-2924. [PMID: 28619191 PMCID: PMC5784411 DOI: 10.1016/j.jacc.2017.04.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. OBJECTIVES The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. METHODS Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. RESULTS The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. CONCLUSIONS Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. Although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk-adjusted analyses.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina.
| | - Pearl Zakroysky
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - David Dai
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Matthew W Sherwood
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Matthew T Roe
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Tracy Y Wang
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Eric D Peterson
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Hitinder S Gurm
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - John C Messenger
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Sunil V Rao
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina
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Doll JA, Dai D, Roe MT, Messenger JC, Sherwood MW, Prasad A, Mahmud E, Rumsfeld JS, Wang TY, Peterson ED, Rao SV. Assessment of Operator Variability in Risk-Standardized Mortality Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2017; 10:672-682. [DOI: 10.1016/j.jcin.2016.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022]
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Messenger JC, Salcedo EE. Alcohol Septal Ablation for Treatment of Symptomatic Hypertrophic Obstructive Cardiomyopathy. Curr Cardiovasc Risk Rep 2017. [DOI: 10.1007/s12170-017-0540-y] [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] [Indexed: 11/30/2022]
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46
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Masoudi FA, Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC, Moore JW, Moussa I, Oetgen WJ, Varosy PD, Vincent RN, Wei J, Curtis JP, Roe MT, Spertus JA. Trends in U.S. Cardiovascular Care. J Am Coll Cardiol 2017; 69:1427-1450. [DOI: 10.1016/j.jacc.2016.12.005] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 11/30/2022]
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Zettler ME, Peterson ED, McCoy LA, Effron MB, Anstrom KJ, Henry TD, Baker BA, Messenger JC, Cohen DJ, Wang TY. Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: Insights from the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) observational study. Am Heart J 2017; 183:62-68. [PMID: 27979043 DOI: 10.1016/j.ahj.2016.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 06/02/2016] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Abstract
The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention. METHODS We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch. RESULTS Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P < .001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel and 87.5% of ticagrelor switches were to clopidogrel; both of these groups most often cited cost as a reason for switching (43.6% and 39.1%, respectively), whereas 60.7% who switched from clopidogrel cited physician decision as a reason. In the 7 days preceding the switch from clopidogrel, 40 (18.5%) had a MACE and 12 (5.6%) had a definite stent thrombosis event, whereas that from prasugrel or ticagrelor, a GUSTO moderate or severe bleeding event occurred in 1 (0.3%) and 0 patients, respectively. CONCLUSIONS Postdischarge ADPri switching occurred infrequently within the first year post-MI and uncommonly was associated with MACEs or bleeding events.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO
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Jackson LR, Peterson ED, McCoy LA, Ju C, Zettler M, Baker BA, Messenger JC, Faries DE, Effron MB, Cohen DJ, Wang TY. Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study. J Am Heart Assoc 2016; 5:JAHA.116.003824. [PMID: 27792656 PMCID: PMC5121485 DOI: 10.1161/jaha.116.003824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Indexed: 11/16/2022]
Abstract
Background Proton pump inhibitors (PPIs) reduce gastrointestinal bleeding events but may alter clopidogrel metabolism. We sought to understand the comparative effectiveness and safety of prasugrel versus clopidogrel in the context of proton pump inhibitor (PPI) use. Methods and Results Using data on 11 955 acute myocardial infarction (MI) patients treated with percutaneous coronary intervention at 233 hospitals and enrolled in the TRANSLATE‐ACS study, we compared whether discharge PPI use altered the association of 1‐year adjusted risks of major adverse cardiovascular events (MACE; death, MI, stroke, or unplanned revascularization) and Global Use of Strategies To Open Occluded Arteries (GUSTO) moderate/severe bleeding between prasugrel‐ and clopidogrel‐treated patients. Overall, 17% of prasugrel‐treated and 19% of clopidogrel‐treated patients received a PPI at hospital discharge. At 1 year, patients discharged on a PPI versus no PPI had higher risks of MACE (adjusted hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.21‐1.58) and GUSTO moderate/severe bleeding (adjusted HR 1.55, 95% CI 1.15‐2.09). Risk of MACE was similar between prasugrel and clopidogrel regardless of PPI use (adjusted HR 0.88, 95% CI 0.62‐1.26 with PPI, adjusted HR 1.07, 95% CI 0.90‐1.28 without PPI, interaction P=0.31). Comparative bleeding risk associated with prasugrel versus clopidogrel use differed based on PPI use but did not reach statistical significance (adjusted HR 0.73, 95% CI 0.36‐1.48 with PPI, adjusted HR 1.34, 95% CI 0.79‐2.27 without PPI, interaction P=0.17). Conclusions PPIs did not significantly affect the MACE and bleeding risk associated with prasugrel use, relative to clopidogrel. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.
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Affiliation(s)
- Larry R Jackson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Lisa A McCoy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christine Ju
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Rymer JA, Harrison RW, Dai D, Roe MT, Messenger JC, Anderson HV, Peterson ED, Wang TY. Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry). Am J Cardiol 2016; 118:959-66. [PMID: 27614853 DOI: 10.1016/j.amjcard.2016.06.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/19/2022]
Abstract
In 2006, the United States (US) Food and Drug Administration published advisory highlighting concerns for late drug-eluting stent thrombosis; its impact on US bare-metal stent (BMS) utilization is unknown. We examined rates of BMS use among Medicare patients at 946 US hospitals in the CathPCI Registry who underwent percutaneous coronary intervention (PCI) during 3 periods: (1) 2004 to 2006 preadvisory (n = 166,458); (2) 2007 to 2008 postadvisory (n = 216,318); and (3) 2012 to 2014 contemporary (n = 827,948). We examined predicted risks of target vessel revascularization and bleeding among BMS recipients by period. We compared 1-year repeat revascularization and death/myocardial infarction risks among BMS recipients immediately preadvisory and postadvisory. BMS were used in 15.8% of preadvisory, 40.9% of postadvisory, and 20.0% of contemporary PCI procedures. Although 19.5% of preadvisory BMS patients had a predicted target vessel revascularization risk ≥15%/year, this decreased to 16.7% postadvisory (p <0.001), and increased back to 18.7% among contemporary BMS recipients (p <0.001). In contrast, 12.3% of preadvisory BMS recipients had a predicted bleeding risk ≥5%/year, compared with 14.6% postadvisory (p <0.001), and 18.2% in contemporary BMS recipients (p <0.001). Postadvisory BMS recipients had a lower risk of repeat revascularization (12.8% vs 14.6%, adjusted hazard ratio 0.87, 95% CI 0.84 to 0.90) but no difference in the composite risk of death/myocardial infarction (15.9% vs 15.9%, adjusted hazard ratio 0.97, 95% CI 0.93 to 1.00). In conclusion, a surge in BMS use after the advisory was not associated with an increased risk of repeat revascularization or adverse outcomes in BMS-treated patients. One in 5 contemporary PCI procedures still involve BMS implantation.
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Anderson LL, Dai D, Miller AL, Roe MT, Messenger JC, Wang TY. Percutaneous coronary intervention for older adults who present with syncope and coronary artery disease? Insights from the National Cardiovascular Data Registry. Am Heart J 2016; 176:1-9. [PMID: 27264214 DOI: 10.1016/j.ahj.2016.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND We explored the risks/benefits of revascularization versus medical management in syncope patients with obstructive coronary artery disease (CAD). METHODS We retrospectively examined Medicare patients ≥65 years undergoing percutaneous coronary intervention (PCI) for syncope at 539 CathPCI Registry hospitals with ≥70% stenosis in at least 1 coronary artery, excluding those with ST-segment elevation myocardial infarction (MI), cardiogenic shock, left main disease, and coronary artery bypass grafting. In a propensity-matched population, we compared short-term (90-day) all-cause readmission risk and long-term (3-year) risks of readmission for syncope and MI, as well as mortality in those receiving PCI versus medical management. RESULTS Among 14,674 syncope patients, 9,549 (65%) had at least 1-vessel obstructive CAD. After exclusions, 3,196 of 7,338 patients (44%) underwent PCI. In the propensity-matched cohort, there was no significant difference in 90-day all-cause readmission risk (28.2% vs 30.3%, adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or long-term risks of readmission for syncope (7.0% vs 6.1%, adjusted HR 1.06, 95% CI 0.83-1.35). PCI-treated patients had significantly higher risk of readmission for MI (5.6% vs 4.0%, adjusted HR 1.56, 95% CI 1.18-2.06) but lower risk of long-term mortality (27.0% vs 30.3%, adjusted HR 0.86, 95% CI 0.77-0.97) than medically managed patients. CONCLUSIONS In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients.
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