2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine, Glenn N.; Bates, Eric R.; Blankenship, James C.; Bailey, Steven R.; Bittl, John A.; Cercek, Bojan; Chambers, Charles E.; Ellis, Stephen G.; Guyton, Robert A.; Hollenberg, Steven M.; Khot, Umesh N.; Lange, Richard A.; Mauri, Laura; Mehran, Roxana; Moussa, Issam; Mukherjee, Debabrata; Nallamothu, Brahmajee K.; Ting, Henry H.

doi:10.1016/j.jacc.2011.08.007

Cited by 1,979 publications

(510 citation statements)

References 892 publications

(685 reference statements)

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“…Patients treated by high‐volume operators and at high‐volume centers have been shown to experience a higher rate of procedural success and lower rates of mortality and postprocedural complications 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. As a consequence, standards of assistance have been recommended for PCI operators 1, 2, 6.…”

Section: Discussionmentioning

confidence: 99%

“…As a consequence, standards of assistance have been recommended for PCI operators 1, 2, 6. Recently, in an observational study, operator experience has emerged as an important prognostic factor in a complex intervention, such as left main PCI, where patients treated by high‐volume and experienced operators had better outcomes 9.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to innovations in device technology and improved operator techniques, percutaneous coronary intervention (PCI) has become a widely used and reproducible therapeutic procedure for the entire spectrum of coronary artery disease 1, 2…”

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confidence: 99%

“…Although patient‐related factors are known to play a key role for those occurrences, it is currently unknown to which degree these adverse events may be also operator dependent. Overall number of procedures performed and the operator experience may affect outcomes of patients undergoing PCI, but this evidence is mainly based on observational studies 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Randomized, controlled trials have played a major role in informing the community on the incidence, predictors, and implications of PCI‐related adverse events.…”

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confidence: 99%

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Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Gargiulo

Heg

Ferrari

et al. 2017

JAHA

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BackgroundOperator experience influences outcomes after percutaneous coronary intervention, but this association in the controlled setting of a randomized, clinical trial is unclear.Methods and ResultsWe investigated operator‐related outcomes (30‐day and 2‐year efficacy and safety end points) among patients undergoing percutaneous coronary intervention and randomized to different dual antiplatelet therapy durations and stent types. A total of 2003 patients were analyzed, and 7 operator groups were compared. The majority of preprocedural and postprocedural characteristics were imbalanced. The primary end point of the study, the composite of death, myocardial infarction, or cerebrovascular accidents, did not differ among operators at 30 days or 2 years. There were no significant differences also for all other individual and composite end points analyzed at 30 days and 2 years, except for 2‐year stent thrombosis (P=0.048) and bleeding events (P=0.022 for Bleeding Academic Research Consortium type 2, 3, or 5). Adjusted comparisons for the main end points showed slight differences among operators at 30 days, but not at 2 years. There was no interaction of operator with dual antiplatelet therapy duration (P=0.112) or stent type (P=0.300). Results remained entirely consistent when operators were stratified by their experience.ConclusionsThere was a weak signal of heterogeneity across study operators for the 30‐day, but not the 2‐year, main study outcomes. No clear effect of operator or operator experience was observed for the comparative efficacy and safety profile of the randomized stent types or dual antiplatelet therapy duration regimens.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Gargiulo

Heg

Ferrari

et al. 2017

JAHA

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“…Treatment with dual antiplatelet therapy in patients with acute myocardial infarction (MI) is a cornerstone of guideline‐recommended pharmacologic therapy, especially if percutaneous coronary intervention (PCI) is performed 1, 2, 3. Although clopidogrel has been the most widely used ADP receptor inhibitor (ADPri) in the United States, higher potency ADPris have been shown to further reduce the risk of adverse cardiovascular outcomes when compared with clopidogrel treatment among MI patients; however, the risk of bleeding is also higher among patients treated with these higher potency ADPris 4, 5…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Initial Prasugrel Versus Clopidogrel Selection for Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From the Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE‐ACS) Study

Vora

Peterson

McCoy

et al. 2016

JAHA

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BackgroundFew studies have examined how antiplatelet therapies are selected during the routine care of acute myocardial infarction patients, particularly relative to the patient's estimated mortality and bleeding risks.Methods and ResultsWe examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE‐ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection. Prasugrel use rates and associated 1‐year risk‐adjusted major adverse cardiovascular events and Global Utilization of Streptokinase and t‐PA for Occluded Coronary Arteries (GUSTO) moderate/severe bleeding outcomes were also examined in relation to predicted mortality and bleeding using the validated Acute Coronary Treatment and Intervention Outcomes (ACTION) risk prediction scores. Among 11 969 patients, 3123 (26%) received prasugrel at the time of percutaneous coronary intervention. The strongest factors associated with prasugrel use included cardiogenic shock (odds ratio [OR] 1.68, 95% CI 1.25–2.26), drug‐eluting stent use (OR 1.45, 95% CI 1.31–1.62), and ST‐segment elevation myocardial infarction presentation (OR 1.23, 95% CI 1.12–1.35). Older age (OR 0.57, 95% CI 0.0.53–0.61), dialysis (OR 0.56, 95% CI 0.32–0.96), prior history of stroke/transient ischemic attack (OR 0.52, 95% CI 0.38–0.73), and interhospital transfer (OR 0.50, 95% CI 0.46–0.55) were associated with lowest prasugrel selection. Prasugrel was used less often than clopidogrel in patients at higher predicted bleeding risk (21.9% versus 29.7%, P<0.001). Yet paradoxically, prasugrel was also less likely than clopidogrel to be used in patients with higher predicted mortality risk (21.1% versus 30.2%, P<0.001). Adjusted bleeding and outcomes events were similar among those receiving prasugrel and clopidogrel in the 4 subgroups of patients based on bleeding risk and ischemic benefits.ConclusionsIn community practice, prasugrel use may be driven more by bleeding risk rather than ischemic benefit. This may result in underutilization of higher potency ADP receptor inhibitor among patients more likely to derive ischemic benefit.

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Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

Maddox

Stanislawski

Grunwald

et al. 2014

JAMA

485

285

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IMPORTANCE Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD). OBJECTIVE To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of all US veterans undergoing elective coronary angiography for CAD between October 2007 and September 2012 in the Veterans Affairs health care system. Patients with prior CAD events were excluded. EXPOSURES Angiographic CAD extent, defined by degree (no apparent CAD: no stenosis >20%; nonobstructive CAD: ≥1 stenosis ≥20% but no stenosis ≥70%; obstructive CAD: any stenosis ≥70% or left main [LM] stenosis ≥50%) and distribution (1,2, or 3 vessel). MAIN OUTCOMES AND MEASURES The primary outcome was 1-year hospitalization for nonfatal MI after the index angiography. Secondary outcomes included 1-year all-cause mortality and combined 1-year MI and mortality. RESULTS Among37 674 patients, 8384 patients (22.3%) had nonobstructive CAD and 20 899 patients (55.4%) had obstructive CAD. Within 1 year, 845 patients died and 385 were rehospitalized for MI. Among patients with no apparent CAD, the 1-year MI rate was 0.11% (n = 8, 95% CI, 0.10%–0.20%) and increased progressively by 1-vessel nonobstructive CAD, 0.24% (n = 10, 95% CI, 0.10%–0.40%); 2-vessel nonobstructive CAD, 0.56% (n = 13, 95% CI, 0.30%–1.00%); 3-vessel nonobstructive CAD, 0.59% (n = 6, 95% CI, 0.30%–1.30%); 1-vessel obstructive CAD, 1.18% (n = 101, 95% CI, 1.00%–1.40%); 2-vessel obstructive CAD, 2.18% (n = 110, 95% CI, 1.80%–2.60%); and 3-vessel or LM obstructive CAD, 2.47% (n = 137, 95% CI, 2.10%–2.90%). After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8–5.1); 2-vessel nonobstructive HR, 4.6 (95% CI, 2.0–10.5); 3-vessel nonobstructive HR, 4.5 (95% CI, 1.6–12.5); 1-vessel obstructive HR, 9.0 (95% CI, 4.2–19.0); 2-vessel obstructive HR, 16.5 (95% CI, 8.1–33.7); and 3-vessel or LM obstructive HR, 19.5 (95% CI, 9.9–38.2). One-year mortality rates were associated with increasing CAD extent, ranging from 1.38% among patients without apparent CAD to 4.30% with 3-vessel or LM obstructive CAD. After risk adjustment, there was no significant association between 1- or 2-vessel nonobstructive CAD and mortality, but there were significant associations with mortality for 3-vessel nonobstructive CAD (HR, 1.6; 95% CI, 1.1–2.5), 1-vessel obstructive CAD (HR, 1.9; 95% CI, 1.4–2.6), 2-vessel obstructive CAD (HR, 2.8; 95% CI, 2.1–3.7), and 3-vessel or LM obstructive CAD (HR, 3.4; 95% CI, 2.6–4.4). Similar associations were noted with the combined outcome. CONCLUSIONS AND RELEVANCE In this cohort of patients undergoing elective coronary angiography, nonobstructive CAD, compared with no apparent CAD, was associated with a significantly greater 1-year risk of MI...

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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Cited by 1,979 publications

References 892 publications

Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction

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