Ad Hoc percutaneous coronary intervention: A consensus statement from the society for cardiovascular angiography and interventions

Blankenship, James C.; Gigliotti, Osvaldo; Feldman, Dmitriy N.; Mixon, Timothy A.; Patel, Rajan A.G.; Sorajja, Paul; Yakubov, Steven J.; Chambers, Charles E.

doi:10.1002/ccd.24701

Cited by 47 publications

(34 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Staged procedure should be considered when contrast volume exceeds 3.7× of creatinine clearance as recommended by both the European Society of Cardiology guidelines and the consensus statement from the Society for Cardiovascular Angiography and Interventions. 10,20 Because previous CM exposure within 72 hours is a risk factor for CIN, 21 it is reasonable to perform the staged procedure at least 3 days later in patients without clinical indications for emergent coronary angiography.…”

Section: Minimizing Contrast Media Volumementioning

confidence: 99%

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Chau

Williams

2016

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

P atients treated by the interventional cardiologist are now older and more frequently have coexistent renal insufficiency than in the past. Exacerbation of renal function can be a serious, morbid complication of cardiac catheterization or intervention and efforts to avoid this untoward event are important to acknowledge.The incidence of contrast-induced nephropathy (CIN) ranges from 2% in patients with normal baseline renal function to as high as 20% to 30% in patients with a baseline creatinine >2 mg/dL.1,2 The most commonly used definition of CIN is an absolute rise in serum creatinine (SCr) of 0.5 mg/dL or a 25% increase from the baseline value, assessed within 48 hours after the procedure. Risk AssessmentMost CIN risk factors can be accessed from clinical history, physical examination, and common laboratory tests. Preexisting chronic kidney disease is probably the most important preprocedural risk factor for CIN. Because an estimated glomerular filtration rate <60 mL/min per 1.73 m 2 is a major risk factor for CIN, 4 the baseline estimated glomerular filtration rate should be determined before any procedure in which contrast is administered. Other independent predictors for CIN include the presence of diabetes mellitus, volume depletion, the use of nephrotoxic drugs, hypotension, age >75 years, advanced heart failure, left ventricular systolic function <45%, and anemia.5,6 Different scoring schemes have been proposed to predict the risk for CIN, but none has been adequately validated. When at-risk patients are identified, various measures can be offered to reduce CIN occurrence. Before the Procedure Withdrawal of Potentially Nephrotoxic MedicationsPatients should be advised to withhold all nonessential medications that may be nephrotoxic for 24 hours before the procedure (Table). Although there has been controversy as to whether angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may predispose to nephrotoxicity, a recent study demonstrated no such effect.7 Accordingly, it is reasonable to continue angiotensin-converting enzyme inhibitors or angiotensin receptor blockers if patients are already taking these drugs. Pharmacological StrategiesN-acetylcysteine was considered a renal protective agent against CIN in the past. However, recent studies have failed to demonstrate a benefit.8 Thus, current guidelines of both the American Heart Association and the European Society of Cardiology do not recommend the use of N-acetylcysteine to prevent CIN in patients undergoing angiographic procedures. 9,10Because of their anti-inflammatory and antithrombotic effects in preservation of endothelial function at the level of the glomerulus, statins seem to play a role in CIN prevention. Several studies have shown the efficacy of short-term, high-dose statins in reducing the incidence of CIN in patients undergoing cardiac catheterization.11,12 Thus, the implementation of high-dose statin before coronary angiography should be considered as an additional preventive measure in patients without contraindic...

show abstract

Section: Minimizing Contrast Media Volumementioning

confidence: 99%

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Chau

Williams

2016

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…Our greatest barriers were the lack of definitive data on the risks and benefits of ad hoc PCI and multivessel PCI and their role in shared decision making by patients and providers. 49,50 The writing committee, therefore, decided that this topic might be considered in future updates of these measures or might be better handled by a writing committee focused entirely on developing performance measures for coronary revascularization (rather than just PCI).…”

Section: Process Measuresmentioning

confidence: 99%

ACC/AHA/SCAI/AMA–Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention

et al. 2014

View full text Add to dashboard Cite

. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-PermissionGuidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page.This Physician Performance Measurement Set (PPMS) and related data specifications were developed by the Physician Consortium for Performance Improvement (the Consortium), including the American College of Cardiology (ACC), the American Heart Association (AHA), and the American Medical Association (AMA), to facilitate quality-improvement activities by physicians. The performance measures contained in this PPMS are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. Although copyrighted, they can be reproduced and distributed, without modification, for noncommercial purposes-for example, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the performance measures for commercial gain, or incorporation of the performance measures into a product or service that is sold, licensed, or distributed for commercial gain. Commercial uses of the PPMS require a license agreement between the user and the AMA (on behalf of the Consortium) or the ACC or the AHA. Neither the AMA, ACC, AHA, the Consortium, nor its members shall be responsible for any use of this PPMS. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.Limited proprietary coding is contained in the measures specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of the code sets. The AMA, the ACC, the AHA, the NCQA, and the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.CPT® PreambleAmerican College of Cardiology (ACC)/American Heart Association (AHA) performance measure sets can serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice. These documents are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of their care and identify opportunities for improvement. The present set of measures breaks important ground for performance measurement. Here, the writing committee was charged with developing measures to benchmark and improve the quality of one of cardiology's most common and important procedures: percutaneous coronary intervent...

show abstract

“…24 Separating diagnostic angiography and CTO-PCI allows for a detailed discussion with the patient about the indications, goals, risks, and alternatives (such as medical therapy and coronary artery bypass graft surgery) to PCI.…”

Section: Timing Of Cto-pcimentioning

confidence: 99%

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

Galassi

Grantham

Kandzari

et al. 2014

Interventional Cardiology Review

View full text Add to dashboard Cite

A chronic total occlusion (CTO) is defined as a completely occluded coronary artery with no antegrade flow (thrombolysis in myocardial infarction [TIMI] 0 flow) for at least three months.1 CTOs are present in 15-30 % of patients undergoing coronary angiography.2-5 In a Canadian prospective registry of 14,439 patients undergoing coronary angiography a CTO was present in 18.4 % of all patients with significant coronary artery disease (CAD).2 Approximately 1/3-1/2 6,7 of patients undergoing CTO percutaneous coronary intervention (PCI) have had a prior acute myocardial infarction (MI). This suggests acute onset of the occlusion, whereas in the remaining patients gradual development of CTO from high-grade lesions likely occurred.The basic histopathologic feature of a CTO is a proximal cap of the occlusion. This is often fibrotic or calcified and may provide considerable resistance to wire advancement during CTO PCI. Distal to the proximal cap and along the occlusion length follows a segment of loose fibrous tissue or organised thrombus, with various extent of calcification. 8,9 In several of these lesions, residual channels may be observed that are not visible under angiography. In addition, microchannels may appear during the CTO's consolidation process, however these are mostly located in the adventitia with extremely tortuous courses and do not generally traverse the entire occluded segment.10 A recent autopsy study of 95 CTO lesions from 82 patients reported frequent negative remodelling of the CTO body (more frequent with longer duration of the occlusion), very rare presence of microchannels and more frequent tapering of the distal cap as compared with the proximal cap (79 % vs. 50 %, P<0.0001). Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.

show abstract

Ad Hoc percutaneous coronary intervention: A consensus statement from the society for cardiovascular angiography and interventions

Cited by 47 publications

References 57 publications

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

Prevention of Contrast-Induced Renal Failure for the Interventional Cardiologist

ACC/AHA/SCAI/AMA–Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention

Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes

Contact Info

Product

Resources

About