Rate of Percutaneous Coronary Intervention for the Management of Acute Coronary Syndromes and Stable Coronary Artery Disease in the United States (2007 to 2011)

Kim, Luke K.; Feldman, Dmitriy N.; Swaminathan, Rajesh V.; Minutello, Robert M.; Chanin, Jake; Yang, Dixon; Lee, Min Kyeong; Charitakis, Konstantinos; Shah, Ashish; Kaple, Ryan; Bergman, Geoffrey; Singh, Harsimran; Wong, S. Chiu

doi:10.1016/j.amjcard.2014.07.013

Cited by 52 publications

(33 citation statements)

References 17 publications

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“…(1–3) The 2013 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Intervention (ACC/AHA/SCAI) clinical competency statement reduced the recommended minimum number of PCI procedures performed annually by each operator from 75 to 50, averaged over 2 years. (4,5) Contemporary, nationwide patterns of operator volumes have not been described, and little is known about the characteristics of procedures performed by low-volume operators.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Zakroysky

Dai

Wojdyla

et al. 2017

Journal of the American College of Cardiology

124

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Background Professional guidelines have reduced the recommended minimum number to an average of 50 PCI procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives To describe 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 nationally representative NCDR CathPCI registry collected between July 1, 2009 and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (< 50 PCIs/year), intermediate- (50–100 PCIs/year), and high-volume (> 100 PCIs/year) groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median number of annual procedures performed per operator was 59 (25th, 75th percentiles: 21, 106); 44% of operators performed < 50 PCI procedures/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 1.53% 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 OR 1.16, 95% CI 1.12–1.21 for low vs. high; adjusted OR 1.05, 95% CI 1.02–1.09 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was seen for post-PCI bleeding. Conclusions Many PCI operators in the U.S. are performing fewer than the recommended number of PCI procedures annually. Though 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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Section: Introductionmentioning

confidence: 99%

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Zakroysky

Dai

Wojdyla

et al. 2017

Journal of the American College of Cardiology

124

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“…More effective implementation of GDMT after the publication of randomized trials examining the role of revascularization strategies for patients with stable CAD, 14,15 more judicious CAD screening protocols, and concerns about inappropriate percutaneous coronary intervention (PCI) have likely resulted in more selective use of diagnostic and revascularization procedures. 12,[16][17][18] Declines in revascularization because of these factors are entirely appropriate. However, it is possible that the decline in the rate of revascularization may be out of proportion to clinically inappropriate use.…”

Section: State Of the Artmentioning

confidence: 99%

Treatment of Higher-Risk Patients With an Indication for Revascularization

et al. 2016

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Patients with severe coronary artery disease with a clinical indication for revascularization but who are at high procedural risk because of patient comorbidities, complexity of coronary anatomy, and/or poor hemodynamics represent an understudied and potentially underserved patient population. Through advances in percutaneous interventional techniques and technologies and improvements in patient selection, current percutaneous coronary intervention may allow appropriate patients to benefit safely from revascularization procedures that might not have been offered in the past. The burgeoning interest in these procedures in some respects reflects an evolutionary step within the field of percutaneous coronary intervention. However, because of the clinical complexity of many of these patients and procedures, it is critical to develop dedicated specialists within interventional cardiology who are trained with the cognitive and technical skills to select these patients appropriately and to perform these procedures safely. Preprocedural issues such as multidisciplinary risk and treatment assessments are highly relevant to the successful treatment of these patients, and knowledge gaps and future directions to improve outcomes in this emerging area are discussed. Ultimately, an evolution of contemporary interventional cardiology is necessary to treat the increasingly higher-risk patients with whom we are confronted.

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“…Inclusion criteria were: age ≥18 years and ≤75 years, the diagnosis was in line with 2013 ESC/ACC/AHA diagnostic criteria; the patients and their families agreed with the study protocol and signed the informed consent; exclusion criteria (who met any 1 of the following conditions would be excluded): age <18 or >75 years; PCI contraindications; contraindications of strengthened antithrombotic therapy; active pathological bleeding or history of intracranial hemorrhage; pregnant women; warfarin treatment; cardiogenic shock; unsuccessful PCI; STEMI mechanical complications such as ventricular septal perforation or papillary muscle rupture; the infarcted vessel was the left main artery; refused clinical follow-up or the clinical follow-up could not be performed [8,9]. …”

Section: Methodsmentioning

confidence: 99%

Genetic Polymorphism of CYP2C19 and Inhibitory Effects of Ticagrelor and Clopidogrel Towards Post-Percutaneous Coronary Intervention (PCI) Platelet Aggregation in Patients with Acute Coronary Syndromes

2016

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BackgroundThe aim of this study was to observe the effects of genetic polymorphism of CYP2C19 on inhibitory effects of ticagrelor (Tic) and clopidogrel (Clo) towards post-percutaneous coronary intervention (PCI) platelet aggregation (IPA) and major cardiovascular events (MACE) in patients with acute coronary syndromes (ACS).Material/MethodsFrom August 2013 to March 2014, 166 patients with ACS undergoing PCI were selected. The patients were randomly grouped into the Tic group and the Clo group. IPA was detected by thromboelastography (TEG) at 1 week after taking the pills. Genotyping of CYP2C19 gene was determined by analysis of gene sequence detection. Patients were followed up for 1 month and MACE was observed.ResultsThe total IPA in the Clo group was significantly increased compared with the Tic group (P<0.05). The IPAs in the 3 subgroups of Clo group were all significantly increased compared with the 3 subgroups of the Tic group (all P<0.05). MACE was not significantly different between Clo and Tic groups (P>0.05). MACE had no significant difference among the 3 subgroups of the Tic group (P>0.05). MACE in the low metabolism subgroup of the Clo group was significantly increased compared with the fast metabolism subgroup and middle metabolism subgroup of Clo group (P<0.05). MACE was not significant different between the fast metabolism subgroup and the middle metabolism subgroup of the Clo group (P>0.05). MACE in the low metabolism subgroup of the Tic group was significantly decreased compared with the low metabolism subgroup of the Clo group (P<0.05).ConclusionsTicagrelor has a better effect on inhibition platelet aggregation than Clopidogrel in ACS patients undergoing PCI.

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Rate of Percutaneous Coronary Intervention for the Management of Acute Coronary Syndromes and Stable Coronary Artery Disease in the United States (2007 to 2011)

Cited by 52 publications

References 17 publications

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Treatment of Higher-Risk Patients With an Indication for Revascularization

Genetic Polymorphism of CYP2C19 and Inhibitory Effects of Ticagrelor and Clopidogrel Towards Post-Percutaneous Coronary Intervention (PCI) Platelet Aggregation in Patients with Acute Coronary Syndromes

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