Temporal Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: Insights From the Washington Cardiac Care Outcomes Assessment Program

Kataruka, Akash; Maynard, Charles; Kearney, Kathleen; Mahmoud, Ahmed N.; Bell, Sean; Doll, Jacob A.; McCabe, James M.; Bryson, Chistopher; Gurm, Hitinder S.; Jneid, Hani; Virani, Salim S.; Lehr, Eric J.; Ring, Michael E.; Hira, Ravi S.

doi:10.1161/jaha.119.015317

Cited by 46 publications

(37 citation statements)

References 36 publications

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“…We did not observe any appreciable differences in readmission rates by publication year, despite significant changes over time in the risk profile and clinical presentation in patients undergoing CABG, and reductions in post-surgery length of stay [ 1 , 2 ]. This might be due to the fact that year of publication does not always correlate with year of clinical practice, given some studies covered a large period of time.…”

Section: Discussionmentioning

confidence: 98%

“…The annual volume and population-based rate of coronary artery bypass graft (CABG) surgery have declined significantly over the past two decades in the United States of America (USA) and in other developed countries [ 1 – 4 ]. These declines reflect lower incidence of coronary artery disease [ 5 ] and increased use of percutaneous coronary artery interventions (PCI) instead of CABG [ 1 , 2 ]. Patients undergoing CABG in recent years also tend to have more extensive disease and more comorbidities than previously [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

Shawon

Odutola

Falster

et al. 2021

J Cardiothorac Surg

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Background Readmission after coronary artery bypass graft (CABG) surgery is associated with adverse outcomes and significant healthcare costs, and 30-day readmission rate is considered as a key indicator of the quality of care. This study aims to: quantify rates of readmission within 30 days of CABG surgery; explore the causes of readmissions; and investigate how patient- and hospital-level factors influence readmission. Methods We conducted systematic searches (until June 2020) of PubMed and Embase databases to retrieve observational studies that investigated readmission after CABG. Random effect meta-analysis was used to estimate rates and predictors of 30-day post-CABG readmission. Results In total, 53 studies meeting inclusion criteria were identified, including 8,937,457 CABG patients. The pooled 30-day readmission rate was 12.9% (95% CI: 11.3–14.4%). The most frequently reported underlying causes of 30-day readmissions were infection and sepsis (range: 6.9–28.6%), cardiac arrythmia (4.5–26.7%), congestive heart failure (5.8–15.7%), respiratory complications (1–20%) and pleural effusion (0.4–22.5%). Individual factors including age (OR per 10-year increase 1.12 [95% CI: 1.04–1.20]), female sex (OR 1.29 [1.25–1.34]), non-White race (OR 1.15 [1.10–1.21]), not having private insurance (OR 1.39 [1.27–1.51]) and various comorbidities were strongly associated with 30-day readmission rates, whereas associations with hospital factors including hospital CABG volume, surgeon CABG volume, hospital size, hospital quality and teaching status were inconsistent. Conclusions Nearly 1 in 8 CABG patients are readmitted within 30 days and the majority of these are readmitted for noncardiac causes. Readmission rates are strongly influenced by patients’ demographic and clinical characteristics, but not by broadly defined hospital characteristics.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

Shawon

Odutola

Falster

et al. 2021

J Cardiothorac Surg

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“…Finally, patients undergoing early catheterization and coronary revascularization exhibited high rates of multivessel disease, which could be amenable to either percutaneous intervention or CABG surgery. Contemporary changes in the frequency and distribution of revascularization procedures, with increasing use of PCI procedures over time, 35 and recommendations for a heart team approach, 36 may have an impact on outcomes after coronary angiography, which can be assessed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Early invasive coronary angiography and acute ischaemic heart failure outcomes

Kosyakovsky

Austin²,

Ross

et al. 2021

European Heart Journal

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Aims While myocardial ischaemia plays a major role in the pathogenesis of heart failure (HF), the indications for coronary angiography during acute HF are not established. We determined the association of early coronary angiography during acute HF hospitalization with 2-year mortality, cardiovascular death, HF readmissions, and coronary revascularization. Methods and results In a two-stage sampling process, we identified acute HF patients who presented to 70 emergency departments in Ontario (April 2010 to March 2013) and determined whether they underwent early coronary angiography within 14 days after presentation using administrative databases. After clinical record review, we defined a cohort with acute ischaemic HF as patients with at least one factor suggesting underlying ischaemic heart disease, including previous myocardial infarction, troponin elevation, or angina on presentation. We oversampled patients undergoing angiography. We used inverse-probability-of-treatment weighting (IPTW) to adjust for baseline differences. Of 7239 patients with acute HF, 2994 met inclusion criteria [median age 75 (interquartile range 65–83) years; 40.9% women]. Early angiography was performed in 1567 patients (52.3%) and was associated with lower all-cause mortality [hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.61–0.90, P = 0.002], cardiovascular death (HR 0.72, 95% CI 0.56–0.93, P = 0.012), and HF readmissions (HR 0.84, 95% CI 0.71–0.99, P = 0.042) after IPTW. Those undergoing early angiography experienced higher rates of percutaneous coronary intervention (HR 2.58, 95% CI 1.73–3.86, P < 0.001) and coronary artery bypass grafting (HR 2.94, 95% CI 1.75–4.93, P < 0.001) within 2 years. Conclusions Early coronary angiography was associated with lower all-cause mortality, cardiovascular death, HF readmissions, and higher rates of coronary revascularization in acute HF patients with possible ischaemia.

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“…As the disease wave spreads across the countries, medical and scientific knowledge expand rapidly, results of a neverseen-before planetary task force aiming at developing preventive measures to reduce the rate of infected persons as well as validating effective therapeutic strategies (2). Since many years, percutaneous coronary intervention (PCI) has been the most commonly applied invasive method to treat coronary disease (3,4). Particularly in the context of acute coronary syndromes, PCI is considered the treatment of choice to reduce short-and long-term cardiovascular Case Report Robotic-assisted intervention strategy to minimize air exposure during the procedure: a case report of myocardial infarction and COVID-19 Submitted May 20, 2020.…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted intervention strategy to minimize air exposure during the procedure: a case report of myocardial infarction and COVID-19

Lemos¹,

Franken²,

Mariani³

et al. 2020

Cardiovasc Diagn Ther

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Percutaneous coronary interventions (PCI) is traditionally a manual procedure executed by one or more operators positioned at a close distance from the patient. The ongoing pandemic of coronavirus disease 2019 (COVID-19) has imposed severe restrictions to such an interventional environment. The novel SARS-CoV-2 virus that causes COVID-19 is transmitted mainly through expelled respiratory particles, which are known to travel approximately 3-6 feet away from infected persons. During PCI, that contamination range obligatorily poses the team and the patient to direct air exposure. We herein present a case report with the description of a minimum-contact strategy to reduce interpersonal air exposure during PCI. The approach designed to minimize proximity between the patient and the healthcare team included the performance of robotic-assisted PCI, operated by unscrubbed cardiac interventionalists from a control cockpit located outside the catheterization suite.Also included, was the delineation of the potential zone of respiratory particle spread; a circle measuring 4 meters (13.1 feet) in diameter was traced on the floor of the cath lab with red tape, centered on the patient's mouth and nose. The team was rigorously trained and advised to minimize time spent within the 4-meter perimeter as much as possible during the procedure. Following this strategy, a 60-year-old male with non-ST-elevation myocardial infarction and COVID-19 was treated with successful coronary implantation of two stents in the obtuse marginal branch and one stent in the circumflex artery. The total duration of the procedure was 103 minutes and 22 seconds. During most of the procedure, the 4-meter spread zone was not entered by any personnel. For each individual team member, the proposed strategy was effective in ensuring that they stayed outside of the 4-meter area for the majority of their work time, ranging from 96.9% to 59.7% of their respective participation. This case report illustrates the potential of robotic-assisted percutaneous coronary intervention in reducing physical proximity between the team and the patient during the procedure.

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Temporal Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: Insights From the Washington Cardiac Care Outcomes Assessment Program

Cited by 46 publications

References 36 publications

Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

Early invasive coronary angiography and acute ischaemic heart failure outcomes

Robotic-assisted intervention strategy to minimize air exposure during the procedure: a case report of myocardial infarction and COVID-19

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