Key Points
Of 55,968 patients undergoing coronary angiography at a single center, iatrogenic catheter‐associated ostial coronary dissection (ICOCAD) was reported in 0.09%.
ICOCAD was associated with ...use of guide catheters, most commonly extra back‐up guides in the left main coronary and Amplatz catheters in the right coronary.
Management with PCI was effective in most cases and led to long‐term freedom from adverse events.
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A hot lead on reducing infarct size Blankenship, James C.
Catheterization and cardiovascular interventions,
April 1, 2019, 2019-04-01, 2019-04-00, 20190401, Volume:
93, Issue:
5
Journal Article
Peer reviewed
Key Points
The intracoronary hyperoxemic oxygen therapy study, designed to demonstrate the safety of supersaturated oxygen (SSO2) infused into the left main coronary after percutaneous coronary ...intervention for anterior ST‐elevation myocardial infarction (STEMI), demonstrated a net adverse clinical event rate of 7.1%, lower than the Food and Drug Administration‐set goal of 10.7%.
SSO2, which has reduced infarct size in clinical STEMI trials, might become an important strategy for treating anterior STEMIs.
Larger postmarketing trials are needed to determine whether decreases in infarct size are observed in real‐world populations, whether they translate into improved clinical outcomes, and whether modifications in technique can streamline the administration of SSO2 therapy.
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Objectives This study sought to identify the frequency and etiology of readmission within 30 days of percutaneous coronary intervention (PCI) in a large integrated healthcare system. Background ...One-fifth of Medicare patients are readmitted within 30 days of hospitalization. Identifying the causes of readmission may help identify strategies to prevent readmission. Methods All patients undergoing PCI (elective, urgent, and emergent) at our center between January 1, 2007, and April 12, 2010, were prospectively entered into the American College of Cardiology National Cardiovascular Data Registry. Patients readmitted to any hospital within 30 days of the index procedure were identified using an administrative database and telephone follow-up. Individual charts were reviewed independently by 2 investigators; disagreements regarding the cause for readmission were resolved by a third investigator. Results During the study period, 3,255 PCI were performed, and 262 patients (8.0%) were readmitted within 30 days. Of these, 261 (99.6%) had medical records available for review. Reasons for readmission included: complications related to the PCI (n = 31, 11.9%); non-PCI cardiac causes related to index admission (n = 93, 35.6%); noncardiac causes related to index admission (n = 34, 13%); causes unrelated to the index admission (n = 103, 39.5%). Multivariable logistic regression modeling revealed that female sex, advanced age, peripheral arterial disease, prior valvular surgery, and PCI complications during the index procedure were associated with 30-day readmission. Conclusions Readmissions within 30 days due to complications related to PCI performed on index admission are rare (0.9% of all PCI) and are an infrequent cause of readmission (<12% of readmissions). Thirty-day readmission after PCI should not be used as a quality metric of PCI performance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary ...intervention (PCI) in less than 90 min from presentation. Background Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation. Methods Our rural PCI hospital implemented a program in 2005 for rapid triage, transfer, and treatment of STEMI patients and made additional improvements in 2006 and 2007. Intervals between milestones in the STEMI triage/transfer/treatment process were assessed before and after implementation of the program. Results During the 5-year study period, 676 patients with 687 STEMIs were transferred from 19 community hospitals and underwent PCI. Median door-to-balloon time decreased from 189 min to 88 min (p < 0.001). The time intervals reflecting efficiency of the referring hospitals, transfer services, and PCI hospital all significantly improved. In 2008, median door-to-balloon times were <90 min for 6 of the 7 most frequently referring hospitals. Delays during off-hours presentation in 2004 were abolished after the program was implemented in 2005. In-hospital mortality decreased from 6% before to 3% after implementation of the program. In multivariate modeling, presentation before initiation of the STEMI program predicted increased risk of in-hospital mortality (odds ratio: 3.74, 95% confidence interval: 1.22 to 11.51, p = 0.021). Conclusions A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Key Points
This single‐center study retrospectively reviewed 12,680 percutaneous coronary interventions (PCIs) to identify those performed by an operator who was awake the previous night performing ...PCI. Success and outcomes of PCIs were similar regardless of whether the operator performed PCIs the previous night.
This study generally confirms the results of a previous single center study and another study using the NCDR CathPCI Registry.
This study suggests that day‐after PCI is generally safe, but it behooves cath lab managers and interventionalists to take simple steps to minimize the risk to patients when day‐after PCIs are performed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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