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, SBCE, SBMB, UL, UM, UPUK
32.
The cost of non‐kidney conserving catheterization Myla, Madhura; Blankenship, James C.
Catheterization and cardiovascular interventions,
November 2020, 2020-11-00, 20201101, Volume:
96, Issue:
6
Journal Article
Peer reviewed
Key Points
Data from an administrative database with over 2 million patients from 2012 to 2017 shows that acute kidney injury (AKI) from contrast nephropathy is steadily increasing, is associated ...with death and complications, and costs $7,000 ‐ $9,000 per case.
Widespread recommendations to pre‐hydrate patients and limit contrast dose have not stemmed the tide of AKI over the past decade.
Several technologies to reduce AKI have been developed but none have reached widespread use. Considering the human and financial cost of AKI, the interventional community should resolve to more aggressively develop and test new technologies.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial ...populations are unknown. Furthermore, the contribution of noncardiac factors – such as pulmonary, gastrointestinal, and psychological – to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication. This retrospective cohort study included patients receiving PCI for any indication from 2003 to 2017 through a single integrated health-care system. Post-PCI CP-related HCU tracked through electronic medical records included (1) office visits, (2) emergency department (ED) visits, and (3) hospital admissions with CP or angina as the primary diagnosis. The strongest predictors of CP-related HCU were identified from >100 candidate variables. Among 6386 patients followed an average of 6.7 years after PCI, 73% received PCI for acute coronary syndrome (ACS), 19% for stable angina, and 8% for other indications. Post-PCI CP-related HCU was common with 26%, 16%, and 5% of patients having ≥1 office visits, ED visits, and hospital admissions for CP within 2 years of PCI. The following factors were significant predictors of all 3 CP outcomes: ACS presentation, documented CP >7 days prior to the index PCI, anxiety, depression, and syncope. In conclusion, CP-related HCU following PCI was common, especially within the first 2 years. The strongest predictors of CP-related HCU included coronary disease attributes and psychological factors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
34.
PFO closure: Where are the neurologists? Blankenship, James C
Catheterization and cardiovascular interventions,
July 2018, 2018-07-00, 20180701, Volume:
92, Issue:
1
Journal Article
Peer reviewed
Key Points
A meta‐analysis of five randomized controlled trials of closure of patent foramen ovale (PFO) versus medical therapy to prevent recurrent stroke shows a statistically significant absolute ...2% decrease in recurrent stroke but no difference in death.
Patients treated with PFO closure have an absolute 2% increase in the risk of atrial fibrillation, usually transient, after the procedure, as well as increased risk of procedural complications, which are usually minor.
Guidelines on PFO closure were written before most data in this meta‐analysis were available. Those guidelines are now outdated.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
35.
SCAI/ACC/AHA Expert Consensus Document Dehmer, Gregory J., MD; Blankenship, James C., MD; Cilingiroglu, Mehmet, MD ...
Journal of the American College of Cardiology,
06/2014, Volume:
63, Issue:
23
Journal Article
Peer reviewed
Open access
Since publication of that document, new studies, meta-analyses, and randomized trials have been published comparing PCI with and without on-site surgery. ...new updates of the ACCF/SCAI Expert ...Consensus Document on Cardiac Catheterization Laboratory Standards and the ACCF/AHA/SCAI Clinical Competence in Coronary Artery Interventional Procedures have been published (3,4).
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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
In a cohort of 219 patients with out of hospital cardiac arrest, survival correlated with age, initial shockable rhythm, recovery of spontaneous circulation (ROSC) before starting ...catheterization, and initial pH.
Mortality was 98% in patients who underwent catheterization before ROSC.
Early studies of emergency extra‐corporeal membrane oxygenation life support combined with hypothermia, and coronary intervention, suggest this “hyper‐invasive” strategy may offer significant improvement in outcomes compared to conventional strategies employed in this study.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
37.
Post‐dilatation trepidation: Post‐dil is “no big dil” Clegg, Stacey; Blankenship, James C.
Catheterization and cardiovascular interventions,
June 1, 2020, 2020-06-01, 2020-06-00, 20200601, Volume:
95, Issue:
7
Journal Article
Peer reviewed
Key Points
Selective stent post‐dilatation (PD) in a cohort of STEMI patients did not affect major adverse cardiac events but it did decrease device‐oriented composite events, a secondary composite ...end point of less clear significance.
This study suggests that selective stent PD in STEMI does not increase the incidence of acute no‐reflow or long‐term adverse clinical events.
In primary PCI for STEMI, if the stent appears under‐expanded, then PD, perhaps guided by intravascular imaging (which was not reported in this study), is reasonable.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Key Points
A survey of patients and physicians in southern California indicates that patients overestimate Medicare payments to hospitals for elective coronary stenting several‐fold and overestimate ...Medicare payments to physicians for coronary stenting over 15‐fold. Patients think payments should be less than they erroneously think hospitals and physicians are paid but should be much more than hospitals and physicians are paid.
The authors hypothesize that patients’ view of physician payments may interfere with the physician–patient relationship, but data from other studies of physician–patient relationships suggest other factors are much more important.
The importance of patients’ opinions regarding physician payments for procedures could be further assessed by surveying patients about relationships with physicians before versus after information is given about actual payments.
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Statin drugs are effective at reducing cardiovascular events, but adherence to statin therapy remains a problem for patients and their physicians. We review a paper estimating the economic costs of ...poor adherence to statin drugs.PURPOSEStatin drugs are effective at reducing cardiovascular events, but adherence to statin therapy remains a problem for patients and their physicians. We review a paper estimating the economic costs of poor adherence to statin drugs.The authors examined two large databases (Medicare and Market Scan databases) including 230,000 patients with hospitalization for myocardial infarction between 2018 and 2019 to determine how many patients were not adhering to guideline-recommended anti-hyperlipidemic medications. They have also calculated the potential consequences of patients who are not adhering to the recommended therapy.METHODSThe authors examined two large databases (Medicare and Market Scan databases) including 230,000 patients with hospitalization for myocardial infarction between 2018 and 2019 to determine how many patients were not adhering to guideline-recommended anti-hyperlipidemic medications. They have also calculated the potential consequences of patients who are not adhering to the recommended therapy.The authors estimate that if all patients were receiving guideline-directed medical therapy, then a 22% relative risk reduction would occur in the 3-year period following discharge from the initial cardiovascular event. These findings are consistent with prior reports. This editorial discusses rationale and strategies clinicians can use to improve patients' compliance with recommendations for lipid-lowering therapy.RESULTSThe authors estimate that if all patients were receiving guideline-directed medical therapy, then a 22% relative risk reduction would occur in the 3-year period following discharge from the initial cardiovascular event. These findings are consistent with prior reports. This editorial discusses rationale and strategies clinicians can use to improve patients' compliance with recommendations for lipid-lowering therapy.The authors conclude that better compliance with guideline-directed lipid therapy after a cardiovascular event would lead to a large reduction in second events. Increased efforts by clinicians to improve adherence to statin therapy are warranted.CONCLUSIONThe authors conclude that better compliance with guideline-directed lipid therapy after a cardiovascular event would lead to a large reduction in second events. Increased efforts by clinicians to improve adherence to statin therapy are warranted.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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