British Columbia Cardiac Registry Research Articles

Coronary Angiography and Revascularization Following Coronary Artery Bypass Grafting in British Columbia: Incidence, Predictors and Longer-term Outcomes

BackgroundCoronary artery bypass grafting (CABG) is established treatment for subsets of coronary artery disease (CAD). Observational data have characterised significant progression of native coronary as well as graft vessel disease during longer-term follow-up, potentially reducing the benefit of CABG. We sought to assess longer-term outcomes following CABG by determining rates of repeat coronary angiography, revascularization procedures, and survival. MethodsData for all patients undergoing isolated CABG in British Columbia between 2001 and 2009 inclusive, and with follow-up until the end of 2013, were retrieved from the British Columbia Cardiac Registry. Cox proportional hazard regression and competing risk regression were performed for survival and subsequent cardiac procedures (coronary angiography, percutaneous coronary intervention [PCI] or repeat CABG). ResultsData were available from 17,316 patients with a mean age at index CABG of 65.7 ± 9.8 years. At a median follow-up of 8.5 (range 4.0 to 12.9) years, 3185 patients (18.4%) had died, 3135 (18.1%) underwent repeat coronary angiography with or without PCI or repeat CABG, and 11,557 (66.7%) had survived without additional procedures. Of those who underwent angiography, 1459 patients (46.5%) underwent further revascularization. In multivariate analysis, the strongest predictors of long-term mortality were dialysis dependency and age >75, whereas left internal mammary artery utilization and aspirin therapy were protective. Repeat revascularization predicted survival (adjusted hazard ratio 0.76; 95% confidence interval, 0.63-0.92; P = 0.004), whereas angiography alone did not. ConclusionsFollowing CABG, patients frequently undergo repeat coronary angiography. Although only a minority of patients receive further revascularization, this appears to be associated with longer-term survival.

Long-term patient and kidney survival after coronary artery bypass grafting, percutaneous coronary intervention, or medical therapy for patients with chronic kidney disease: a propensity-matched cohort study.

Revascularization in patients with chronic kidney disease (CKD) and coronary artery disease (CAD) is often deferred because of concern over progression of renal failure. Revascularization with either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) leads to progression of renal failure, but improves survival compared with medical therapy in patients with CKD. Linkages between the British Columbia Cardiac Registry and the British Columbia Renal Registry of patients with established CAD and CKD who underwent CABG, PCI, or were treated medically were propensity matched. Overall patient survival was analyzed using a Cox proportional hazard model. Primary renal outcomes, defined as patients requiring long-term dialysis or progressive loss in kidney function, were analyzed using a competing risk approach. On the basis of the matched cohort, the risk of renal outcome in the first three months was the highest in the CABG group, but comparable between the PCI and the medical group (estimated probability at 3 months: 12.7% for CABG, 5.4% for PCI, 4.4% for medical; P<0.01). The estimated probability for the renal outcome at 24 months was similar across the groups: 37.9% for CABG, 37.6% for PCI, and 35.2% for medical therapy (P=0.62). The mortality risk at 24 months was lower for CABG (3.9%) compared with PCI (14.5%) or medical therapy (16.4%) (P<0.01). In patients with CAD and CKD who undergo the current practice of CABG, PCI, or are treated with medical therapy, progression of renal failure is higher in the first 3 months for CABG, but similar for all groups at 24 months. The 2-year mortality is lower in patients treated with CABG compared with PCI or medical therapy.

TCT-6 The optimal timing for staged non-culprit vessel intervention following primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction and multivessel disease: insights from the British Columbia Cardiac Registry using decision analytical methods

Patients having culprit vessel intervention at primary percutaneous coronary intervention (PCI) may undergo staged PCI of non-culprit disease. Whether this is performed as an inpatient (IP) or outpatient (OP) requires balancing of the risks of PCI in the vulnerable peri-infarct period versus

TCT-444 The prognostic significance of complete revascularization across all indications for percutaneous coronary intervention: an analysis of 28,632 patients with multivessel disease from the British Columbia Cardiac Registry

TCT-444 The prognostic significance of complete revascularization across all indications for percutaneous coronary intervention: an analysis of 28,632 patients with multivessel disease from the British Columbia Cardiac Registry

3118Temporal trends in PCI outcomes in the elderly: An analysis from the British Columbia Cardiac Registry

3118Temporal trends in PCI outcomes in the elderly: An analysis from the British Columbia Cardiac Registry

3123The impact of renal disease on target vessel revascularisation following percutaneous coronary intervention: a contemporary analysis of 45,287 patients from the British Columbia Cardiac Registry

3123The impact of renal disease on target vessel revascularisation following percutaneous coronary intervention: a contemporary analysis of 45,287 patients from the British Columbia Cardiac Registry

Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Registry.

BackgroundCardiogenic shock complicating ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. In the primary percutaneous coronary intervention (PPCI) era, randomized trials have not shown a survival benefit with intra-aortic balloon pump (IABP) therapy. This differs to observational data which show a detrimental effect, potentially reflecting bias and confounding. Without robust and valid risk adjustment, findings from non-randomized studies may remain biased.MethodsWe compared long-term mortality following IABP therapy in patients with cardiogenic shock undergoing PPCI during 2008–2013 from the British Columbia Cardiac Registry. We addressed measured and unmeasured confounding using propensity score and instrumental variable methods.ResultsA total of 12,105 patients with STEMI were treated with PPCI during the study period. Of these, 700 patients (5.8%) had cardiogenic shock. Of the patients with cardiogenic shock, 255 patients (36%) received IABP therapy. Multivariable analyses identified IABP therapy to be associated with increased mortality up to 3 years (HR = 1.67, 95% CI:1.20–2.67, p<0.001). This association was lost in propensity-matched analyses (HR = 1.23, 95% CI: 0.84–1.80, p = 0.288). When addressing measured and unmeasured confounders, instrumental variable analyses demonstrated that IABP therapy was not associated with mortality at 3 years (Δ = 16.7%, 95% CI: -12.7%, 46.1%, p = 0.281). Subgroup analyses demonstrated IABP was associated with increased mortality in non-diabetics; patients not undergoing multivessel intervention; patients without renal disease and patients not having received prior thrombolysis.ConclusionsIn this observational analysis of patients with STEMI and cardiogenic shock, when adjusting for confounding, IABP therapy had a neutral effect with no association with long-term mortality. These findings differ to previously reported observational studies, but are in keeping with randomized trial data.

Prognostic Significance of Polymer Coatings in Zotarolimus-Eluting Stents

Polymer coatings on drug-eluting stents (DES) serve as a vehicle for delivery of antirestenotic drugs. Whether they influence outcomes for contemporary DES is unknown. The evolution of polymer coatings for zotarolimus-eluting stents (ZES) provides a natural experiment that facilitates such analysis. The Resolute ZES (R-ZES) uses the same antirestenotic drug as the Endeavor ZES (E-ZES) but has a more biocompatible polymer with enhanced drug release kinetics. However, there are limited data on the real-world comparative efficacy of R-ZES and the preceding E-ZES. Thus, we analyzed 17,643 patients who received either E-ZES or R-ZES from 2008 to 2014 from the British Columbia Cardiac Registry. A total of 9,869 patients (56%) received E-ZES and 7,774 patients (44%) received R-ZES. Compared with E-ZES, R-ZES was associated with lower 2-year mortality (4.1% vs 6.4%, p <0.001) and 2-year target vessel revascularization (TVR; 6.8% vs 10.7%, p <0.001). R-ZES use was an independent predictor of lower mortality rate and TVR. This was confirmed in propensity-matched analyses for 2-year mortality (hazard ratio [HR] 0.59, 95% CI 0.49 to 0.71, p <0.001) and 2-year TVR (HR 0.86, 95% CI 0.75 to 0.98, p = 0.032). Instrumental variable analyses demonstrated R-ZES to be associated with lower 2-year mortality (Δ = -2.2%, 95% CI -4.3% to -0.2%, p = 0.032) and 2-year TVR (Δ = -3.3% to 95% CI -6.1% to -0.7%, p = 0.015). Acknowledging the limitations of observational analyses, this study has shown that R-ZES was associated with lower long-term TVR and mortality. These data are reassuring for the newer R-ZES and demonstrate how polymer coatings may influence the clinical performance of DES with wider implications for future DES development and design.

Embolic protection device use and its association with procedural safety and long-term outcomes following saphenous vein graft intervention: An analysis from the British Columbia Cardiac registry.

Embolic protection devices (EPDs) have been designed and introduced to reduce distal embolization and peri-procedural myocardial infarction during saphenous vein graft (SVG) intervention. Current guidelines give a class I recommendation to EPD use during SVG intervention when technically feasible. However, the routine use of these devices has recently been debated. We analyzed 1,359 patients undergoing isolated SVG intervention between 2008 and 2013 in the British Columbia Cardiac Registry. We analyzed (a) post-procedural TIMI flow; and (b) target vessel revascularization (TVR) and mortality at 1 and 2 years. EPD use was an independent predictor of post-procedural TIMI 2/3 flow (OR = 2.38, 95% CI: 1.51-3.74, P < 0.001). At 1 year, EPD use was an independent predictor for lower TVR (HR = 0.35, 95% CI: 0.14-0.85, P = 0.021) and a trend towards lower mortality (HR = 0.45, 95% CI: 0.18-1.10, P = 0.082). These associations were lost at 2 years where EPD use was not predictive of mortality (HR = 0.62, 95% CI: 0.33-1.17, P = 0.144) or TVR (HR = 0.70, 95% CI: 0.41-1.17, P = 0.176). These findings were confirmed in propensity-matched and inverse probability treatment weighted analyses. In this analysis of patients undergoing SVG intervention, EPD use was a strong predictor for improved post-procedural TIMI flow. Whilst EPD use was associated with lower TVR and a trend for lower mortality at 1 year, these associations were lost at 2 years. These findings would appear to support the use of EPD for SVG intervention. © 2015 Wiley Periodicals, Inc.

TCT-445 The prognostic significance of repeat revascularization after percutaneous coronary intervention: an analysis of 41,180 patients from the British Columbia Cardiac Registry

Repeat revascularization following percutaneous coronary intervention (PCI) is a common end-point in clinical studies which may reflect restenosis, myocardial infarction or stent thrombosis events. However, the association between repeat revascularization and long-term mortality is poorly defined.

Early failure of the Biotronik Linox implantable cardioverter defibrillator lead.

The Linox and Durata implantable cardioverter defibrillator (ICD) leads were introduced to British Columbia (BC) in 2008. We determined their performance and the potential risk factors for lead failure in a large population-based patient registry. We used the BC Cardiac Registry, a mandatory Governmental database of ICD implants, to identify all recipients of Linox and Durata leads in BC between October 2008 and April 2012, and those subsequently undergoing reoperation. Lead failure was defined as recurrent nonphysiological high-rate sensing unrelated to external electromagnetic interference or T-wave oversensing; a sudden rise in impedance unrelated to perforation or lead dislodgement; or abnormal lead parameters with definite evidence of lead fracture or insulation failure. We determined the estimated cumulative lead survival by the Kaplan-Meier method, and the risk factors for lead failure in a proportional hazards model. Over a median of 39 (27-50) months, the Linox failed more frequently than the Durata (16/477 [3.4%] vs. 4/838 [0.4%]; P < 0.001), and had a significantly lower estimated cumulative survival (91.6 [80.6-96.5]% vs. 99.4 [98.4-99.8]% at 5 years; P < 0.0001). Linox failure was characterized by high-rate nonphysiological sensing (11 cases), and/or a sudden impedance rise (7 cases). Insulation failure was clearly confirmed in 6 cases of Linox failure. Female sex was a significant risk factor for Linox failure (adjusted HR = 2.1[1.3-3.4]; P = 0.004). This multicenter registry indicates a high rate of Linox lead failure, particularly in female patients. Ongoing surveillance of the Linox ICD lead performance is recommended.

Parkinsonian tremor-induced electrocardiographic artifacts mimicking atrial flutter/fibrillation or ventricular tachycardia

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Outcomes following percutaneous coronary intervention and coronary artery bypass grafting surgery in Chinese, South Asian and white patients with acute myocardial infarction: administrative data analysis

BackgroundLittle is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). We compared 30-day and long-term mortality, recurrent AMI, and congestive heart failure in South Asian, Chinese and White patients with AMI who underwent PCI and CABG.MethodsHospital administrative data in British Columbia (BC), Canada were linked to the BC Cardiac Registry to identify all patients with AMI who underwent PCI (n = 4729) or CABG (n = 1687) (1999–2003). Ethnicity was determined from validated surname algorithms. Logistic regression for 30-day mortality and Cox proportional-hazards models were adjusted for age, sex, socio-economic status, severity of coronary disease, comorbid conditions, time from AMI to a revascularization procedure and distance to the nearest hospital.ResultsFollowing PCI, Chinese had higher short-term mortality (Odds Ratio (OR): 2.36, 95% CI: 1.12-5.00; p = 0.02), and South Asians had a higher risk for recurrent AMI (OR: 1.34, 95% CI: 1.08-1.67, p = 0.007) and heart failure (OR 1.81, 95% CI: 1.00-3.29, p = 0.05) compared to White patients. Risk of heart failure was higher in South Asian patients who underwent CABG compared to White patients (OR (95% CI) = 2.06 (0.92-4.61), p = 0.08). There were no significant differences in mortality following CABG between groups.ConclusionsChinese and South Asian patients with AMI and PCI or CABG had worse outcomes compared to their White counterparts. Further studies are needed to confirm these findings and investigate potential underlying causes.

Abstract 358: Annual Quality of Care Evaluations of Cardiac Surgery in British Columbia

Background: Cardiac Services BC (CSBC) is responsible for planning, coordinating, monitoring, and, in some cases, funding cardiac services across British Columbia (BC) in collaboration with senior administrators and physicians from five regional health authorities. CSBC maintains the BC Cardiac Registry (BCCR), a longitudinal clinical registry of all invasive cardiac procedures performed in BC. For over 10 years, CSBC has used BCCR data to evaluate annually quality of care indicators for isolated coronary artery bypass graft (CABG), isolated valve, and CABG+valve surgeries. Methods: In preparation for each annual review, CSBC meets with an established Planning Committee of representative surgeons. BCCR data is linked to provincial Vital Statistics data, to the national Discharge Abstract Database, and for the last 3 yearly analyses to the provincial Central Transfusion Registry which provides robust data on red blood cell (RBC) transfusion. At the annual review, CSBC meets with surgeons who are included in the analyses to present the indicator data. Results: In the 2012 evaluation, the following quality of care indicators were presented for the 2007-2011 period: 30-day mortality and 30-day stroke; 30-day RBC transfusion; and indicators for evidence-based medications at discharge. Risk-adjusted analyses were prepared for the 30-day mortality and 30-day stroke indicators to provide valid comparisons over time and according to hospital and surgeon. Patient characteristics and pre-procedural factors were included in the risk models. The risk-adjusted models performed well with C-statistics for the 30-day mortality models for isolated CABG, isolated valve, and CABG+valve surgeries of 0.86, 0.89, and 0.81, and for the 30-day stroke models 0.80, 0.83, and 0.74, respectively. Expected rates by hospital and by surgeon were determined from each risk model, and observed to expected (O/E) ratios were used for comparison of hospitals and surgeons. Rates of RBC transfusion varied by hospital, and a large reduction in transfusion rates from 69% (378 of 546) in 2007 to 43% (252 of 589) in 2011 was observed at one site with historically higher rates. Conclusion: Presenting quality of care indicators annually has raised awareness of outcome rates and variations which existed across the province. The annual process of engaging surgeons in the evaluation process and linkage with other administrative databases to obtain outcome data has been associated with a reduction in use of RBC transfusion and instigated further investigations into regional variation in mortality rates. The addition of new indicators and other risk-adjusted analyses in the future may further improve quality of care in cardiac surgery in BC.

Abstract 113: Regional Variation In The Receipt Of Coronary Revascularization Following Diagnostic Catheterization In British Columbia

Background: Differences in the management of coronary artery disease have previously been found to be partly attributable to non-clinical factors, but there have been few studies examining this issue in Canada. Variation in revascularization rates across regions of the province of British Columbia (BC) has been previously observed but not studied. The BC Cardiac Registry allows a unique opportunity to explore the factors that contribute to this variation and the associated clinical outcomes. Methods: All BC residents aged 20 years and older who received a diagnostic catheterization between 2008/09 and 2010/11 in one of five hospitals in the province with a catheterization laboratory were identified from the BC Cardiac Registry, a longitudinal clinical registry of all cardiac procedures performed in the province. Patients were followed to determine hospital level rates of revascularization (PCI or CABG) within 90 days of the diagnostic catheterization. Risk-adjustment was performed with a logistic regression model to determine whether the cathing hospital was an independent predictor of revascularization rates. All cause mortality rates following diagnostic catheterization were calculated and Cox regression was used to determine the effect of the cathing hospital on 1-year mortality. Results: The cohort included 32,585 diagnostic catheterization cases, of which 73.9% (24,076) received revascularization within 90 days. Unadjusted hospital rates ranged from 64.6% (2,730 of 4,224) to 83.8% (5,135 of 6,130). Among cases who received revascularization, the PCI:CABG ratios ranged from 3.1 to 4.7. The logistic regression model measuring the association between cathing hospital and the receipt of revascularization demonstrated significant hospital differences, despite controlling for demographic and clinical risk factors. The OR of receiving revascularization at hospital B compared to hospital A was nearly 3-fold (OR=2.8, 95% CI 2.6 - 3.1). There were also significant hospital differences after risk-adjustment in the receipt of PCI vs. CABG. Hospital C was more likely to treat patients with PCI (OR=1.3, 95% CI 1.2-1.5) compared to hospital A. Exploration of interaction terms found that hospital differences were significant among STEMI patients. The probability of mortality at 1 year following diagnostic catheterization ranged from 0.035 to 0.067 among hospitals, based on Kaplan-Meier estimation. Cox regression modeling revealed that there were significant hospital differences in 1-year mortality after adjusting for patient characteristics. Conclusions: There was substantial regional variation in revascularization practice among hospitals in the province of British Columbia, Canada. Identification of subgroups where variation in practices were significant, such as use of PCI vs. CABG among STEMI patients, offer opportunities for follow-up and quality improvement.

Transfusion Managament in Cardiac Surgery in British Columbia: Review of 8352 Patients.

AbstractAbstract 2277 Background:Transfusion of blood products remains an essential intervention during hospitalization for cardiac surgeries. Published data reveal significant variability in the patterns of transfusion of blood products among different centers. In addition, published data suggest that allogenic transfusions are associated with worse outcomes in cardiac surgery patients.This project was conducted to investigate for significant variability in transfusion practices in the management of cardiac surgery patients in the 4 cardiac surgery centers within the province of British Columbia (BC). Secondary objectives include assessing for correlation of specific patient and surgical characteristics with risk of transfusion, in addition to comparing one-year mortality in patients who received transfusions with those who did not. Methods:A retrospective review of data collected through the BC Cardiac Registry (BCCR) was performed. All adult patients who underwent cardiac surgery in BC between January 1,2008 to December 31,2010 were included. The following patients were excluded: Jehovah's witnesses, heart transplantation recipients and patients who underwent aortic aneurysm repair not including aortic valve surgery. In patients who underwent more that one surgery within 365 days, data were only collected for the first cardiac surgery.The following data were collected: age, gender, type of surgery, clinical urgency, institution, preoperative hemoglobin, preoperative eGFR, duration of cardio-pulmonary bypass and use of cell saver technology. Mortality data over 1 year post operatively and quantities of packed red blood cells (PRBCs), frozen plasma (FP), platelets and cryoprecipitate (cryo) transfused during surgery and within 30 days afterwards were also collected. Cardiac surgery centers were anonymized.Chi-square test and Fisher exact test were used to analyze variation in transfusion requirements. Kaplan-Meir curves will be created for estimation of survival. Multivariate regression analysis will be used to identify risk factors for transfusion. Results:After excluding patients as outlined above, 8352 patients were included in the analysis.A summary of transfusion rates of different blood products in different types of cardiac surgeries among different centers is summarized in table 1.Statistical analysis is currently in progress to assess for association between transfusion of blood products and survival, in addition to multivariate analysis to identify risk factors for transfusion. Conclusions:Significant differences are noted in transfusion requirement of PRBCs, FP and platelets during and within 30 days of cardiac surgery among the four different cardiac surgery centers in British Columbia. The differences are not accounted for by surgery type alone. Further research is required to identify factors to account for the observed variability. Consideration will be made for development of further measures for standardization of transfusion management in this patient group.Table 1:Rates of transfusion of different blood products classified by type of surgery and surgical center. Letters A-D represent anonymized surgical centers. CHD: Congenital heart diseaseSurgery type, number of patients (%)Blood productsPatients who received transfusions by surgical center %p-ValueABCDBCCABG, N= 5326 (63.8)PRBCs61.438.2927.2341.9742.79<0.0001FP11.052.7521.1820.1413.93<0.0001Platelets16.572.189.6319.6512.41<0.0001Cryo0.280.890.480.210.450.0459Pure valve, N=1376 (16.5)PRBCs57.7236.231.8333.5338.88<0.0001FP11.748.928.9827.4920.13<0.0001Platelets10.743.6814.0127.7914.17<0.0001Cryo1.341.530.241.211.020.1963CABG+valve, N=1121 (13.4)PRBCs79.2162.4153.9851.3361.82<0.0001FP18.288.2839.135.7425.16<0.0001Platelets17.924.8324.2239.5421.23<0.0001Cryo2.870.341.381.91.610.0919CABG+valve+other, N=137 (1.6)PRBCs95.2462.354.5545.4562.770.0041FP19.0511.4839.3927.2721.90.0160Platelets19.056.5618.1845.4517.520.0008503Cryo4.761.64001.460.4434Valve+other, N=230 (2.8)PRBCs67.6538.6742.1931.5842.170.0072FP17.655.335047.3730<0.0001Platelets20.591.3331.2540.3522.17<0.0001Cryo003-131.751.30.3441CHD repair N=162 (1.9)PRBCs5038.8928.5733.3335.190.2327FP13.3316.6730.1639.2228.40.0551Platelets3.335.5611.1127.4514.20.0107Cryo05.5603.921.850.1448 Disclosures:No relevant conflicts of interest to declare.

Non-red blood cell transfusion as a risk factor for mortality following percutaneous coronary intervention

BackgroundBleeding following percutaneous coronary intervention (PCI) is common and may lead to transfusion and death. Although previous work has examined the effect of red blood cell (RBC) transfusion in patients with coronary disease, no study had investigated whether transfusion of non-RBC components was associated with mortality following PCI. MethodsAll subjects transfused in the 10days following PCI were identified using the British Columbia Cardiac and Central Transfusion Registries. Patients undergoing cardiac surgery following PCI were excluded as transfusion was assumed to be due to surgical related bleeding. Transfusion products were categorised as RBC and non-RBC comprising platelets, plasma and cryoprecipitate. Blood product use was compared according to thirty day mortality using multivariate regression and propensity adjustment for confounding variables. ResultsFrom a total of 32,580 patients who underwent PCI, 952 patients received at least 1 blood product within 10days of PCI. Non-RBC transfusion occurred more commonly in the cohort of transfused patients dying within 30days (p<0.001). After adjustment for baseline risk, transfusion of plasma/cryoprecipitate (HR 5.17; 95% C.I. 2.87–9.32, p<0.001) and platelets (HR 2.13; 95% C.I. 1.10–4.13, p=0.03) was associated with increased 30day mortality. In a propensity risk adjusted model, transfusion of plasma/cryoprecipitate and RBC transfusion volume remained as significant predictors of 30-day mortality (p<0.001). ConclusionsTransfusion following PCI appears to be associated with an increased risk of death within 30days. We now report that transfusion with plasma rich non-RBC products may confer an additional mortality risk to patients undergoing PCI.

Chronic kidney injury in patients after cardiac catheterisation or percutaneous coronary intervention: a comparison of radial and femoral approaches (from the British Columbia Cardiac and Renal Registries)

BackgroundAcute kidney injury (AKI) is a well-recognised complication of cardiac catheterisation and percutaneous coronary intervention (PCI). However, the incidence of chronic kidney disease (CKD) after catheterisation and PCI has not...

Red blood cell storage duration and mortality in patients undergoing percutaneous coronary intervention

Blood transfusion has been associated with an increased mortality in patients undergoing percutaneous coronary intervention (PCI). Although the reasons for this remain unclear, it may be related to the structural and functional changes occurring within red blood cells (RBCs) during storage. We investigated whether RBC storage duration was associated with mortality in patients requiring transfusion after PCI. We collected data on all RBC transfusions occurring within 10 days of PCI (excluding those related to cardiac surgery) using the British Columbia Cardiac Registry and Central Transfusion Registry. Transfusion details were analyzed according to 30-day survival. From a total of 32,580 patients undergoing PCI, 909 (2.8%) patients received RBCs with a mean storage duration of 25 +/- 10 days. In these 909 patients, mean transfusion volumes were lower in survivors (2.8 +/- 2.1 vs 3.8 +/- 2.9 U, P = .002) than those who died within 30 days. In a multivariate analysis to adjust for baseline risk, mean RBC storage age (HR 1.02 [95% CI 1.01-1.04], P = .002) and transfusion volume (HR 1.26 [95% CI 1.18-1.34], P < .001) both predicted 30-day mortality. Transfused patients who received only older blood (RBC min age >28 days) appeared to be at greater risk of death (HR 2.49 [95% CI 1.45-4.25], P = .001). Red blood cell transfusion is associated with increased 30-day mortality in patients undergoing PCI. Although current transfusion practice permits RBC storage for up to 42 days, the use of older red cells may pose an additional hazard to this patient group.

Percutaneous coronary intervention and 30‐day mortality: The British Columbia PCI risk score

To construct a calculator to assess the risk of 30-day mortality following PCI. Predictors of 30-day mortality are commonly used to aid management decisions for cardiac surgical patients. There is a need for an equivalent risk-score for 30-day mortality for percutaneous coronary intervention (PCI) as many patients are suitable for both procedures. The British Columbia Cardiac Registry (BCCR) is a population-based registry that collects information on all PCI procedures performed in British Columbia (BC). We used data from the BCCR to identify risk factors for mortality in PCI patients and construct a calculator that predicts 30-day mortality. Patients (total n = 32,899) were divided into a training set (n = 26,350, PCI between 2000 and 2004) and validation set (n = 6,549, PCI in 2005). Univariate predictors of mortality were identified. Multivariable logistic regression analysis was performed on the training set to develop a statistical model for prediction of 30-day mortality. This model was tested in the validation set. Variables that were objective and available before PCI were included in the final risk score calculator. The 30-day mortality for the overall population was 1.5% (n = 500). Area under the ROC curve was 90.2% for the training set and 91.1% for the validation set indicating that the model also performed well in this group. We describe a large, contemporary cohort of patients undergoing PCI with complete follow-up for 30-day mortality. A robust, validated model of 30-day mortality after PCI was used to construct a risk calculator, the BC-PCI risk score, which can be accessed at www.bcpci.org.