Percutaneous Coronary Intervention Hospital Research Articles

Plasma levels of bactericidal/permeability-increasing protein correlate with systemic inflammation in acute coronary syndrome

BackgroundNeutrophils play important roles in atherosclerosis and atherothrombosis. Bactericidal/permeability-increasing protein (BPI) is mainly expressed in the granules of human neutrophils in response to inflammatory stress. This observational, cross-sectional study investigated the plasma level of BPI in patients with acute coronary syndrome (ACS) and its correlation with blood neutrophil counts and circulating inflammatory biomarkers. MethodsA total of 367 patients who had acute chest pain and who were admitted to our hospital for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) from May 1, 2020 to August 31, 2020 were recruited. Among them, 256 had a cardiac troponin value above the 99th percentile upper reference limit and were diagnosed with ACS. The remaining patients (n = 111) were classified as non-ACS. The TIMI and GRACE scores were calculated at admission. The Gensini score based on CAG was used to determine atherosclerotic burden. Plasma levels of interleukin (IL)-1β, myeloperoxidase-DNA (MPO-DNA), high sensitivity C-reactive protein (hs-CRP), S100A8/A9, and BPI were measured using enzyme-linked immunosorbent assays. Correlations of plasma BPI levels with examination scores and levels of circulating inflammatory biomarkers were explored. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic efficacy of BPI for ACS and myocardial infarction. ResultsPatients in the ACS group showed significantly higher plasma BPI levels compared to the non-ACS group (46.42 ± 16.61 vs. 16.23 ± 6.19 ng/mL, p < 0.05). Plasma levels of IL-1β, MPO-DNA, hs-CRP, and S100A8/A9 in the ACS group were also significantly higher than those in the non-ACS group (all p < 0.05). In addition, plasma BPI levels were positively correlated with the TIMI, GRACE, and Gensini scores (r = 0.176, p = 0.003; r = 0.320, p < 0.001; r = 0.263, p < 0.001, respectively) in patients with ACS. Plasma BPI levels were also positively correlated with blood neutrophil counts (r = 0.266, p < 0.001) and levels of circulating inflammatory biomarkers (IL-1β, r = 0.512; MPO-DNA, r = 0.452; hs-CRP, r = 0.554; S100A8/A9, r = 0.434; all p < 0.001) in patients with ACS. ROC curve analysis revealed that the diagnostic efficacy of BPI for ACS was not inferior to that of IL-1β, MPO-DNA, hs-CRP, S100A8/A9, or blood neutrophil counts. ROC analysis also showed that the diagnostic efficacy of BPI for myocardial infarction was not inferior to that of creatine kinase (CK)-MB or cardiac troponin I. ConclusionBPI is associated with systemic inflammation in ACS and may be involved in the process of atherosclerosis and atherothrombosis. The potential of BPI as a prognostic and diagnostic biomarker for ACS should be investigated in clinical settings.

Is more better? A multilevel analysis of percutaneous coronary intervention hospital openings and closures on patient volumes.

It is unknown how changes in the percutaneous coronary intervention (PCI) "built environment" have impacted PCI volumes at the community, hospital, and patient levels. This study sought to determine how PCI hospital openings and closures effect community- and hospital-level PCI volumes as well as the likelihood of receiving PCI at a low-volume hospital. We conducted a retrospective cohort study of 3,966,025 Medicare Fee-For-Service patients in 37,451 zip codes and 2564 U.S. hospitals who underwent PCI from 2006 to 2017. We conducted community-, hospital-, and patient-level analyses using ordinary least squares regressions with fixed effects to determine changes in PCI volumes after PCI hospital openings or closures. Between 2006 and 2017, a total of 17% and 7% of patients lived in communities that experienced PCI hospital openings and closures, respectively. Openings were associated with a 10% increase in community PCI volume, a 2% increase in the share of elective PCI, and a doubling in the likelihood of receiving PCI at a low-volume hospital. In communities with low baseline PCI capacity, openings were associated with a 12% increase in community PCI volume, and in high-capacity communities, an 8% increase. PCI closures were associated with a 9% decrease in community PCI volume in high-capacity communities but no measurable change in low-capacity communities. PCI service expansion is associated with increased PCI at low-volume hospitals and a greater number of elective procedures. Increased governmental oversight may be necessary to ensure that openings and closures of these specialized services yield the desired benefits.

Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean: Análisis Parcial de Costos e Impacto Económico de la Angioplastia Coronaria Ambulatoria en un Hospital Privado del Caribe

ObjectivesThis study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022. MethodsThis study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a “first-come-first-served” approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient. ResultsPCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference. ConclusionsPCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.

Attempted retrieval of guidewire fragment using the twisting wire technique causes coronary perfusion: Case report.

Guidewire fracture is one of the biggest risks of percutaneous coronary intervention, twisting wire technique is very useful for retrieving the fractured wire, but the potential risks have been inadequately reported. Herein, we present a case of retrieval of guidewire fragments using the twisting wire technique that causes coronary perfusion. A 37-year-old male patient was admitted to our hospital for elective percutaneous coronary intervention of the left circumflex coronary artery. For chronic total occlusion of the distal left circumflex coronary artery, antegrade recanalization by wire escalation, and parallel wire techniques were attempted. However, we shockingly found that the BMW guidewire, anchored in the right coronary artery, spontaneously fractured from the proximal right coronary artery, and a lengthy fragment of the guidewire remained in the coronary. Many attempts were made to retrieve the remnant guidewire including the twisting wire technique, which leads to the perforation of the coronary. Finally, percutaneous retrieving procedures were stopped in favor of surgical extraction via a small coronary arteriotomy. This procedure was successful. To the best of our knowledge, the present case is the first reported spontaneous fracture of the guidewire. Leaving such a lengthy remnant guidewire in the artery, or leaving stenting over the wire, would impose a high risk of coronary thrombosis, perforation, and embolization. Yet, the perforation of the artery that occurred in this case, which could have had life-threatening consequences, resulted from our attempts to retrieve the guidewire using the twisting wire technique.

Predictive Value of Global Longitudinal Strain on the Recovery of Left Ventricular Function Following ST-Segment Elevation Myocardial Infarction

Background: Identifying reliable predictors for ventricular recovery at the outset is crucial for patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Objectives: This study aimed to evaluate the role of baseline global longitudinal strain (GLS) in predicting myocardial recovery following an acute infarction. Methods: We enrolled 60 consecutive patients diagnosed with STEMI and admitted to Al-Zahra Hospital for PCI from March 2022 to March 2023. Echocardiography was performed on all patients within 48 hours after revascularization to measure baseline parameters, including left ventricular ejection fraction (LVEF) and GLS. Follow-up echocardiography was conducted 6 months later to reassess LVEF. Results: At the 6-month follow-up, 38 (63.3%) patients showed a ≥ 5% improvement in LVEF, indicating ventricular recovery. The change in GLS was significantly different between the groups (recovered: -4.72 ± 2.00, not recovered: -2.41 ± 2.15, P &lt; 0.001). A baseline GLS ≤ -4.5 and &gt; -14.8 was predictive of either failure to recover or successful recovery of LVEF with 100% negative and positive predictive values, respectively. Baseline GLS values &gt; -9.2 were predictive of LV recovery with 50% sensitivity and 83.3% specificity (P = 0.0002, AUC (95% confidence interval) = 0.697 (0.594, 0.799)). The type of revascularization was linked to better prediction outcomes, with patients undergoing primary and rescue PCIs more likely to recover during the follow-up period compared to those receiving deferred PCI after 24 hours (P = 0.032). Conclusions: While certain baseline GLS value thresholds may serve as predictors of LVEF recovery in patients with STEMI undergoing primary PCI, further prospective studies with larger cohorts are needed to establish more precise cut-off values.

Optimizing Door-to-Balloon Time for Patients Undergoing Primary Percutaneous Coronary Intervention at King Abdullah Medical City.

The acute myocardial infarction mortality risk rises by 8% per year for every 30-minute delay in early coronary intervention following the onset of symptoms. Thus, it is important to reduce the door-to-balloon time as much as possible, especially in hospitals where early coronary intervention is carried out within 90 minutes. The purpose of this study was to determine the impact of King Abdullah Medical City's strategies on balloon time for patients with ST elevation myocardial infraction. Prospective observational research was conducted in King Abdullah Medical City. This study included 67 patients who had a primary percutaneous coronary intervention. Data were collected in Hajj 2023 through direct observation using a checklist that included two parts: (I) patients' demographic characteristics and relevant time intervals. The data were analyzed using descriptive statistics (frequency and percentage; median and interquartile range) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test, Spearman correlation coefficient test). It was noted that the median overall door-to-balloon time was 68 minutes for direct admission patients and 100 minutes (median) for interhospital transferred patients, with a statistically significant P value of 0.001. DTBT had no significant correlation with either the length of stay or hospital mortality rates (P > 0.05). King Abdullah Medical City accomplished an international benchmark in door-to-balloon time for ST elevation myocardial infraction patients visiting the hospital for percutaneous coronary intervention during the hajj season. Healthcare organizations can take proactive steps to optimize the management of STEMI cases. This includes establishing efficient communication channels, standardizing protocols, and facilitating seamless transitions between healthcare facilities.

Using registry data to determine actual cardiac rehabilitation participation after percutaneous coronary intervention

Abstract Background Comprehensive cardiac rehabilitation (CR) has proven beneficial effects, and is a class 1A recommendation in European Society of Cardiology guidelines. Still, CR is grossly underused globally. In Norway, few studies on CR participation exist, and the extent to which CR is underused is more uncertain. Using data from national quality registries provides an opportunity to estimate actual CR participation, and whether there are some groups that participate less often than others do. Aim To determine actual use of CR, comprehensive or single component, in patients after percutaneous coronary intervention (PCI), with a special attention on women, older people, patients with comorbidities and education level. Methods CONCARDPCI is a prospective multicentre cohort study including 1970 patients after PCI at three Norwegian university hospitals during 2017-2019. Socio-demographic characteristics were self-reported during the index hospitalization for PCI. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Data on CR participation were extracted from the Norwegian Control and Payment of Health Reimbursements Database, and measured at 2-, 6- and 12 months after index hospitalisation. Results One year after PCI, one out of six patients (16%) had received single- or multicomponent CR. At 2 months, 7% had participated in CR, from 2–6 months, 12% participated in CR and from 6–12 months, 2% participated in CR. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). At 6 months, fewer women than men had participated in CR (9% vs. 13%, p=0.020). During the 12 month period, 12% of women and 17% of men participated in CR (p=0.019). The patients participating in CR were significantly younger (60 vs. 67, p&amp;lt;0.001) at all measuring points. A sizeable proportion had previous cardiovascular comorbidities including hypertension (52%) and hypercholesterolemia (47%). Patients with hypercholesterolemia participated significantly less than those without at 2 months (6% vs. 8%, p=0.031) and 6 months (9% vs. 14%, p=0.001). Those with hypertension also participated less than those without at 2 months (5% vs. 9%, p=0.002) and 6 months (9% vs. 15%, p&amp;lt;0.001). Further, 26% had previous PCI, and those with a history of PCI participated less than those with no history at 2 months (3% vs. 9%, p&amp;lt;0.001) and 6 months (6% vs. 14%, p&amp;lt;0.001). Finally, those with a lower educational level participated less at 2 months (primary school 4% vs. college/university 10%, p=0.034) and 6 months (primary school 9% vs. college/university 15%, p=0.050). Conclusion Very few patients participated in comprehensive or single component CR. Those with a lower educational level and women participated less often in CR, and the proportion was even lower in patients with comorbidities. New modes of delivery for CR is needed to meet the large group of patients not receiving follow-up according to guidelines.

The Impact of Hypothyroidism on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Introduction: Hypothyroidism either subclinical (SCH) or overt is independently associated with an increased risk of coronary artery disease (CAD). The combined effects of SCH and overt hypothyroidism on clinical outcomes after percutaneous coronary intervention (PCI) are largely unknown. Aim: The aim of the study is to assess the impact of subclinical and overt hypothyroidism among patients presenting with CAD undergoing PCI. Materials and Methods: A total of 102 patients who were referred to the Madras Medical Mission Hospital for PCI from September 2020 to March 2021 were enrolled in the study. These patients were categorized into three groups. Each group has 34 patients and was followed for one year. Group 1: Patients with normal TSH levels (TSH-0.45 -5mlU/Liter) and euthyroid at T3, T4 levels. Group 2: Patients with subclinical hypothyroidism with elevated TSH levels (TSH=5-15mlU/liter) and normal thyroid with T3, T4 levels. Group 3: Patients with a family history of overt hypothyroidism or high TSH levels(&lt;15mlU/liter) and low T3 and T4 levels [16]. Results: We applied ANOVA to find the PCI outcomes. A p-value of &lt;0.05 was accepted as significant. Age (p-0.03), recent myocardial infarction (p-0.04), diabetes mellitus (p&lt;0.001), HbA1C (p-0.012), and systolic blood pressure (p-0.04) were found to be significant. Post-PCI bleeding complications (p&lt;0.001) during one month, six months, and one-year follow-up were the main observation of the study. Conclusion: The prior history of DM and elevated HbA1c levels observed in the overt hypothyroid group indicate that DM was one of the key factors associated with overt hypothyroidism. Despite the fact that PCI was safe for patients with hypothyroidism, the risk of early post-PCI bleeding was of concern.

Abstract 18822: Disparities in Access and Long-Term Survival in St Elevation Myocardial Infarction Patients the Brazilian Public and Private Health Services- Victim Registry

Introduction: This study aims to evaluate the impact of disparities in access to specialized services and reperfusion therapies on the long-term survival of patients with ST-elevation myocardial infarction (STEMI) treated under the Unified Health System (SUS) and those covered by Private Healthcare Insurance (PHI). Scarce data exist for regions characterized by significant socioeconomic disparities. Methods: The VICTIM registry was utilized to compare disparities among STEMI patients treated under SUS and PHI. The registry involved all Percutaneous Coronary Intervention (PCI) hospitals in Sergipe, the smallest state in Brazil, consisting of one facility for SUS patients and three facilities for private patients. We examined the patient's opportunity to reach a PCI hospital, reperfusion data from 2014 to 2018, and long-term survival through telephone interviews between 2020 and 2021. Long-term outcomes evaluated using the Gehan-Breslow test with Dunn correction, and significance level p&lt;0.05. Results: Out of the 1.082 patients evaluated, 893 (82.53%) received treatment under SUS, while 189 (17.47%) covered by PHI. SUS patients had to travel a distance six times greater from the site of pain to the PCI hospital (58.2 km vs. 8.7 km; p&lt;0.001); had lower rates of reperfusion (49.8% vs. 67.2%; p&lt;0.001) and primary PCI (47.2% vs. 66.5%; p&lt;0.001); and often had to pass through at least one institution before reaching the PCI hospital (76.1% vs. 41%; p&lt;0.001). The time from symptom onset to seeking help was similar for both groups, but the overall time from symptom onset to arrival at the PCI hospital was longer for public service patients (10.3h vs. 5.3h; p&lt;0.001). Fibrinolytic therapy was underused (2.5% vs. 1.1%; p=0.411). Long-term survival results displayed in Figure 1. Conclusions: SUS patients exhibited higher long-term mortality rates, longer travel distances, and reduced access to reperfusion therapies compared to PHI patients, indicating disparities in care.

Abstract 15665: Lack of Association Between Inpatient Percutaneous Coronary Intervention Volume and Thirty-Day Readmissions After Acute Myocardial Infarction- Cardiogenic Shock

Introduction: Volume-outcome relationship data is limited for acute myocardial infarction-cardiogenic shock (AMI-CS). Revascularization is mainstay of therapy in AMI-CS. Objectives: Authors sought to examine relation between hospital inpatient percutaneous coronary intervention (PCI) volume and 30-day readmissions after an AMI-CS admission. Methods: Nationwide Readmissions Database (NRD) 2016-2019 was analyzed. Hospitals were categorized into quartiles (Q1, lowest to Q4, highest) based on annual inpatient PCI volume. Primary outcome of interest was 30-day unplanned all-cause readmissions. Secondary outcomes included cardiac, non-cardiac and heart-failure (HF) readmissions at 30-days. Results: A total of 49,558 index AMI-CS admissions were present in 3,954 PCI performing hospitals. Median hospital PCI volume was 174 (inter-quartile range 70-316). 59% admissions for AMI-CS were present in quartile Q4. Overall, 30-day readmission rate was 18.5% (n=9,179); of which 56.2% were cardiac, 43.8% were non-cardiac and 25.8% were related to HF. We did not find any difference in 30-day all-cause readmissions (Q1 = 17.6% vs. Q2 = 18.4% vs. Q3 = 18.2% vs. Q4 = 18.7%, p=0.55). Similarly, cardiac (Q1 = 10.9% vs. Q2 = 11.0% vs. Q3 = 10.6% vs. Q4 = 10.2%, p=0.29), and HF (Q1 = 5.0% vs. Q2 = 4.8% vs. Q3 = 4.8% vs. Q4 = 4.8%, p=0.99) readmissions were not different across quartiles. Non-cardiac readmissions were more-commonly observed in higher quartiles (Q1 = 6.7% vs. Q2 = 7.4% vs. Q3 = 7.7% vs. Q4 = 8.5%, p=0.001). However, no significance was noted with any outcome after multivariable adjustment. Similarly, no relationship was observed between hospital PCI volume as continuous variable and all-cause or cause-specific readmissions on restricted cubic spline analysis. Conclusions: In a national representative sample of 3,954 hospitals with 49,558 AMI-CS admissions, we found lack of an association between hospital PCI volume and 30-day all cause or cause-specific readmissions.

Comparing In-Hospital Outcomes for Acute Myocardial Infarction Patients in High-Volume Hospitals Performing Primary Percutaneous Coronary Intervention vs. Regional General Hospitals.

It has been reported that patients with acute myocardial infarction (AMI) transferred to low-volume primary percutaneous coronary intervention (PCI) hospitals (<115/year) in low population density areas experience higher in-hospital mortality rates. This study compared in-hospital outcomes of patients admitted to high-volume primary PCI hospitals (≥115/year) with those for other regional general hospitals. Retrospective analysis was conducted on data obtained from 2,453 patients with AMI admitted to hospitals in Iwate Prefecture (2014-2018). Multivariate analysis revealed that the in-hospital mortality rate of AMI among patients in regional general hospitals was significantly higher than among patients in high-volume hospitals. However, no significant difference in mortality rate was observed among patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI. Although no significant difference was found in the in-hospital mortality rate of patients with Killip class I STEMI, significantly lower in-hospital mortality rates were observed in patients admitted in high-volume hospitals for Killip classes II, III, and IV. Although in-hospital outcomes for patients with STEMI undergoing primary PCI were similar, patients with heart failure or cardiogenic shock exhibited better in-hospital outcomes in high-volume primary PCI hospitals than those in regional general hospitals.

Predictive value of hemoglobin to serum creatinine ratio combined with serum uric acid for in-hospital mortality after emergency percutaneous coronary intervention in patients with acute myocardial infarction

To investigate the clinical value of hemoglobin to serum creatinine ratio (Hb/SCr) combined with blood uric acid (SUA) in predicting in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). The clinical data of AMI patients who underwent emergency PCI in the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. The general information, underlying medical history, blood routine, liver and kidney function, blood coagulation routine, SUA and other indicators were collected from patients. The primary composite endpoint was defined as in-hospital death, including in-hospital all-cause death during PCI and 15-day post-procedure hospitalization. Multivariate Logistic regression was used to analyze factors associated with in-hospital death after emergency PCI in patients with AMI. Multivariate Logistic regression was used to analyze the independent related factors and construct a risk prediction model. The Hosmer-Lemeshow method and receiver operator characteristic curve (ROC curve) were used to test the goodness of fit and predictive effect of the model and correlates, respectively. A total of 1 976 patients were enrolled, 92 died in hospital and 1 884 survived. SUA was higher in the death group than that in the survival group (μmol/L: 476.88±132.04 vs. 354.87±105.31, P < 0.01), and the Hb/SCr ratio was significantly lower than that in the survival group (13.84±5.48 vs.19.20±5.74, P < 0.01). Pearson analysis showed a linear negative correlation between SUA and Hb/SCr ratio (r = -0.502, P < 0.01). Logistic regression risk model analysis finally included age [odds ratio (OR) = 0.916], Hb/SCr ratio (OR = 0.182), white blood cell count (WBC, OR = 2.733), C-reactive protein (CRP, OR = 3.611), SUA (OR = 4.667), blood glucose (Glu, OR = 2.726), homocysteine (Hcy, OR = 2.688) 7 factors to construct a risk prediction model, which were independent correlation factors for in-hospital death in AMI patients after emergency PCI (all P < 0.05). Hosmer-Lemeshow test verified the fitting effect of the model, and the result showed P = 0.447. The area under the ROC curve (AUC) of the model for predicting in-hospital death in AMI patients after emergency PCI was 0.764 [95% confidence interval (95%CI) was 0.712-0.816, P = 0.001]. When the cut-off value was 0.565 8, the sensitivity was 70.7%, the specificity was 70.2%, and the Yoden index was 0.410. When Hb/SCr ratio+SUA, SUA, Hb/SCr ratio, Hb and SCr were used to predict in-hospital death in AMI patients after emergency PCI, the AUC of Hb/SCr ratio+SUA was the largest, which was 0.810. When the optimal cut-off value was -0.847, the sensitivity was 77.7%, the specificity was 74.5%, and the Youden index was 0.522. Age, SUA, Hb/SCr ratio, WBC, CRP, Glu, and Hcy are independent risk factors for in-hospital death after emergency PCI in AMI patients. The lower the Hb/SCr ratio and the higher the SUA at admission, the higher the risk of in-hospital death after emergency PCI in AMI patients. Hb/SCr ratio combined with SUA has a higher predictive value for in-hospital death after emergency PCI in AMI patients than single index, which is helpful for early identification of high-risk patients.

Differential Treatment and Outcomes for Patients With Heart Attacks in Advantaged and Disadvantaged Communities.

Background Racially and ethnically minoritized groups, people with lower income, and rural communities have worse access to percutaneous coronary intervention (PCI) than their counterparts, but PCI hospitals have preferentially opened in wealthier areas. Our study analyzed disparities in PCI access, treatment, and outcomes for patients with acute myocardial infarction based on the census-derived Area Deprivation Index. Methods and Results We obtained patient-level data on 629 419 patients with acute myocardial infarction in California between January 1, 2006 and December 31, 2020. We linked patient data with population characteristics and geographic coordinates, and categorized communities into 5 groups based on the share of the population in low or high Area Deprivation Index neighborhoods to identify differences in PCI access, treatment, and outcomes based on community status. Risk-adjusted models showed that patients in the most advantaged communities had 20% and 15% greater likelihoods of receiving same-day PCI and PCI during the hospitalization, respectively, compared with patients in the most disadvantaged communities. Patients in the most advantaged communities also had 19% and 16% lower 30-day and 1-year mortality rates, respectively, compared with the most disadvantaged, and a 15% lower 30-day readmission rate. No statistically significant differences in admission to a PCI hospital were observed between communities. Conclusions Patients in disadvantaged communities had lower chances of receiving timely PCI and a greater risk of mortality and readmission compared with those in more advantaged communities. These findings suggest a need for targeted interventions to influence where cardiac services exist and who has access to them.

Patients reporting to be healthy and not needing to change lifestyle after percutaneous coronary intervention - a cause for action?

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority, The Norwegian Nurses Association Background A substantial proportion of patients with coronary artery disease do not achieve risk factors control, and are subsequently readmitted to hospital. In addition to decreased longevity, this increases the burden to the healthcare system and already strained resources. Aim To determine lifestyle and clinical characteristics of patients reporting to be healthy and not needing to change their lifestyle after percutaneous coronary intervention (PCI). Methods CONCARDPCI is a prospective multicentre cohort study including 3417 patients after PCI at seven Norwegian and Danish university hospitals during 2017-2019. Socio-demographic characteristics were obtained by self-report during the index hospitalization for PCI, and self-report on perceived health and the need to do lifestyle changes were repeated after 12 months. Clinical data were collected from patients’ medical records and the Norwegian Registry on Invasive Cardiology. Descriptive statistics, as well as t-test and chi-square test, scrutinized the aim. Results At baseline, 18% reported to be healthy and not needing to change their lifestyle. This increased to 28% (p&amp;lt;0.001) at 12 months. Most patients were men (78%) with a mean age of 66 years (SD 11, range 20-96 years). A sizeable proportion had previous cardiovascular comorbidities, including history of myocardial infarction (21%), hypertension (52%) and hypercholesterolemia (47%). Further, 27 % were obese (BMI &amp;gt;=30), 17% were smoking, 26% had previous PCI, and 9% previous coronary artery bypass grafting (CABG). Patients reporting to be healthy and not needing to change their lifestyle were older (69 vs 65, p&amp;lt;0.001). At baseline, compared to the total study population, significantly fewer patients with history of: hypercholesterolemia 13% (p = 0.002), hypertension 12% (p = 0.001), previous PCI 11% (p&amp;lt;0.001), previous CABG 9% (p&amp;lt;0.001), obesity 6% (p&amp;lt;0.001) and smoking 4% (p&amp;lt;0.001) reported to be healthy and asserted not needing to change lifestyle. After 12 months, more patients with risk factors reported to be both healthy and not needing to change lifestyle: those having hypercholesterolemia 25% (p&amp;lt;0.001), hypertension 25% (p&amp;lt;0.001), obesity 17% (p&amp;lt;0.001) and smoking 11% (p&amp;lt;0.001), as well as those with history of previous PCI 19% (p&amp;lt;0.001) or CABG 18% (p&amp;lt;0.001). Although the proportion was less for those with history of risk factors than for the total study population at 12 months, the increase in this group was large and significant. Conclusion The proportion of patients reporting to be healthy and not needing to change their lifestyle increased significantly in the longer term. This applied especially to patients with risk factors such as hypercholesterolemia, hypertension, obesity and current smoking, as well as those with history of previous PCI or CABG. For patients to better understand the seriousness and implications of their disease, patient education and increased health literacy is important.

Left atrial function index predicts poor outcome in STEMI patients treated with percutaneous coronary intervention

The prognostic value of the left atrial function index (LAFI) in acute ST segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention (PCI) is unknown. This study sought to determine whether the LAFI predicts prognosis in STEMI patients treated with PCI. Patients with newly diagnosed STEMI who were treated with PCI in Hunan Provincial People's Hospital from March 2020 to October 2020 were prospectively enrolled. All patients underwent transthoracic echocardiography at baseline and follow-up. The endpoint events included rehospitalization due to unstable angina, nonfatal myocardial infarction, rehospitalization due to heart failure and cardiovascular death. A total of 156 STEMI patients treated with PCI were studied with a median follow-up of 14 months. Forty-eight patients had endpoint events. The LAFI had the highest area under the receiver operating characteristic curve (AUC) predicting the endpoint events, with an AUC of 0.90 (95% CI 0.84–0.94). Multivariate Cox analysis demonstrated that only the LAFI (HR: 0.91, 95% CI 0.87–0.96, P < 0.0001) was independently predictive of endpoint events. Kaplan‒Meier survival curves showed that patients with an LAFI ≤ 42.25 cm/cc/m2 had more events than patients with an LAFI > 42.25 cm/cc/m2 (HR: 19.15, 95% CI 8.90–41.21, P < 0.001). The LAFI is a strong and independent predictor of events in STEMI patients treated with PCI.

Cost Change of Elective Percutaneous Coronary Artery Intervention for Chronic Coronary Syndrome in Japan From 2010 to 2019.

Because of revisions to insurance reimbursement costs, medical fees have changed for investigations and percutaneous coronary intervention (PCI) treatment of chronic coronary syndrome (CCS). In this retrospective study, we investigated these changes and their effects on mortality and cardiovascular events. We included 1,483 patients who underwent elective PCI for CCS between April 2010 and September 2019. The primary outcomes were changes in PCI procedure fees and all included hospitalization fees due to the biennial revisions of reimbursement costs across 5 time periods (~2 years each). Secondary outcomes were rates of survival and freedom from major adverse cerebral and cardiovascular events (MACCE) in each time period. Patient characteristics were generally unchanged over the study period; however, treatment procedures changed significantly, with changes in the approach site (from transfemoral to transradial access; P<0.0001) and final device (from bare-metal stents to drug-eluting stents; P<0.0001), and an increase in the use of imaging modalities (P<0.0001). Medical fee parameters (primary outcomes) decreased significantly from 2010 to 2019 (P<0.001): PCI procedure fees decreased by 25%, whereas all included hospitalization fees decreased by 20%. There were no significant differences in survival or freedom-from-MACCE rates between periods. Because of revisions to reimbursement prices, there were rapid and significant decreases in PCI procedure and hospitalization fees for CCS. These changes had no effect on mortality or cardiovascular events.

C78 SPONTANEOUS CORONARY ARTERY DISSECTION: THE ROLE OF CORONARY CT ANGIOGRAPHY IN THE FOLLOW–UP MANAGEMENT

Abstract Background Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome, myocardial infarction (MI) and sudden death. Although the gold standard for diagnosis is invasive coronary angiography, Coronary Computed Tomography Angiography (CCTA) is a new useful tool for the diagnosis and follow–up (FU). Treatment could involve a conservative or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting. AIMS: 1) analyze the clinical and CCTA features at baseline of patients with SCAD; 2) evaluate the clinical and anatomic patients outcome with conservative or invasive treatment; 3) evaluate in patients treated with the conservative approach the clinical and anatomic features of those dismissed with single (SAPT) or double (DAPT) antiplatelet therapy. Methods Clinical and anatomic data of 57 patients with SCAD, followed up with CCTA enrolled retrospectively between 2010 ad 2022, were collected at baseline and at the FU. The clinical endpoints evaluated were: all causes mortality, hospitalization for cardiovascular cause, SCAD or PCI ex–novo and MI. The anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline. Results 46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) under PCI. Patients treated with PCI were more smokers (45,5% vs 15,2%; p=0,042), had peripherical arteriopathy (18,2% vs 0%; p=0,034), higher troponin peak (40425,8 vs 13436; p=0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p=0,050). Moreover the PCI population had a significant involvement of more than one coronary artery (72,7% vs 6,5%; p&amp;lt;0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p=0,001) and of the truncus communis (45,4% vs 0%; p&amp;lt;0,001). At the FU, there were no statistical differences for clinical and anatomic endpoints between the two groups (p&amp;gt;0,05). Among patients treated with conservative therapy, there was a more significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p=0,033). Conclusions Patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated. DAPT at discharge is associated with a higher rate of SCAD recurrence at FU.

Recurrence of Protruding Calcified Nodule Visualized Using Optical Coherence Tomography Following Stent Implantation

Disparities in access to percutaneous coronary intervention (PCI) for patients with acute myocardial infarction may result from openings and closures of PCI-providing hospitals, potentially leading to low hospital PCI volume, which is associated with poor outcomes.The authors sought to determine whether openings and closures of PCI hospitals have differentially impacted patient health outcomes in high- vs average-capacity PCI markets.In this retrospective cohort study, the authors identified PCI hospital availability within a 15-minute driving time of zip code communities. The authors categorized communities by baseline PCI capacity and identified changes in outcomes associated with PCI-providing hospital openings and closures using community fixed-effects regression models.From 2006 to 2017, 20% and 16% of patients in average- and high-capacity markets, respectively, experienced a PCI hospital opening within a 15-minute drive. In average-capacity markets, openings were associated with a 2.6 percentage point decrease in admission to a high-volume PCI facility; high-capacity markets saw an 11.6 percentage point decrease. After an opening, patients in average-capacity markets experienced a 6.5% and 8.6% relative increase in likelihood of same-day and in-hospital revascularization, respectively, as well as a 2.5% decrease in mortality. PCI hospital closures were associated with a 10.4% relative increase in admission to high-volume PCI hospitals and a 1.4 percentage point decrease in receipt of same-day PCI. There was no change observed in high-capacity PCI markets.After openings, patients in average-capacity markets derived significant benefits, whereas those in high-capacity markets did not. This suggests that past a certain threshold, facility opening does not improve access and health outcomes.

Do PCI Facility Openings and Closures Affect AMI Outcomes Differently in High- vs Average-Capacity Markets?

BackgroundDisparities in access to percutaneous coronary intervention (PCI) for patients with acute myocardial infarction may result from openings and closures of PCI-providing hospitals, potentially leading to low hospital PCI volume, which is associated with poor outcomes. ObjectivesThe authors sought to determine whether openings and closures of PCI hospitals have differentially impacted patient health outcomes in high- vs average-capacity PCI markets. MethodsIn this retrospective cohort study, the authors identified PCI hospital availability within a 15-minute driving time of zip code communities. The authors categorized communities by baseline PCI capacity and identified changes in outcomes associated with PCI-providing hospital openings and closures using community fixed-effects regression models. ResultsFrom 2006 to 2017, 20% and 16% of patients in average- and high-capacity markets, respectively, experienced a PCI hospital opening within a 15-minute drive. In average-capacity markets, openings were associated with a 2.6 percentage point decrease in admission to a high-volume PCI facility; high-capacity markets saw an 11.6 percentage point decrease. After an opening, patients in average-capacity markets experienced a 6.5% and 8.6% relative increase in likelihood of same-day and in-hospital revascularization, respectively, as well as a 2.5% decrease in mortality. PCI hospital closures were associated with a 10.4% relative increase in admission to high-volume PCI hospitals and a 1.4 percentage point decrease in receipt of same-day PCI. There was no change observed in high-capacity PCI markets. ConclusionsAfter openings, patients in average-capacity markets derived significant benefits, whereas those in high-capacity markets did not. This suggests that past a certain threshold, facility opening does not improve access and health outcomes.

Effect of hospital assignment on mortality for AMI patients

BackgroundInternational guidelines recommend percutaneous coronary intervention (PCI) to treat acute myocardial infarction (AMI) if PCI can be performed within two hours. PCI is a centralized treatment, and therefore a common trade-off is whether to send AMI patients directly to a hospital that performs PCI, or postpone a potential PCI-treatment by first receiving acute treatment at a local hospital that can not perform PCI. In this paper, we estimate the effect of sending patients directly to a PCI-hospital on AMI mortality.MethodsUsing nation-wide individual-level data from 2010 to 2015, we studied mortality rates for AMI patients sent directly to a hospital that performs PCI (N=20 336) compared to AMI patients sent to a hospital not performing PCI (N=33 437). Since the underlying health of patients may affect both hospital assignment and mortality, estimates from traditional multivariate risk adjustment models are likely biased. We therefore apply an instrumental variable (IV) model using the historical municipal share sent directly to a PCI-hospital as an instrument for being sent directly to a PCI-hospital.ResultsPatients sent directly to a PCI-hospital are younger and have fewer comorbidities than patients who are first sent to a non-PCI-hospital. IV results suggest that those initially sent to PCI-hospitals have 4.8 percentage points decrease (95% CI (- 18.1)-8.5) in mortality after one month compared to those initially sent to non-PCI-hospitals.ConclusionOur IV results suggest that there is a non-significant decrease in mortality for AMI patients sent directly to a PCI hospital. The estimates are too imprecise to conclude that health personnel should change their practice and send more patients directly to a PCI-hospital. Moreover, the results may be taken to suggest that health personnel navigate AMI patients to the best treatment option.