Outcomes Of Coronary Intervention Research Articles

C-reactive protein and other cardiovascular biomarkers are prediction of long-term outcomes in patients undergoing percutaneous coronary intervention

Objective The association of high-sensivity C-reactive protein (hs-CRP) on patients undergoing percutaneous coronary intervention （PCI） and the long-term prognostic value were evaluated. Methods A prospective cohort study was prospectively conducted in 287 consecutive patients who were hospitalized in the Department of Cardiology of Shanghai Zhongshan Hospital undergoing primary PCI between Dec.2007 and Dec.2008. Levels of hs-CRP and other cardiovascular risk factors were determined before PCI. The patients were followed up for a mean of 54 months. Their cardiovascular end points were recorded. Results The mean value of serum hs-CRP in patients with cardiovascular disease （CVD） readmission and death was significantly higher than those without CVD readmission and death (2.21 mg/L versus 1.10 mg/L, Z=-3.152；6.60 mg/L versus 1.22 mg/L, Z=-3.192；P both 3.0 mg/L are 43.75%（35/80）and 8.75%（7/80）,respectively. The survival time was all less than 20 months. Conclusions The results demonstrated that hs-CRP is an independent risk factor in cardiovascular disease. High hs-CRP is strongly associated with 5-year occurance of readmission and death for cardiovascular events. Hs-CRP can be a strong indicator of risk stratification and prognostic evaluation on cardiovascular high-risk populations. （Chin J Lab Med,2014,37:213-218） Key words: Cardiovascular diseases; C-reactive protein; Biological markers; Prognosis

PT137 Evaluation of thrombolysis versus primary percutaneous coronary intervention (PCI) outcomes for patients with early presentation (within 60 minutes) of acute ST elevation myocardial infarction (STEMI)

EF 49 12 45 16 NS P O ST E R A B ST R A C T S percutaneous coronary intervention (PCI), as thrombolysis can be administered within few minutes of STEMI diagnosis. Metropolitan hospitals are equipped with more staff, access to physician/cardiology and sufficient resources for further treatment compared to rural centres. It is unclear how these expertise and choices may impact on either expediting or delaying decision making in revascularization strategies. Objectives: Compare efficiency of thrombolysis in rural versus greater Brisbane metropolitan areas in those patients with acute STEMI. Methods: Acute STEMI patients who were directly or eventually referred to a tertiary centre in Brisbane (Princess Alexandra Hospital) over a 4 months period were identified. The onset to needle time (OTN), first diagnostic ECG to needle times and Door to needle (DTN) times were estimated in patients presenting with acute STEMI within 6 hours. Maximum creatine kinase (CK) rise used as the assessment of the extent of myocardial infarction. Results: A total of 195 (average age 61yrs, 78% male) acute STEMI patients were prospectively reviewed over the past 4 months. The Table 1 and 2 below shows the results in detail.

TCT-455 Clinical Outcomes in the Percutaneous Coronary Intervention of In-Stent Restenosis with the XIENCE V Everolimus-Eluting Stent

Though percutaneous coronary intervention with the XIENCE V(r) everolimus-eluting stent (EES, Abbott Vascular, Santa Clara, CA) for native coronary artery disease has favorable results compared to first generation drug-eluting stents, outcomes with EES for the treatment of in-stent restenosis (ISR)

TCT-284 Impact of female gender on bleeding complications and 1-year outcomes of transradial coronary intervention. A propensity score matched analysis: Korea TransRadial coronary Intervention registry

TCT-284 Impact of female gender on bleeding complications and 1-year outcomes of transradial coronary intervention. A propensity score matched analysis: Korea TransRadial coronary Intervention registry

Clinical outcomes of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

Purpose: Transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI). However, it is more technically challenging and associated with failure in elderly patients because the elderly may be associated with advanced vascular disease with tortuosity of subclavian artery, aortic root dilation and calcification, and diffuse atherosclerosis. We compared the clinical outcomes of the TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods: A total of 1,945 (8.9%) octogenarians were selected from 21,815 patients in the Korea Working Group on Myocardial Infarction Registry. TR group was consisted of 336 (17.3%) patients and TF group 1,609 (82.7%) patients. Procedural success and complications, door-to-balloon-time, in-hospital mortality and major adverse cardiovascular event (MACE, defined as death, MI, or revascularization), and the death and total MACE at one-year were evaluated. Results: TR group had lower Killip class, but used more drug-eluting stents and longer stents compared to TF group. Extent of coronary disease and lesion severity were similar in both groups. Procedural success was not different (97.7% vs 98.3%), but in-hospital complications were significantly lower in TR group (8.1% vs 20.3%, p<0.0001). Door-to-balloon time was not different in both groups (84.5 vs 87.0 minutes, p=0.372) in 1,170 (60.2%) patients with ST-segment elevation MI. In-hospital mortality and MACE were significantly lower in TR group compared to TF group (3.4 vs 11.4%, p<0.0001; 3.4 vs 11.4%, P<0.0001, respectively). One-year mortality and MACE were also lower in TR group (9.8 vs 18.4%, p<0.0001; 13 vs. 21.9%, p=0.001, respectively). Conclusions: This study showed that, in octogenarians with acute MI who underwent PCI, TR approach was more effective for PCI than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.

Characteristics and In-Hospital Outcomes of Patients With Non–ST-Segment Elevation Myocardial Infarction Undergoing an Invasive Strategy According to Hemoglobin Levels

The benefit of an invasive strategy in non-ST-segment elevation myocardial infarction (NSTEMI) was established from randomized trials that included few anemic patients. The aim of this study was to describe the characteristics, therapies, and mortality of patients with NSTEMIs who undergo an invasive strategy in relation to their admission hemoglobin levels. Data from 73,067 patients with NSTEMIs who underwent cardiac catheterization and who were captured by the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION-GWTG) were examined. Patients were divided into 3 hemoglobin groups on the basis of initial hemoglobin level: (1) <10 g/dl, (2) 10 to 12 g/dl, or (3) >12 g/dl. Patients with hemoglobin <10 g/dl had more co-morbidities and more 3-vessel coronary artery disease at catheterization compared with those with hemoglobin >12 g/dl (46.2% vs 33.9%, all p values <0.0001). They received fewer acute antithrombotic therapies, less often underwent revascularization (57.4% vs 74.1%), and had higher rates of red blood cell transfusion before catheterization (32.1% vs 0.3%, all p values <0.0001). After adjustment, in-hospital mortality was inversely associated with initial hemoglobin, with a 7% increase for each 1 g/dl decrease in hemoglobin lower than 15 g/dl (odds ratio 1.07, 95% confidence interval 1.02 to 1.11). In conclusion, in patients presenting with NSTEMIs and managed with an invasive strategy, a lower hemoglobin level is associated with more extensive coronary artery disease, less use of revascularization and evidence-based therapies, and increased mortality.

CRT-59 IVUS Guided PCI: Taxus Libertē Post Approval Study

Intravascular ultrasound (IVUS) has been used to quantitate coronary artery disease burden, understand lesion morphology and optimize PCI. Numerous trials have investigated the impact of IVUS on outcomes of coronary intervention. Using 3615 patients from TAXUS Libertc post approval study (December

Outcome of Cardiovascular Screening and Percutaneous Coronary Interventions in Renal Transplant Candidates: A Single-Center Observational Study in Germany

Outcome of Cardiovascular Screening and Percutaneous Coronary Interventions in Renal Transplant Candidates: A Single-Center Observational Study in Germany

TCT-611 Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. a report of more than 90 000 stent implantations

Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention : a report of more than 90 000 stent implantations

Treatment of Coronary Bifurcation Lesions with Drug‐Eluting Stents: Insights from the First Phase of the Prospective Multicenter German Drug‐Eluting Stent Registry

Controversy exists about the impact of treating bifurcations on overall outcome of coronary interventions using drug-eluting stents (DES). We sought to investigate 1-year outcome of the treatment of bifurcation lesions using DES in a large "real-world" cohort. Among 5,126 patients enrolled in phase I of the multicenter German Drug-Eluting Stent Registry, 814 (16%) were treated for a bifurcation lesion. Patients with bifurcations were compared to those without bifurcations in terms of baseline characteristics, major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) at 1 year. Usage of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) was also evaluated. In total, 1,021 and 5,189 stents were implanted in the bifurcation (1.25 stents/patient) and nonbifurcation (1.2 stents/patient) group, respectively, but 64.5% of bifurcation lesions were treated with a single stent. More complex lesion and procedural characteristics were observed in the bifurcation group. However, there was no difference in 1-year MACCE rates (a composite of death, myocardial infarction, and stroke) between the bifurcation group and nonbifurcation group (8.1% vs. 8.3%, P = 0.85). Rates of TVR (11.2% vs. 10.8%, P = 0.75) and Academic Research Consoritum-defined definite stent thrombosis (0.9% vs. 0.8%, P = 0.67) were also comparable. MACCE and TVR rates remained similar after adjustment for differences in baseline characteristics. MACCE and TVR in SES patients were 7.2% and 12.6% versus 8.7% and 10.2% in PES patients (P = 0.46 and P = 0.30, respectively). In this large multicenter registry, treatment of bifurcation lesions with DES appears effective and safe. The presence of bifurcations did not affect 1-year outcomes after DES implantation. The outcomes for SES and PES were similar.

In-hospital Outcomes of Ad Hoc vs. Elective Percutaneous Coronary Interventions

In-hospital Outcomes of Ad Hoc vs. Elective Percutaneous Coronary Interventions

Abstract P337: Prediction of In-Hospital Major Bleeding Among Patients With Acute Myocardial Infarction: Results From 90,273 Patients in the Acute Coronary Treatment Intervention Outcomes Network Registry®- Get With the Guidelines™ (AR-G)

Background: Bleeding is a common complication of acute myocardial infarction (AMI) management and is associated with worse outcomes. Risk estimation is important to guide choice and intensity of therapy and minimize bleeding-related adverse events. Methods: Using AR-G data, an in-hospital major bleeding model and risk score was developed. Major bleeding was defined as a HCT drop &gt;12%, ICH, retroperitoneal bleeding or transfusion if baseline HCT &gt;28%, and transfusion if baseline HCT &lt;28% with witnessed bleeding. The model used only baseline variables and was developed (n=72,313) and validated (n=17,960) in STEMI and NSTEMI patients (251 US centers from 1/07 to 12/08). C statistic was tested in the derivation and validation cohorts and across key subgroups. Results: Twelve independent factors were identified: heart rate, baseline hemoglobin, female sex, initial creatinine, older age, EKG changes, heart failure or shock on presentation, diabetes, peripheral artery disease, lower weight, systolic blood pressure, and home warfarin use. The model discriminated in the derivation (c=0.73) and validation (c=0.71) cohorts. A score (0-91) was created for the relative odds for major bleeding. Bleeding risk increased tenfold from lowest to highest score: very low risk (3.9%), low risk (7.3%), moderate risk (16.1%), high risk (29%), and very high risk (40%). This trend was consistent across age, sex, and MI type (Figure). Conclusion: The AR-G bleeding model and score estimates bleeding risk across a broad range of STEMI and NSTEMI patients. The model provides clinicians an easy-to-use aid to facilitate treatment decision making and may ultimately promote better patient outcomes.

Quality assessment and improvement in interventional cardiology: A position statement of the society of cardiovascular angiography and interventions, Part II: Public reporting and risk adjustment

As described in Part I of this Position Statement [1], programmatic assessment of percutaneous coronary intervention (PCI) outcomes is fundamental to the delivery of high quality care. Quality improvement requires documenting clinical outcomes and modifying behaviors based on the data. Part II addresses public reporting, current risk models utilized in PCI, recommendations for their proper use and interpretation, and limitations in current methodologies. Currently, PCI quality is often judged based on advertising, Internet health grades, and public reporting of raw mortality rates. These sources lack sufficient detail and the expertise needed to provide accurate evaluations of facilities or individual operator quality. We propose that PCI quality appraisals be based on the development and use of risk-adjusted models that meaningfully assess clinical outcomes.

Timing of In-Hospital Coronary Artery Bypass Graft Surgery for Non–ST-Segment Elevation Myocardial Infarction Patients: Results From the National Cardiovascular Data Registry ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines)

Timing of In-Hospital Coronary Artery Bypass Graft Surgery for Non–ST-Segment Elevation Myocardial Infarction Patients: Results From the National Cardiovascular Data Registry ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines)

Clinical outcomes of patients undergoing percutaneous coronary intervention for ST-elevation type and no-ST-elevation type of acute myocardial infarction

Objective To evaluate the short-term and long-term outcomes of patients with ST-segment elevation myocardial infarction （STEMI） compared with those with non-STEMI after percutaneous coronary intervention （PCI）. Method The DESIRE Ⅱ （Drug-Eluting Stent Impact on Revascularization Ⅱ） was a single-center registered retrospective study of coronary revascularization in our institution between July 2003 and September 2009.Data of demographics, clinical features and revascularization record of STEMI and non-STEMI patients from the DESIRE Ⅱ trial were analyzed. The patients were followed up in OPD or by telephone after discharge. MACCE （major adverse cardiocerebral events） including death, neo-myocardial infarction, stroke and revascularization were recorded. The clinical outcomes of patients of two types were evaluated. Results There were 6005 patients studied with a median follow-up of 566 days. A total of 1009 STEMI and non-STEMI patients were analyzed. The patients with non-STEMI （ n = 206） had higher prevalence of hypertension and history of higher frequency of myocardial infarction as well as revascularization compared with patients with STEMI （ n = 803）. The patients with non-STEMI had higher ratio of treatment for multivessel disease （43.7% vs. 34.4%, P = 0.039）. There were no significant differences in in-hospital mortality and long-term outcomes （one year survival rate： 96% vs. 98%）between patients with STEMI and non-STEMI. The predictors of 1-year mortality were LVEF and blood creatine.Conclusions Despite different chnical features, patients with STEMI and non-STEMI after PCI had similar both short-term and long-term outcomes Key words: Myocardial infarction; ST; Percutaneous coronary intervention; Prognosis

TCT-216: Six Months Angiographic Outcomes and Twelve Months Clinical Outcomes of Chronic Total Coronary Occlusion Intervention According to the Different Collateral Grades

TCT-216: Six Months Angiographic Outcomes and Twelve Months Clinical Outcomes of Chronic Total Coronary Occlusion Intervention According to the Different Collateral Grades

TCT-194: Six Months Angiographic Outcomes and Twelve Months Clinical Outcomes of Chronic Total Coronary Occlusion Intervention: Single Vessel Disease versus Multi Vessel Disease

TCT-194: Six Months Angiographic Outcomes and Twelve Months Clinical Outcomes of Chronic Total Coronary Occlusion Intervention: Single Vessel Disease versus Multi Vessel Disease

The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis

Although various studies reported better outcomes in centres performing a high volume of procedures of coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCIs), it is unclear how strong this relation is and whether it pertains to today's practice. Medline, Embase, and conference reports were searched for studies reporting the effect of high volume of CABG or PCI on in-hospital mortality, adjusted for differences in case-mix. Of 140 potentially relevant papers, 15 were included, 2 of which reported data on both CABG and PCI. Meta-analysis of 10 studies on PCI, comprising 1 322 342 patients in 1746 hospitals, indicated an odds ratio (OR) of in-hospital mortality for patients treated in a high-volume hospital of 0.87 (95% confidence interval (CI) 0.83-0.91) compared to those treated in a low-volume hospital. The 7 CABG studies taken together, comprising 1 470 990 patients in 2040 hospitals, also revealed a significant effect of high volume (OR 0.85; CI 0.79-0.92). A differential effect for specific cut-off points could not be identified. Meta-regression did not show notable changes in the effect size over the years. Patients undergoing CABG or PCI in a high-volume hospital exhibit lower in-hospital mortality than those treated at low-volume hospitals. Our meta-analysis does not support the view that this relation has attenuated over time.

AS-121: Impact of Myocardial Infarction on Midterm Outcomes of Chronic Total Coronary Occlusion Intervention

AS-121: Impact of Myocardial Infarction on Midterm Outcomes of Chronic Total Coronary Occlusion Intervention

AS-191: Impact of Diabetes Mellitus on Midterm Outcomes of Chronic Total Coronary Occlusion Intervention with Drug-Eluting Stents

AS-191: Impact of Diabetes Mellitus on Midterm Outcomes of Chronic Total Coronary Occlusion Intervention with Drug-Eluting Stents