Ad Hoc percutaneous coronary interventions in patients with stable coronary artery disease—A study of prevalence, safety, and variation in use from the American College of Cardiology National Cardiovascular Data Registry (ACC‐NCDR®)

Catheterization and Cardiovascular Interventions - Tập 68 Số 5 - Trang 696-703 - 2006
Ronald J. Krone1, Richard E. Shaw2, Lloyd W. Klein3, James C. Blankenship4, William S. Weintraub5
1Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. [email protected]
2Sutter Health, San Francisco, California.
3Cardiology Section, Rush Medical College, Chicago, Illinois
4Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania
5Division of Cardiology, Christiana Care Health Services, Newark, Delaware

Tóm tắt

AbstractObjective: To utilize the American College of Cardiology National Cardiovascular Data Registry (ACC‐NCDR®) to monitor the performance and safety of ad hoc PCIs. Background: The performance of ad hoc PCI remains controversial. Patients' preference, cost, and vascular access issues favor an ad hoc strategy. Adequate time for thoughtful decision‐making, scheduling complexity, informed consent, and physician reimbursement favor PCI on a subsequent day. Methods: We analyzed results in 68,528 patients with stable angina entered in the ACC‐NCDR from 2001–2003. Ad hoc PCI was evaluated in many clinical and nonclinical subgroups. A multivariable analysis was performed to determine whether ad hoc PCI had an independent relationship with complications or procedure success. Results: Overall, 60.6% of patients underwent ad hoc PCI. There was no difference in ad hoc PCI mortality, renal failure, or vascular complications from staged PCI. A lower percentage of patients at high vs. low risk and with vs. without renal failure underwent ad hoc PCIs (58.6% vs.63.0% and 50.7% vs. 60.9% respectively). There was wide variation in the performance of ad hoc PCIs according to payer (70.2–60.3%), hospital PCI volume (67–50.2%), hospital owner (89.7–59.6%), and geographic area (75.5–47.4%). Ad hoc PCI per se was not independently related to PCI success or complications. Conclusions: PCI success was related to patient/lesion related factors and not to the performance of ad hoc PCIs per se. Although ad hoc PCI can be performed in more patients than at present, this strategy will never be possible in all patients at all times. © 2006 Wiley‐Liss, Inc.

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Catheterization and Cardiovascular Interventions

Tập 68 Số 5

696-703

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