Background:
In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region.
Methods:
The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway.
Results:
From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry.
Conclusions:
ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.
This study confirms the long-term safety and efficacy of the TAXUS® DES in unprotected LM stenting. Diabetes and the need for a second stent in distal LM interventions were associated with an increased risk of adverse outcomes.
Background: There have been several reports that statin therapy is associated with a slightly higher incidence of new-onset diabetes mellitus(DM) or impaired glucose intolerance(IGT). It is still controversial whether the chronic statin therapy is a risk factor of IGT and new onset DM, in Asian population. Methods: We investigated the 13,561 patients(pts) that was HbA1c level Ͻ6.0% and fasting glucose level Ͻ124 mg/dL(statin therapy groupϭ4016 and control groupϭ9545). To adjust potential confounders including age, gender, hypertension, hyperlipidemia, chronic kidney disease, hyper/hypo-thyroidism, lipid profile, beta-blocker, diuretics, a propensity score matched analysis was performed using the logistic regression model. The primary end-point was the cumulative incidence of new-onset DM, IGT, and impaired fasting glucose(IFG). Also, Multivariable Cox-regression analysis adjusted aforementioned variables was performed to determine the impact of statin therapy on the incidence of new-onset DM, IGT, and IFG. Results: Mean follow-up duration was 534Ϯ604 days in all group, and 608Ϯ607 days in propensity score matching group. Baseline characteristics was similar between the two groups except hyperlipidemia (11.1% vs. 3.5%, pϽ0.001). In Kaplan-Meyer curve, there was no difference between the two groups (pϭ0.501, figure A). Also, in cox-regression analysis performed in all pts, statin therapy was not associated with the increased incidence of primary end-point(figure B). Conclusions: In our study, there was no clear association with statin therapy and IGT and new-onset DM in a series of cardiovascular pts in Asian population.
Background
Development of appropriateness indicators of medical interventions has become a major quality-of-care issue, especially in the domain of interventional cardiology (IC). The objective of this study was to develop and evaluate the accuracy of an indicator of the appropriateness of interventional cardiology acts (invasive coronary angiographies (ICA) and percutaneous coronary interventions (PCI)) in patients with coronary stable disease and silent ischemia, automated from a French registry.
Methods
All ICA and PCI recorded in a Regional IC Registry (ACIRA) and operated for a stable coronary artery disease or silent ischemia from January 1st to December 31th 2013 in eight IC hospitals of Aquitaine, southwestern France, were included.
The indicator was developed to reflect European guidelines. Classification of appropriateness by the indicator, measured on the registry database, was compared to the classification of a reference standard (expert judgment applied through complete record review) on a random sample of 300 interventions.
Accuracy parameters were estimated. A second version of the indicator was defined, based on the analysis of false negative and positive results, and its accuracy estimated.
Results
The second indicator accuracy was: sensitivity 63.5% (95% confidence interval CI [51.7–75.3]), specificity 76.0% (95%CI [70.4–81.6]), PPV 43.0% (95% CI [33.0–53.0]) and NPV 88.0% (95% CI [83.4–92.6]). When stratified on the type of act, parameters were better for ICA alone than for PCI.
Conclusions
Accuracy of the indicator should raise with improvement of database quality. Despite its average accuracy, it is already used as a benchmark indicator for cardiologists. It is sent annually to each IC center with value of the indicator at the region level to allow a comparison.
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