Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.)

Routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infarction at 2 years when compared with standard angiography-guided PCI. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774).

Angiography is inaccurate in assessing the functional significance of a coronary stenosis when compared with the FFR, not only in the 50% to 70% category but also in the 70% to 90% angiographic severity category.

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Objectives This study evaluates the variation in practice patterns associated with contrast-induced acute kidney injury (CI-AKI) and identifies clinical practices that have been associated with a reduction in CI-AKI. Background Contrast-induced acute kidney injury (AKI) is a recognized as a complication of invasive cardiovascular procedures and is associated with cardiovascular events, prolonged hospitalization, end-stage renal disease, and all-cause mortality. Reducing the risk of CI-AKI is a patient safety objective set by the National Quality Forum. Methods We prospectively collected quantitative and qualitative data from 10 centers, which participate in the Northern New England Cardiovascular Disease Study Group PCI Registry. Quantitative data were collected from the PCI registry. Qualitative data were obtained through clinical team meetings to map care processes related to CI-AKI and focus groups to understand attitudes towards CI-AKI prophylaxis. Fixed and random effects modeling were conducted to test the differences across centers. Results Significant variation in rates of CI-AKI were found across ten medical centers. Both fixed effects and mixed effects logistic regression demonstrated significant variabiltiy across centers even after adjustment for baseline co-variates (p<0.001 for both modeling approaches). We found patterns in reported processes and clinical leadership that were attributable to centers with lower rates of CI-AKI. These included: reducing NPO time to 4 hours prior to case, and standardizing volume administration protocols in combination with administering 3–4 high doses of N-acetylcysteine (1200 mg) for each patient. Conclusions These data suggest that clinical leadership and institution-focused efforts to standardize preventive practices can help reduce the incidence of CI-AKI.