Temporal Trends in Coronary Angiography and Percutaneous Coronary Intervention

Waldo, Stephen W.; Gokhale, Madhura; O’Donnell, Colin; Plomondon, Mary E.; Valle, Javier A.; Armstrong, Ehrin J.; Schofield, Richard S.; Fihn, Stephan D.; Maddox, Thomas M.

doi:10.1016/j.jcin.2018.02.035

Cited by 69 publications

(31 citation statements)

References 21 publications

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“…Our findings regarding the beginning of the last decade are broadly consistent with data from the United States Veterans Affairs Healthcare System, where up to 48.5% of CAGs were ‘negative’ in 2007–2010 [ 43 ], but the temporal evolution in the US is unknown at present. Interestingly, in the US the numbers of CAGs appear constant over time (with CAG patients, similar to our results, getting older) [ 44 ] while rates of coronary revascularization have seen a significant decline in the last decade [ 45 ].…”

Section: Discussionsupporting

confidence: 76%

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Chmiel

Książek

Stryszak

et al. 2018

pwki

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IntroductionInvasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.AimTo assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.Material and methodsAnonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001).ResultsThe median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.ConclusionsDespite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.

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Section: Discussionsupporting

confidence: 76%

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Chmiel

Książek

Stryszak

et al. 2018

pwki

View full text Add to dashboard Cite

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“…Complications and clinical outcomes also remained constant, with a downward tendency 18 . The study addressed patients whose procedures included arterial femoral and transradial access.…”

Section: Discussionmentioning

confidence: 99%

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

Paganin

Beghetto

Feijó

et al. 2018

Rev. Latino-Am. Enfermagem

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Objective:to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. Method:a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. Results:237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. Conclusion:the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

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“…Furthermore, since 1998, CABG rates in United States have been declining while PCI rates remain constant 15,16 . Paralleling the change in revascularization approach, patients undergoing PCI are now progressively older with increasing rates of cerebrovascular disease, diabetes, heart failure and renal failure 17 . With an aging population, increased complexity of CAD, escalating number of comorbidities, and increasing number of PCIs performed in patients with multivessel CAD, understanding peri‐procedural risk profile is necessary for improved PCI outcomes 1,2 …”

Section: Discussionmentioning

confidence: 99%

Coronary anatomy and comorbidities impact on elective PCI outcomes in left main and multivessel coronary artery disease

Yager

Schulman‐Marcus

Torosoff

2020

Cathet Cardio Intervent

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Introduction: The effects of coronary anatomy, lesion complexity, and comorbidities on outcomes of elective percutaneous coronary intervention (PCI) in high-risk patients with left main (LM) and/or multivessel coronary artery disease (CAD) are not well studied, as these patients are typically underrepresented in the clinical trials.Methods: This cohort study involved 33,568 consecutive elective PCI cases, excluding patients with prior coronary artery bypass graft, acute coronary syndrome within 24 hr of index PCI, or shock. All data were obtained from the New York State's PCI Reporting System from the calendar year 2015. In-hospital mortality was the primary outcome of study. Logistic regression models were built to calculate odds ratios (OR) with 95% confidence intervals (CI) for in-hospital mortality after adjustment for coronary anatomy and significant clinical comorbidities.Results: In this cohort of elective PCI cases all cause in-hospital mortality was low (0.3%), with a clear mortality gradient according to the extent of CAD: 0.1% in 1 vessel disease, 0.4% in 2 vessel, 0.5% in 3 vessel disease, and 3.2% in patients with LM CAD (p < .001). Mortality was also significantly increased in patients with multiple comorbidities: 0.1% in patients with 1 comorbidity, 0.7% with 2, 2.5% with 3, and 7.4% with 4 or more studied comorbidities (p < .0001). When adjusted for coronary anatomy and lesion complexity, having any 4 or more comorbidities was associated with significantly increased odds of dying after elective PCI (OR 25.9, 95% CI 8.152-82.063, p < .0001). Furthermore, when compared to patients with 3-vessel CAD, and accounted for comorbidities, the patients with LM disease still had significantly increased (OR 5.254, 95% CI 3.104-8.891, p < .0001) odds of dying after elective PCI. Conclusions:In patients undergoing elective PCI, multivessel CAD and particularly LM disease are associated with significantly increased all-cause mortality. Furthermore, when adjusted for the extent of CAD and lesion complexity, comorbidity burden remains an important predictor of mortality.

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Temporal Trends in Coronary Angiography and Percutaneous Coronary Intervention

Cited by 69 publications

References 21 publications

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

Coronary anatomy and comorbidities impact on elective PCI outcomes in left main and multivessel coronary artery disease

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