ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)—executive summary21When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Smith SC, Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, Kuntz RE, Popma JJ, Schaff HV, Williams DO. ACC/AHA guidelines for percutaneous coronary intervention: executive summary and recommendations: a report of the American College of Card

The objective of this study was to characterize variation in mortality rates across hospitals performing percutaneous coronary intervention (PCI) in the United States. For this purpose, data (n = 735,022) from the Nationwide Inpatient Sample from 1996 to 2001 were analyzed. The primary outcome for the analysis was postprocedural in-hospital mortality. Mortality rates were calculated by race, gender, geographic region, comorbid status and hospital volume. There were significant variations in mortality across gender groups, comorbid status, regions and by hospital volume status. Independent predictors of mortality in this large cohort were older age, female gender, lower income and lower hospital volume. The data suggests targets for quality improvement initiatives for patients undergoing PCI particularly in the elderly, females, lower income patients and low volume hospitals. Even in the contemporary era of adjunctive pharmacological therapies and ubiquitous use of stents, hospital volume remains a significant independent predictor of in-hospital mortality.

Section: Discussionsupporting

confidence: 82%

Variation in Outcomes after Percutaneous Coronary Intervention in the United States and Predictors of Periprocedural Mortality

Mukherjee

Wainess

Dimick³

et al. 2005

“…While awaiting further data, current ACC/AHA practice guidelines on percutaneous coronary intervention [91]suggest that late revascularization should be reserved to patients with symptomatic myocardial ischemia and/or ischemic LV dysfunction. Treatment of stable patients is not recommended, especially if the intervention provides increased procedural risks, and the myocardial viability is questionable.…”

Section: Discussionmentioning

confidence: 99%

The ‘Open-Artery Hypothesis’: New Clinical and Pathophysiologic Insights

Abbate

Biondi‐Zoccai²,

Baldi³

et al. 2003

The open-artery hypothesis states that myocardial reperfusion, even if late for myocardial salvage, provides benefits and prevents adverse cardiac remodeling. While observational data in humans regarding the deleterious impact of a permanent infarct-related artery occlusion and the benefits of spontaneous reperfusion are quite consistent, the reports regarding late revascularization are inconclusive in order to prove such a hypothesis. The observational studies tend to have selection biases, while randomized trials to date are too small to be conclusive. Moreover, the pathophysiological mechanisms underlying presumed benefits of reperfusion are still unclear. However, although the open-artery hypothesis remains unproven, the current evidence suggesting benefits calls for additional studies. Limitations of ischemic left ventricular dilatation and myopathy could markedly reduce cardiovascular morbidity and mortality after acute myocardial infarction.

“…At the start of the procedure, a bolus of unfractionated heparin (100 IU/kg) was administered with a target active clotting time of >300 s in the absence of glycoprotein IIb/IIIa inhibitor therapy and 200-300 s with glycoprotein IIb/IIIa inhibitor therapy. Successful PCI was defined according to the American Heart Association/American College of Cardiology Task Force recommendations [12]. …”

Section: Methodsmentioning

confidence: 99%

“…The primary endpoint was the occurrence of postprocedural myocardial injury, defined as a postprocedural elevation of CK-MB or cTnI more than 1 times the 99th percentile of the URL, according to the universal definition [12]. Normal limits were ≤4 ng/ml for CK-MB and ≤0.04 ng/ml for cTnI as measured by our local laboratory.…”

Section: Methodsmentioning

confidence: 99%

Protective Effect of Metformin on Myocardial Injury in Metabolic Syndrome Patients following Percutaneous Coronary Intervention

Zhao

et al. 2013

Objectives: The present study tested the hypothesis that pretreatment with metformin decreases postprocedural myocardial injury and improves clinical outcomes in metabolic syndrome patients following percutaneous coronary intervention (PCI). Methods: We enrolled 152 metabolic syndrome patients with no prior history of metformin treatment. Patients scheduled for elective coronary intervention were randomized to the metformin or control group 7 days before the procedure. Creatine kinase-MB (CK-MB) and troponin I levels were measured at baseline and 8 and 24 h after the procedure, and clinical outcomes were monitored for 1 year. Results: Post-PCI myocardial injury as indicated by CK-MB elevation (14.5 vs. 32.9%, p = 0.008) and troponin I elevation (14.5 vs. 34.2%, p = 0.005) was significantly lower in the metformin group than in the control group. Postprocedural peak values of CK-MB (2.70 ± 4.30 vs. 6.29 ± 8.03 ng/ml, p < 0.001) and troponin I (0.02 ± 0.05 vs. 0.07 ± 0.10 ng/ml, p = 0.001) were also significantly lower in the metformin group than in the control group. At 1 year, the composite endpoint of death from any cause, post-PCI myocardial infarction (MI), MI after PCI hospitalization or ischemia-driven target lesion revascularization occurred in 7.9% of metformin-treated patients and 28.9% of controls (hazard ratio 0.25, 95% CI 0.10-0.62, log rank p = 0.001). Conclusions: A 7-day metformin pretreatment regimen (250 mg 3 times a day) significantly reduces postprocedural myocardial injury and improves 1-year clinical outcomes in metabolic syndrome patients undergoing PCI.