Access Site Practice and Procedural Outcomes in Relation to Clinical Presentation in 439,947 Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom

Ratib, Karim; Mamas, Mamas A.; Anderson, Simon; Bhatia, Gurbir; Routledge, Helen; Belder, Mark de; Ludman, Peter; Fraser, Douglas G.; Nolan, James

doi:10.1016/j.jcin.2014.06.026

Cited by 118 publications

(75 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous studies have shown radial access to be associated with many benefits, such as reductions in bleeding rates and major vascular complications 37, 38, 39, 40, 41, 42, 43. It is also the patient‐preferred arterial access site44, 45 and associated with lower cost 34, 36.…”

Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…The utilization of radial (RA) over femoral arterial access (FA) for acute coronary intervention in ST‐elevation myocardial infarction (STEMI) is supported by a reduction in mortality, ischemic, and bleeding endpoints 1, 2, 3, 4, 5, 6, 7, 8. This has led various interventional societies to encourage its utilization over femoral access 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study

Shavadia

Welsh

Gershlick

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundThe effectiveness of radial access (RA) in ST‐elevation myocardial infarction (STEMI) has been predominantly established in primary percutaneous coronary intervention (pPCI) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral (FA) access in STEMI undergoing either a pharmacoinvasive (PI) strategy or pPCI.Methods and ResultsWithin STrategic Reperfusion Early After Myocardial Infarction (STREAM), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site (FA: PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ST‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients (P<0.001). On multivariable analysis, this benefit on the primary composite outcome favoring RA persisted (adjusted odds ratio [OR], 0.59; 95% CI, 0.44–0.78; P<0.001) and was evident in both pPCI (adjusted OR, 0.63; 95% CI, 0.43–0.92) and PI cohorts (adjusted OR, 0.57 95% CI, 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group (RA vs FA, 5.2% vs 6.0%; P=0.489).ConclusionsRegardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00623623.

show abstract

“…This is not the first BCIS study to document this march toward radial access dominance or the association of radial access with improved outcomes. 2 Nor is this the largest temporal trends study demonstrating significant growth of the radial strategy: the National Cardiovascular Database Registry (NCDR) studied >2.8 million patients in the United States and documented a growth in radial access from 1.2% to 16.1% of all PCI procedures from 2007 to 2012 3 ; like the current BCIS study, the NCDR analysis also demonstrated regional heterogeneity in growth and improved outcomes among patients receiving radial as opposed to femoral access.…”

mentioning

confidence: 81%

Nonlinear Mathematics of Death and Vascular Access

Dauerman

2016

Circulation

View full text Add to dashboard Cite

Access Site Practice and Procedural Outcomes in Relation to Clinical Presentation in 439,947 Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom

Cited by 118 publications

References 50 publications

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study

Nonlinear Mathematics of Death and Vascular Access

Contact Info

Product

Resources

About