Improving the process of informed consent for percutaneous coronary intervention: Patient Outcomes from the Patient Risk Information Services Manager (ePRISM) study

Spertus, John A.; Bach, Richard G.; Bethea, Charles F.; Chhatriwalla, Adnan K.; Curtis, Jeptha P.; Gialde, Elizabeth; Guerrero, Mayra; Gosch, Kensey; Jones, Philip G.; Kugelmass, Aaron D.; Leonard, Bradley; McNulty, Edward; Shelton, Marc E.; Ting, Henry H.; Decker, Carole

doi:10.1016/j.ahj.2014.11.008

Cited by 45 publications

(36 citation statements)

References 23 publications

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“…(11,12) Details of the PRISM study have been described previously. (13) Briefly, 3,299 consecutive patients undergoing PCI at 10 U.S. hospitals between 2009–2011 were approached to participate in the PRISM study.…”

Section: Methodsmentioning

confidence: 99%

Predicting long‐term bleeding after percutaneous coronary intervention

Sharma

Chhatriwalla

Cohen

et al. 2016

Cathet Cardio Intervent

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Objectives To construct a model to predict long-term bleeding events following percutaneous coronary intervention (PCI). Background Treatment with dual antiplatelet therapy following PCI involves balancing the benefits of preventing ischemic events with the risks of bleeding. There are no models to predict long-term bleeding events after PCI. Methods We analyzed 1-year bleeding outcomes from 3,128 PCI procedures in the PRISM study. Patient-reported bleeding events were categorized according to Bleeding Academic Research Consortium (BARC) definitions. Logistic regression analysis was used to develop a model predicting BARC ≥ 1 bleeding. Results BARC 0, 1, 2 or 3 bleeding was observed in 574 (18.4%); 2382 (76.2%); 114 (3.6%) and 58 (1.8%) patients, respectively. Compared to patients who had no bleeding, patients with BARC ≥ 1 bleeding were more often female (30 vs. 23%), Caucasian (94 vs. 83%), had a higher incidence of DES implantation (83 vs. 76%) and warfarin therapy (7.4 vs. 3.9%), and a lower incidence of diabetes (31 vs. 45%; p-value <0.01 for all comparisons). A 27-variable model had moderate discrimination (c-statistic of 0.674), and good calibration, as did a parsimonious model with 10 variables (c-statistic =0.667). This model performed well in predicting BARC ≥ 2 bleeding events as well (c-statistic =0.653). Conclusions Bleeding is common in the first year after PCI, and can be predicted by pre-procedural patient characteristics and use of DES. Objective estimates of bleeding risk may help support shared decision-making with respect to stent selection and duration of antiplatelet therapy following PCI.

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Section: Methodsmentioning

confidence: 99%

Predicting long‐term bleeding after percutaneous coronary intervention

Sharma

Chhatriwalla

Cohen

et al. 2016

Cathet Cardio Intervent

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“…9 Consecutive patients undergoing PCI were enrolled and those who completed 1-year clinical follow-up with the disease-specific health Seattle Angina Questionnaire (SAQ) and generic EuroQol 5 Dimensions (EQ-5D) were included in the present analysis. Each patient underwent a detailed, independent chart abstraction by trained study coordinators to collect demographic, comorbidity and disease severity information (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Association of Smoking Status With Health-Related Outcomes After Percutaneous Coronary Intervention

Jang

Buchanan

Gosch

et al. 2015

Circ: Cardiovascular Interventions

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Background Patients who smoke at the time of percutaneous coronary intervention (PCI) would ideally have a strong incentive to quit, but most do not. We sought to compare the health status outcomes of those who did and did not quit smoking after PCI with those who were not smoking prior to PCI. Methods and Results A cohort of 2,765 PCI patients from 10 US centers were categorized into never, past (smoked in the past, but had quit prior to PCI), quitters (smoked at time of PCI, but then quit), and persistent smokers. Health status was measured with the disease-specific Seattle Angina Questionnaire (SAQ) and the EuroQol 5 Dimensions (EQ-5D), adjusted for baseline characteristics. In unadjusted analyses, persistent smokers had worse disease-specific and overall health status as compared with other groups. In fully-adjusted analyses, persistent smokers showed significantly worse health-related quality of life as compared with never smokers. Importantly, of those who smoked at the time of PCI, quitters had significantly better adjusted SAQ angina frequency scores (mean difference=2.73; 95% CI, 0.13 to 5.33) and trends towards higher disease specific (SAQ quality of life mean difference=1.97; 95% CI, -1.24 to 5.18), and overall (EQ-5D VAS scores mean difference=2.45; 95% CI, -0.58 to 5.49) quality of life as compared with persistent smokers at 12 months. Conclusions While smokers at the time of PCI have worse health status at 1 year than those who never smoked, smokers who quit after PCI have less angina at 1 year than those who continue smoking.

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“…11–13 Briefly, from May 26, 2009 to October 21, 2011, consecutive patients undergoing PCI for all indications at 10 US hospitals were invited to participate in OPS/PRISM at the time of PCI. Baseline data were obtained through a combination of chart abstraction and a detailed interview performed by trained study coordinators at each site.…”

Section: Methodsmentioning

confidence: 99%

Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

Grodzinsky

Kosiborod

Tang

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background Prior studies suggest that among patients with stable coronary artery disease (CAD), patients with diabetes mellitus (DM) have less angina and more silent ischemia as compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients following elective percutaneous coronary intervention (PCI) has not been recently examined. Methods and Results In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range 0–100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age 65, 74.7% male), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM vs. not: 27.9% vs. 20.9% [p=0.01] and 32.8% vs. 25.5%, [p=0.01], respectively), while beta-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated measures model, the risk of angina was similar over the year following PCI in patients with vs. without DM (RR 1.04, 0.80–1.36). Conclusions Patients with stable CAD and DM exhibit a burden of angina that is at least as high as those without DM, despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina due to silent ischemia.

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Improving the process of informed consent for percutaneous coronary intervention: Patient Outcomes from the Patient Risk Information Services Manager (ePRISM) study

Cited by 45 publications

References 23 publications

Predicting long‐term bleeding after percutaneous coronary intervention

Predicting long‐term bleeding after percutaneous coronary intervention

Association of Smoking Status With Health-Related Outcomes After Percutaneous Coronary Intervention

Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus

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