Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome

Kini, Annapoorna; Lee, Paul C.; Mitre, Cristina A.; Kim, Michael C.; Kamran, Mazullah; Duffy, Mary E.; Marmur, Jonathan D.; Sharma, Sanjeev

doi:10.1016/j.amjmed.2003.09.021

Cited by 10 publications

(3 citation statements)

References 32 publications

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“…17 For the 1-year MI models, we used covariates based on clinical reasoning and previous studies. [18][19][20] Covariates included age, sex, race, ethnicity, diabetes mellitus, dyslipidemia, hypertension, renal failure, cerebrovascular disease, peripheral arterial disease, body weight, chronic obstructive pulmonary disorder, smoking, and previous MI. A robust estimator of the covariance matrix was used to account for clustering by site.…”

Section: Discussionmentioning

confidence: 99%

Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery

et al. 2014

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The US Department of Veterans Affairs (VA) has the largest integrated health care delivery system in the nation and serves a large number of veterans living in rural locations. In an effort to improve patients' access to cardiology services, the VA began offering PCI programs at facilities without on-site CT surgery in 2005, coupled with strict quality oversight. Specifically, it established a national clinical quality oversight program-the Clinical Assessment, Reporting, and Tracking (CART) Program-for all VA cath labs that collected real-time data on cath laboratory Background-The safety of percutaneous coronary intervention (PCI) at medical facilities without on-site cardiothoracic (CT) surgery has been established in clinical trials. However, the comparative effectiveness of this strategy in real-world practice, including impact on patient access and outcomes, is uncertain. The Veterans Affairs (VA) health care system has used this strategy, with strict quality oversight, since 2005, and can provide insight into this question. Methods and Results-Among 24 387 patients receiving PCI at VA facilities between October 2007 and September 2010, 6616 (27.1%) patients underwent PCI at facilities (n=18) without on-site CT surgery. Patient drive time (as a proxy for access), procedural complications, 1-year mortality, myocardial infarction, and rates of subsequent revascularization procedures were compared by facility. Results were stratified by procedural indication (ST-segment-elevation myocardial infarction versus non-ST-segment-elevation myocardial infarction/unstable angina versus elective) and PCI volume. With the inclusion of PCI facilities without on-site CT surgery, median drive time for patients treated at those facilities decreased by 90.8 minutes (P<0.001). Procedural need for emergent coronary artery bypass graft and mortality rates were low and similar between facilities. Adjusted 1-year mortality and myocardial infarction rates were similar between facilities (hazard ratio in PCI facilities without relative to those with on-site CT surgery, 1.02; 95% confidence interval, 0.87-1.2), and not modified by either PCI indication or PCI volume. Subsequent revascularization rates were higher at sites without on-site CT surgery facilities (hazard ratio, 1.21; 95% confidence interval, 1.03-1.42). Conclusions-This study suggests that providing PCI facilities without on-site CT surgery in an integrated health care system with quality oversight improves patient access without compromising procedural or 1-year outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery

et al. 2014

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“…ore than 13 million Americans have a history of coronary heart disease (CHD), myocardial infarction (MI), congestive heart failure (CHF), or angina. Determining which of these patients will have future major adverse coronary events (MACE) is difficult (Kini et al, 2003). The risk of future MACE is currently determined by a combination of tests and traditional risk factors (Pearson, 2002) that include measuring left ventricular function, assessing angiographic findings, examining for the presence of ischemia (Kulick & Rahimtoola, 1991;Naqvi et al, 1997), lipid levels, age, gender, race, smoking status, diabetes, and blood pressure.…”

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confidence: 99%

“…NOTE: CRP ¼ C-reactive protein; HPA ¼ hypothalamic-pituitary-adrenal; ICAM ¼ intracellular adhesion molecule; IL-1 ¼ interleukin 1; IL6 ¼ interleukin 6; MCP-1 ¼ monocyte chemoattractant protein 1; MMP ¼ matrix metalloproteinase; TNFa ¼ tumor necrosis factor alpha; VCAM ¼ vascular cell adhesion molecule. that activate peripheral macrophages to produce inflammatory proteins (Kini et al, 2003) and cortiosteroids that enhance expression of inflammatory protein receptors on endothelial cells (Mortensen, 2001), thereby increasing recruitment, adhesion, and migration of monocytes into the coronary arteries. Higher circulating levels of systemic inflammatory proteins also increase expression of adhesion molecules (ICAM, vascular cell adhesion molecule [VCAM], E-selectin, and P-selectin) and MCP-1.…”

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confidence: 99%

Inflammatory Protein Levels and Depression Screening After Coronary Stenting Predict Major Adverse Coronary Events

Frazier

Vaughn

Willerson

et al. 2009

Biological Research For Nursing

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Background Traditional risk factors cannot account for the majority of future major adverse coronary events (MACE) in patients diagnosed with heart disease. We examined levels of inflammatory proteins to be possible predictors of future MACE and physiological and psychological factors that initiate temporal increases in inflammatory protein levels. Methods Peripheral blood samples and depression data were collected 4 to 12 hr after elective coronary stent insertion in 490 patients. Depression screening was assessed by a single-question screening tool. Predictive modeling for future MACE was performed by using survival analysis, with time from the index event (placement of the stent) to future MACE as the dependent variable. Results Patients with high-sensitivity c-reactive protein (hsCRP) in the second and third quartiles were 3 and 2.5 times more likely to have a MACE than patients with hsCRP in the first quartile, respectively. As levels of vascular cell adhesion molecule and monocyte chemoattractant protein-1 increased, so did the risk of future MACE. Patients who screened positive for depression were approximately 2 times more likely to have a MACE within 24 months after stent placement than were patients who did not screen positive. Conclusions Our results suggest that hsCRP, vascular cell adhesion molecule, and monocyte chemoattractant protein-1 levels, measured after coronary stent insertion in patients with coronary heart disease, are prognostic of future MACE. Furthermore, positive depression screening is an independent predictor of future MACE.

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APACHE-II score and Killip class for patients with acute myocardial infarction

et al. 2010

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Prediction of outcome after percutaneous coronary intervention for the acute coronary syndrome

Cited by 10 publications

References 32 publications

Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery

Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery

Inflammatory Protein Levels and Depression Screening After Coronary Stenting Predict Major Adverse Coronary Events

APACHE-II score and Killip class for patients with acute myocardial infarction

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