Search

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on (a) varied clinical presentations; (b) appropriate personal protection equipment (PPE) for health care workers; (c) the roles of the emergency department, emergency medical system, and the cardiac catheterization laboratory (CCL); and (4) regional STEMI systems of care. During the COVID-19 pandemic, primary percutaneous coronary intervention (PCI) remains the standard of care for STEMI patients at PCI-capable hospitals when it can be provided in a timely manner, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI-capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option., (© 2020 Wiley Periodicals, Inc.)

Background: Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied., Methods and Results: Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year. AKI was defined using Acute Kidney Injury Network (AKIN) criteria. Adverse events included death, myocardial infarction, bleeding, and recurrent kidney injury. Using Cox methods, we determined the relationship between in-hospital AKI and risk of post-discharge adverse events by AKIN stage. In a cohort of 453 475 elderly patients undergoing PCI, 39 850 developed AKI (8.8% overall; AKIN stage 1, 85.8%; AKIN 2/3, 14.2%). Compared with no AKI, in-hospital AKI was associated with higher post-discharge hazard of death, myocardial infarction, or bleeding (AKIN 1: hazard ratio [HR], 1.53; confidence interval [CI], 1.49-1.56 and AKIN 2/3: HR, 2.13; CI, 2.01-2.26), recurrent AKI (AKIN 1: HR, 1.70; CI, 1.64-1.76; AKIN 2/3: HR, 2.22; CI, 2.04-2.41), and AKI requiring dialysis (AKIN 1: HR, 2.59; CI, 2.29-2.92; AKIN 2/3: HR, 4.73; CI, 3.73-5.99). For each outcome, the highest incidence was within 30 days., Conclusions: Post-PCI AKI is associated with increased risk of death, myocardial infarction, bleeding, and recurrent renal injury after discharge. Post-PCI AKI should be recognized as a significant risk factor not only for in-hospital adverse events but also after hospital discharge., (© 2017 American Heart Association, Inc.)

Objectives: A novel radiation dose reduction technology was evaluated in a cardiac catheterization laboratory during routine clinical care to determine if it could reduce radiation dose to patients undergoing coronary angiography and percutaneous coronary intervention. These results were compared to patients undergoing similar procedures in a cardiac catheterization laboratory without this technology., Background: There is a safety priority in clinical care to reduce X-ray radiation dose to patients in order to lower the risk of deterministic and stochastic effects. Dose reduction technologies must be verified in clinical settings to prove if they reduce X-ray radiation dose and to what extent., Methods: Radiation dose data and procedure characteristics of 268 consecutive patients were collected and analyzed from a cardiac catheterization laboratory with dose reduction technology installed (referred to as Lab A, n = 135) and from a cardiac catheterization laboratory without this technology (referred as Lab B, n = 133)., Results: For diagnostic procedures, the median total dose-area product in Lab A was reduced by 46% (P < 0.0001) compared to Lab B, with no differences in terms of body mass index (P = 0.180), total fluoroscopy times (P = 1), number of acquired images (P = 0.920), and contrast medium (P = 0.660). For interventional procedures, the median total dose-area product in Lab A was reduced by 34% (P = 0.015) compared to Lab B, with no differences in terms of body mass index (P = 0.665), total fluoroscopy times (P = 0.765), number of acquired images (P = 0.923), and contrast medium (P = 0.969)., Conclusions: This new dose reduction technology significantly reduces X-ray radiation dose without affecting fluoroscopy time, number of images, and contrast medium used during diagnostic and interventional coronary procedures., (© 2015, Wiley Periodicals, Inc.)

Background: In the SAFE-PCI for Women trial, patient preference for radial access for future procedures was greater than for femoral access. We sought to assess whether radial or femoral access impacts formal measures of quality-of-life (QOL) among women undergoing cardiac catheterization., Methods: We assessed QOL using European quality of life-5 dimensions (EQ-5D) and EQ visual analog scale (EQ-VAS) scores among 304 women randomized to radial or femoral arteriotomy in the SAFE-PCI for Women trial at sites with QOL substudy approval. Patient surveys were administered at baseline, hospital discharge, and 30 days (for percutaneous coronary intervention patients)., Results: Women randomized to both treatments had similar EQ-5D index and EQ-VAS scores at baseline, hospital discharge, and 30-day follow-up. After adjustment for baseline scores, there was no effect of assigned treatment on EQ-5D (discharge 0.004; 95% CI -0.03 to 0.04; 30 days -0.03; 95% CI -0.09 to 0.02) or EQ-VAS (discharge -1.31; 95% CI -4.74 to 2.12; 30 days -2.10; 95% CI -8.92 to 4.71) scores. At discharge, 60.5% versus 63.5% (P = .60) of patients in radial and femoral groups were free from access site pain; at 30 days, rates were 85.7% versus 77.6% (P = .30), respectively. Patient preference for the same access strategy for repeat procedures was greater in the radial versus femoral group (77.2% vs 26.8%; P < .0001)., Conclusions: Using established QOL instruments, we did not measure any difference in QOL or functional status according to access site strategy in women undergoing cardiac catheterization, yet patient preference for the radial approach was significantly greater. Other factors influencing patient choice for radial access should be investigated., (Published by Elsevier Inc.)

Objectives: We sought to investigate the radiation exposure and contrast utilization associated with using a strategy of transradial access and rotational angiography (radial-DARCA) compared to the traditional approach of transfemoral access and standard angiography (femoral-SA)., Background: There is an increased focus on optimizing patient safety during cardiac catheterization procedures. Professional guidelines have highlighted physician responsibility to minimize radiation doses and contrast volume. Dual axis rotational coronary angiography (DARCA) is the most recently investigated type of rotational angiography. This new technique permits complete visualization of the left or right coronary tree with a single injection, and is felt to reduce contrast and radiation exposure., Methods: A total of 56 consecutive patients who underwent radial-DARCA were identified. From the same time period, an age- and gender-matched group of 61 patients who had femoral-SA were selected for comparison. Total volume of contrast agent used, fluoroscopy time, and 2 measures of radiation dose (dose area product and air kerma) were recorded for each group., Results: Mean contrast agent use and patient radiation exposure of the radial-DARCA group were significantly less than that of the femoral-SA group. There was no significant difference in fluoroscopy time between the 2 groups., Conclusions: Physicians can successfully employ an innovative safety strategy of transradial access combined with DARCA that is feasible and is associated with lower radiation doses and contrast volume than femoral artery access and traditional coronary angiography approach., (© 2013, Wiley Periodicals, Inc.)

Objective: To determine the safety and efficacy of dual-axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA)., Background: Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well-documented limitations. Dual-axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement. This technological advancement obtains numerous unique images of the left or right coronary tree with a single coronary injection. We sought to assess the safety and efficacy of DARCA as well as determine DARCA's adequacy for CAD screening and assessment., Methods: Thirty patients underwent SA following by DARCA. Contrast volume, radiation dose (DAP) and procedural time were recorded for each method to assess safety. For DARCA acquisitions, blood pressure (BP), heart rate (HR), symptoms and any arrhythmias were recorded. All angiograms were reviewed for CAD screening adequacy by two independent invasive cardiologists., Results: Compared to SA, use of DARCA was associated with a 51% reduction in contrast, 35% less radiation exposure, and 18% shorter procedural time. Both independent reviewers noted DARCA to be at least equivalent to SA with respect to the ability to screen for CAD., Conclusion: DARCA represents a new angiographic technique which is equivalent in terms of image quality and is associated with less contrast use, radiation exposure, and procedural time than SA., (Copyright © 2011 Wiley-Liss, Inc.)

Introduction: Interventional cardiology, with large numbers of complex procedures and potentially serious complications, stands out as an obvious discipline in which to apply simulation to help prevent medical errors. The objective of the study was to determine whether it is feasible to develop a valid and reliable evaluation approach using medical simulation to assess technical and cognitive skills of physicians performing coronary interventions., Methods: Clinical case scenarios were developed by a committee of subject matter experts, who defined key decision nodes, such as stent positioning, and introduced unanticipated complications, such as coronary perforation. Subjects were 115 physicians from 10 U.S. healthcare institutions at three levels of expertise: novice, skilled, or expert. Subjects completed a questionnaire, one practice case and six test cases on a SimSuite simulator (Medical Simulation Corporation, Denver, CO), and an opinion survey. Clinical specialists rated subjects' procedural skills., Results: A technical and cognitive skills evaluation of performance in interventional cardiology procedures using medical simulation yielded results that distinguished between a novice group and skilled or expert groups (P<0.001) and scores correlated moderately with clinical specialist ratings of subjects' procedural skills and with number and complexity of procedures performed in practice during the previous year. Approximately 90% of subjects generally thought that the cases were well simulated and presented situations encountered in practice., Conclusions: This study suggests that an evaluation approach using high-fidelity medical simulation to assess technical and cognitive skills of physicians performing interventional cardiology procedures can be used to identify physicians who are extremely poor performers and not likely to be providing appropriate patient care. We believe that use of a high-fidelity simulator incorporating situations with multiple events, immediate feedback, and high sensory load would complement the results of traditional written examinations of medical knowledge to provide a more comprehensive assessment of physician ability in interventional cardiology.

Background: Although fixed view x-ray angiography remains the primary technique for anatomic imaging of coronary artery disease, the known shortcomings of 2D projection imaging may limit accurate 3D vessel and lesion definition and characterization. A recently developed method to create 3D images of the coronary arteries uses x-ray projection images acquired during a 180 degrees C-arm rotation and continuous contrast injection followed by ECG-gated iterative reconstruction. This method shows promise for providing high-quality 3D reconstructions of the coronary arteries with no user interaction but requires clinical evaluation., Methods and Results: The reconstruction strategy was evaluated by comparing the reconstructed 3D volumetric images with the 2D angiographic projection images from the same 23 patients to ascertain overall image quality, lesion visibility, and a comparison of 3D quantitative coronary analysis with 2D quantitative coronary analysis. The majority of the resulting 3D volume images were rated as having high image quality (66%) and provided the physician with additional clinical information such as complete visualization of bifurcations and unobtainable views of the coronary tree. True-positive lesion detection rates were high (90 to 100%), whereas false-positive detection rates were low (0 to 8.1%). Finally, 3D quantitative coronary analysis showed significant similarity with 2D quantitative coronary analysis in terms of lumen diameters and provided vessel segment length free from the errors of foreshortening., Conclusions: Fully automated reconstruction of rotational coronary x-ray angiograms is feasible, produces 3D volumetric images that overcome some of the limitations of standard 2D angiography, and is ready for further implementation and study in the clinical environment.

This article reviews the current technique of coronary angiography, focusing on the choice of arterial access site; navigation from the arterial access site to the ascending thoracic aorta; cannulation of the native coronary arteries in their normal, variant, and anomalous locations; and cannulation of saphenous vein and arterial graft conduits. The authors conclude that, although no didactic training can substitute for the hands-on apprenticeship obtained during general cardiology and interventional cardiology fellowships, the intellectual elements fundamental to coronary angiography outlined here will result in a more efficient, effective, and safe procedure for patients.

This article reviews the currently available contrast media used for imaging during coronary angiography and percutaneous intervention. Recent data regarding potential adverse effects of contrast media and strategies to minimize adverse events are discussed. In addition, the authors review the state of the art in automated contrast injection for coronary angiography, including protocols used for performance of rotational coronary angiography and digital subtraction imaging in the catheterization laboratory.

Current expert-recommended views for coronary angiography are based on heuristic experience and have not been scientifically studied. We sought to identify optimal viewing regions for first and second order vessel segments of the coronary arteries that provide optimal diagnostic value in terms of minimizing vessel foreshortening and overlap. Using orthogonal 2D images of the coronary tree, 3D models were created from which patient-specific optimal view maps (OVM) allowing quantitative assessment of vessel foreshortening and overlap were generated. Using a novel methodology that averages 3D-based optimal projection geometries, a universal OVM was created for each individual coronary vessel segment that minimized both vessel foreshortening and overlap. A universal OVM model for each coronary segment was generated based on data from 137 patients undergoing coronary angiography. We identified viewing regions for each vessel segment achieving a mean vessel foreshortening value of 5.8 +/- 3.9% for the left coronary artery (LCA) and 5.6 +/- 3.6% for the right coronary artery (RCA). The overall mean overlap values achieved were 8.7 +/- 7.9% for the LCA and 4.6 +/- 3.2% for the RCA. This scientifically-based OVM evaluation of coronary vessel segments provides the means to facilitate acquisitions during coronary angiography and interventions that minimize imaging inaccuracies related to foreshortening and overlap, improving the accuracy, efficiency, and safety of diagnostic and interventional coronary procedures.

Objective: To evaluate the clinical utility of images acquired from rotational coronary angiographic (RA) acquisitions compared to standard "fixed" coronary angiography (SA)., Background: RA is a novel angiographic modality that has been enabled by new gantry systems that allow calibrated automatic angiographic rotations and has been shown to reduce radiation and contrast exposure compared to SA. RA provides a dynamic multiple-angle perspective of the coronaries during a single contrast injection., Methods: The screening adequacy, lesion assessment, and a quantitative coronary analysis (QCA) of both SA and RA were compared by independent blinded review in 100 patients with coronary artery disease (CAD)., Results: SA and RA recognize a similar total number of lesions (P = 0.61). The qualitative assessment of lesion characteristics and severity between modalities was comparable and lead to similar clinical decisions. Visualization of several vessel segments (diagonal, distal RCA, postero-lateral branches and posterior-descending) was superior with RA when compared to SA (P < 0.05). A QCA comparison (MLD, MLA, LL, % DS) revealed no difference between SA and RA. The volume of contrast (23.5 +/- 3.1 mL vs. 39.4 +/- 4.1; P = 0.0001), total radiation exposure (27.1 +/- 4 vs. 32.1 +/- 3.8 Gycm(2); P = 0.002) and image acquisition time (54.3 +/- 36.8 vs. 77.67 +/- 49.64 sec; P = 0.003) all favored RA., Conclusion: Coronary lesion assessment, coronary screening adequacy, and QCA evaluations are comparable in SA and RA acquisition modalities in the diagnosis of CAD however RA decreases contrast volume, image acquisition time, and radiation exposure.

Acute left main coronary artery thrombosis is an uncommon, but important clinical entity. We report 6 consecutive cases of acute left main thrombosis that highlight the spectrum in clinical presentation of this entity, and the potential of an initial medical approach in managing a subset of these patients.

Objective: Evaluate the safety of prolonged coronary injections during a rotational acquisition covering 180 degrees., Background: Rotational angiography has been adapted to coronary angiography and shown to reduce radiation and contrast exposure. Three-dimensional (3D) reconstructions and other advanced applications require imaging over a 180 degrees -arc with a single but longer injection of larger contrast volumes., Methods: Thirty patients referred for angiography were enrolled. Blood pressure (BP), heart rate (HR), symptoms, and ectopy were recorded before-and-after injections., Results: Pre and post-injection HRs for the LCA/RCA were not statistically different (LCA-pre-injection 63+/-13 bpm vs. LCA-post-injection 62+/-11 bpm, P=0.54 and RCA-pre-injection 65+/-12 bpm vs. RCA-post-injection 65+/-10, P=0.88). Central aortic pressure values were not statistically different for the RCA injections (RCA-systolic-pre-injection 118+/-14 mm Hg vs. RCA-systolic-post-injection 112+/-25 mm Hg, P=0.15, and RCA diastolic-pre-injection 69+/-9 mm Hg vs. RCA-diastolic-post-injection 60+/-10 mm Hg, P=0.88) but were statistically significant for the LCA injections (LCA systolic-pre-injection 122+/-19 mm Hg vs. LCA-systolic-post-injection 116+/-17 mm Hg, P=0.0004, and LCA-diastolic-pre-injection 69+/-10 mm Hg vs. LCA-diastolic-post-injection 65+/-9 mm Hg, P=0.0007). There were no symptoms or electrical events documented during or immediately post-injection., Conclusion: This study demonstrates the feasibility and safety of longer coronary injections. There were no significant HR changes, clinically insignificant pressure changes, and no adverse reactions. Additional studies will be needed to assure its safety in a larger and clinically more varied patient population., (Copyright (c) 2007 Wiley-Liss, Inc.)

Being able to accurately choose an optimal view for stent positioning, non foreshortened length and to avoid side branches is imperative during therapeutic procedures. Traditional imaging limitations may include the selection of an incorrectly sized stent, inaccurate placement, and/or the need for additional stents. With the use of newer acquisition techniques and three-dimensional (3-D) modeling/reconstructions this can be minimized. We present a case in which with the assistance of 3-D and its computer derived optimal view, and optimal length, a significant amount of vessel foreshortening was eliminated therefore improving the procedural outcome.

A new method is introduce for the three-dimensional (3D) reconstruction of the coronary stents in-vivo utilizing two-dimensional projection images acquired during rotational angiography (RA). The method is based on the application of motion compensated techniques to the acquired angiograms resulting in a temporal snapshot of the stent within the cardiac cycle. For the first time results of 3D reconstructed coronary stents in vivo, with high spatial resolution are presented. The proposed method allows for a comprehensive and unique quantitative 3D assessment of stent expansion that rivals current x-ray and intravascular ultrasound techniques.

The goal of this study was to determine the severity of vessel foreshortening in standard angiographic views used during percutaneous coronary intervention (PCI). Coronary angiography is limited by its two-dimensional (2D) representation of three-dimensional (3D) structures. Vessel foreshortening in angiographic images may cause errors in the assessment of lesions or the selection and placement of stents. To date, no technique has existed to quantify these 2D limitations or the performance of physicians in selecting angiographic views. Stent deployment was performed in 156 vessel segments in 149 patients. Using 3D reconstruction models of each patient's coronary tree, vessel foreshortening was measured in the actual working view used for stent deployment. A computer-generated optimal view was then identified for each vessel segment and compared to the working view. Vessel foreshortening ranged from 0 to 50% in the 156 working views used for stent deployment and varied by coronary artery and by vessel segment within each artery. In general, views of the mid circumflex artery were the most foreshortened and views of the right coronary artery were the least foreshortened. Expert-recommended views frequently resulted in more foreshortening than computer-generated optimal views, which had only 0.5% +/- 1.2% foreshortening with < 2% overlap for the same 156 segments. Optimal views differed from the operator-selected working views by > or = 10 degrees in over 90% of vessels and frequently occurred in entirely different imaging quadrants. Vessel foreshortening occurs frequently in standard angiographic projections during stent deployment. If unrecognized by the operator, vessel foreshortening may result in suboptimal clinical results. Modifications to expert-recommended views using 3D reconstruction may improve visualization and the accuracy of stent deployment. These results highlight the limitations of 2D angiography and support the development of real-time 3D techniques to improve visualization during PCI., (Copyright 2005 Wiley-Liss, Inc.)

This study evaluates the safety and clinical utility of rotational angiography in the diagnosis of coronary artery disease. High-speed rotational angiography is a newly available angiographic modality that gives a dynamic multiple-angle perspective of the coronary tree during a single contrast injection. We prospectively randomized 56 patients referred for diagnostic coronary angiography to either standard or rotational angiography. Contrast and radiation utilization were compared between the two groups. The number of additional cine acquisitions needed was used to determine adequacy of the diagnostic study protocol. Rotational angiography was successfully completed in all subjects. There was a 33% reduction in contrast utilization in the rotational group as compared to the standard group (35.6 +/- 12.6 vs. 52.8 +/- 10.7 ml, respectively; P < 0.0001). Additionally, there was a 28% reduction in total radiation exposure in the rotational group as compared to the standard group (39.0 +/- 18.5 vs. 53.9 +/- 23.4 Gycm(2), respectively; P = 0.01). Total whole-body radiation exposure to the primary operator was 144 mrem with rotational angiography and 170 mrem with standard angiography. Procedure time tended to be shorter for rotational angiography (353.9 +/- 146.7 vs. 396.8 +/- 165.8 s; P = 0.3). Rotational coronary angiography can be rapidly performed in any patient and provides a significant reduction in contrast and radiation utilization while at the same time providing adequate angiographic data to complement or replace standard coronary angiography in the evaluation of coronary artery disease., (Copyright 2004 Wiley-Liss, Inc.)

Traditional angiography of the vasculature is limited by its 2-dimensional projection of complex 3-dimensional structures and the consequent imaging artifacts that interfere with visualization. During the last 10 years, technologies capable of minimizing the shortcomings of traditional angiography have been developed and are now in clinical use. Rotational angiography and 3-dimensional imaging are 2 of these powerful tools and, together, represent a major advance in the angiographic diagnosis and treatment of patients with coronary, cerebral, and peripheral vascular disease.

Traditional quantitative coronary angiography is performed on two-dimensional (2-D) projection views. These views are chosen by the angiographer to minimize vessel overlap and foreshortening. With 2-D projection views that are acquired in this nonstandardized fashion, however, there is no way to know or estimate how much error occurs in the QCA process. Furthermore, coronary arteries possess a curvilinear shape and undergo a cyclical deformation due to their attachment to the myocardium. Therefore, it is necessary to obtain three-dimensional (3-D) information to best describe and quantify the dynamic curvilinear nature of the human coronary artery. Using a patient-specific 3-D coronary reconstruction algorithm and routine angiographic images, a new technique is proposed to describe: 1) the curvilinear nature of 3-D coronary arteries and intracoronary devices; 2) the magnitude of the arterial deformation caused by intracoronary devices and due to heart motion; and 3) optimal view(s) with respect to the desired "pathway" for delivering intracoronary devices.

The objective of this study was to derive a method for quantifying the dynamic geometry of coronary arteries. Coronary artery geometry plays an important role in atherosclerosis. Coronary artery geometry also influences the performance of coronary interventions. Conversely, implantation of stents may alter coronary artery geometry. Clinical tools to define vessel shape have not been readily available. Using a Frenet-Serret curvature analysis applied to 3D reconstruction data derived from standard coronary angiograms, 21 coronary arteries were analyzed at end-diastole (ED) and end-systole (ES). Vessels were divided anatomically: type 1 consisted of vessels lying in the AV groove (left circumflex, right coronary) and type 2 consisted of vessels overlying actively contracting myocardium (left anterior descending, diagonal, obtuse marginal, right ventricular marginal, posterior descending, posterolateral). Vessel segments were analyzed by assessing the changes in curvature, torsion, and discrete flexion points (FPs), areas of systolic bending in the arterial contour. The curvature from ED to ES of type 1 vessels was unchanged (-0.02 +/- 0.03 cm(-1)), while the curvature change of type 2 vessels showed a 38% increase (0.33 +/- 0.04 cm(-1); P < 0.001). Type 1 vessels had fewer FPs per vessel than type 2 vessels (0.38 +/- 0.18 and 2.40 +/- 0.23 FP/vessel, respectively; P < 0.001). FPs were more common in distal segments and branch vessels. A method to quantify cyclic changes in coronary artery shape was applied to 3D data sets derived from standard coronary angiograms. Coronary arteries undergo a cyclic change in shape resulting in changes in overall curvature as well as formation of discrete flexion points. These changes in vessel shape are asymmetrically distributed in coronary arteries., (Copyright 2002 Wiley-Liss, Inc.)

The article focuses on cohort analysis performed to understand the association between bleeding and percutaneous coronary intervention (PCI) and subsequent association with increased morbidity and health care costs. Post procedural bleeding is associated with nonfatal myocardial infraction, blood transfusion and stroke. The study was conducted on CathPCI registry performed in the U.S. between 2004 - 2011. The results obtained showed that in-hospitality mortality rate increased with increase in number of post procedural bleeding events in PCI-registered patients.

Cardiovascular disease is a leading cause of death and disability in the United States. National programs, such as the National Cardiovascular Data Registry, facilitate assessments of the quality of care and outcomes for broad populations of patients with cardiovascular disease. This report provides data for 2014 from 4 National Cardiovascular Data Registry hospital quality programs: 1) CathPCI (Diagnostic Catheterization and Percutaneous Coronary Intervention) for coronary angiography and percutaneous coronary intervention (667,424 procedures performed in 1,612 hospitals); 2) ICD Registry for implantable cardioverter-defibrillators (158,649 procedures performed in 1,715 hospitals); 3) ACTION–GWTG (Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines) for acute coronary syndromes (182,903 patients admitted to 907 hospitals); and 4) IMPACT (Improving Pediatric and Adult Congenital Treatment) for cardiac catheterization and intervention for pediatric and adult congenital heart disease (20,169 procedures in 76 hospitals). The report provides perspectives on the demographic and clinical characteristics of enrolled patients, characteristics of participating centers, and selected measures of processes and outcomes of care in these programs. [ABSTRACT FROM AUTHOR]