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Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black (n=132, 34.1%) and white (n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline (p=0.09) or at follow-up (p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders (b = -6.6, p=0.05, 95% CI -13.2, -0.11). [ABSTRACT FROM AUTHOR]

The article investigates the effect of a decline in door-to-balloon (DTB) time in patients with ST-elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention in Michigan from 2003 to 2008. It assessed the yearly trend in DTB time for 8,771 patients as part of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. The DTB time declined each year from 113 to 76 minutes. In-hospital mortality however was unchanged, suggesting that the reduced DTB time did not provide the expected survival benefit.

Background: With continuing technical advances in percutaneous coronary interventions (PCI) for coronary artery disease (CAD), patients undergoing coronary artery bypass surgery (CABG) often have complex coronary anatomy that is not ideal for PCI. Because of the complex anatomy, these patients have a higher risk of early graft occlusion. The feasibility of PCI in the treatment of early graft occlusion is not well established. Methods: A retrospective chart review was performed of patients presenting with recurrent ischemia within three months post-CABG and at one-year follow-up. Results: Forty-six patients with 156 grafts were identified. Three presented with STEMI, 21 with NSTEMI, 21 with unstable angina, and one with congestive heart failure. Sixty-three grafts were occluded or stenosed (>70%). Twenty-seven grafts (43%) in 17 patients were not amenable to PCI. The other 34 grafts (54%) in 23 patients underwent successful PCI. PCI was performed upon native vessels and occluded grafts with equal frequency. Six patients had patent grafts. At one-year follow-up, six of 23 patients in the PCI group were readmitted with ischemia; five vessels (14%) in four patients had restenosed. There were no deaths. In the group with no PCI, 11 of 23 patients were readmitted with ischemia with one death. Conclusion: PCI for early post-CABG occlusion was safely performed in slightly more than half of target vessels. PCI was performed upon native vessels and occluded grafts with equal frequency. After initial PCI success, the clinical target vessel restenosis rate was 14% at one-year follow-up. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of bivalirudin based therapy among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease in a large multicenter registry. Background: The REPLACE II trial demonstrated the non-inferiority of a strategy of bivalirudin compared with heparin and glycoprotein (GP) IIbIIIa inhibition in patients undergoing PCI. There is a paucity of outcome data with bivalirudin use in the setting of real-world PCI practice. Methods: We evaluated the outcome of 11,719 patients who underwent elective PCI for stable coronary artery disease (CAD) from 2002 to 2004 in a large regional consortium, and who were treated with bivalirudin (n = 2051) or with heparin and GP IIbIIIa inhibitors (n = 9,668). The primary endpoints were transfusion and in-hospital major adverse cardiovascular events (MACE) defined as the composite of death, MI, stroke, and any coronary artery bypass grafting (CABG) or target lesion revascularization. Results: Compared with patients who received heparin plus GP IIbIIIa inhibitors, patients who received bivalirudin had a similar incidence of post-procedural MI, stroke, in-hospital death, MACE (2.88 vs. 2.48, P = 0.30), or transfusion (2.83% vs. 2.41%, P = 0.27). Patients at greater risk of bleeding were more likely to be treated with bivalirudin. After adjusting for the propensity to receive bivalirudin and for baseline co-morbidities, there was no difference in the odds of MACE or the need for transfusion between the two groups. Conclusion: Compared with heparin plus GP IIbIIIa inhibition, use of bivalirudin in patients undergoing PCI for stable CAD is associated with similar ischemic and bleeding complications. Given the ease of administration and lower cost, bivalirudin provides an attractive treatment option in this patient population. [ABSTRACT FROM AUTHOR]

Context: Quality of care of patients with acute myocardial infarction (AMI) has received intense attention. However, it is unknown if a structured initiative for improving care of patients with AMI can be effectively implemented at a wide variety of hospitals. Objective: To measure the effects of a quality improvement project on adherence to evidence-based therapies for patients with AMI. Design and Setting: The Guidelines Applied in Practice (GAP) quality improvement project, which consisted of baseline measurement, implementation of improvement strategies, and remeasurement, in 10 acute-care hospitals in southeast Michigan. Patients: A random sample of Medicare and non-Medicare patients at baseline (July 1998–June 1999; n = 735) and following intervention (September 1–December 15, 2000; n = 914) admitted at the 10 study centers for treatment of confirmed AMI. A random sample of Medicare patients at baseline (January–December 1998; n = 513) and at remeasurement (March–August 2001; n = 388) admitted to 11 hospitals that volunteered, but were not selected, served as a control group. Intervention: The GAP project consisted of a kickoff presentation; creation of customized, guideline-oriented tools designed to facilitate adherence to key quality indicators; identification and assignment of local physician and nurse opinion leaders; grand rounds site visits; and premeasurement and postmeasurement of quality indicators. Main Outcome Measures: Differences in adherence to quality indicators (use of aspirin, β-blockers, and angiotensin-converting enzyme [ACE] inhibitors at discharge; time to reperfusion; smoking cessation and diet counseling; and cholesterol assessment and treatment) in ideal patients, compared between baseline and postintervention samples and among Medicare patients in GAP hospitals and the control group. Results: Increases in adherence to key treatments were seen in the administration of aspirin (81% vs 87%; P =... [ABSTRACT FROM AUTHOR]

Outcome data regarding postoperative acute coronary syndrome treated with percutaneous coronary intervention (PCI) are limited. The objective of this study was to determine clinical outcomes of patients undergoing PCI within 7 days after a surgical procedure. We assessed outcomes of 517 patients who underwent PCI within 7 days after a surgery across 44 hospitals from January 2010 to December 2011 from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry. Patients with postoperative PCI were compared with all other patients with PCI using propensity-matched analysis. Of the 65,175 patients who underwent PCI within the study period, 517 patients had undergone surgery within the previous 7 days. In unadjusted analysis, patients with postsurgical PCI had higher in-hospital mortality (6.96% vs 1.33%), stroke (0.96% vs 0.26%), bleeding events (6.96% vs 2.6%), heart failure (6.96% vs 2.36%), and cardiogenic shock (7.16% vs 1.95%). After propensity matching, mortality remained higher in postsurgical patients (6.5% vs 3.96%, odds ratio 1.7 [1.1 to 2.6], p = 0.02). The odds of mortality were especially high among patients who would otherwise be considered low risk (<1% of predicted mortality in a nonsurgical setting) in whom a recent surgery was strongly associated with death (odds ratio 5.7, p = 0.02). In conclusion, PCI performed within 7 days after a surgical procedure is associated with an increased risk of early mortality. Although some of this increased risk is related to an adverse clinical profile, higher mortality is also observed in patients otherwise considered low risk for PCI. [ABSTRACT FROM AUTHOR]