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Background: There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described., Objective: We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG., Methods: We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated adult patients with OHCA were included if they presented between January 1, 2015 and December 31, 2019 and received CAG during hospitalization. Emergency medical services run sheets and hospital records were analyzed. Patients without evidence of STEMI were grouped and compared based on time from arrival to CAG performance into "early" (≤ 6 h) and "delayed" (> 6 h)., Results: Two hundred twenty-one patients were included. Median time to CAG was 18.6 h (interquartile range [IQR] 1.5-94.6 h). Early catheterization was performed on 94 patients (42.5%) and delayed catheterization was performed on 127 patients (57.5%). Patients in the early group were older (61 years [IQR 55-70 years] vs. 57 years [IQR 47-65] years) and more likely to be male (79.8% vs. 59.8%). Those in the early group were more likely to have clinically significant lesions (58.5% vs. 39.4%) and receive revascularization (41.5% vs. 19.7%). Patients were more likely to die in the early group (47.9% vs. 33.1%). Among survivors, there was no significant difference in neurologic recovery at discharge., Conclusions: OHCA patients without evidence of STEMI who received early CAG were older and more likely to be male. This group was more likely to have intervenable lesions and receive revascularization., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG., Methods: We conducted a multicenter retrospective cohort study among eight regional hospitals. Adult patients who experienced atraumatic OHCA with successful initial resuscitation and subsequent CAG between January 2015 and December 2019 were included. We collected data on prehospital documentation of potential ACS symptoms prior to OHCA as well as clinical factors readily available during postarrest care. The primary outcome in multivariable regression modeling was the presence of significant coronary lesions (defined as >50% stenosis of left main or >75% stenosis of other coronary arteries)., Results: Four-hundred patients were included. Median (interquartile range) age was 59 (51-69) years; 31% were female. At least one significant stenosis was found in 62%, of whom 71% received PCI. Clinical factors independently associated with a significant lesion included a history of myocardial infarction (adjusted odds ratio [aOR] = 6.5, [95% confidence interval {CI} = 1.3 to 32.4], p = 0.02), prearrest chest discomfort (aOR = 4.8 [95% CI = 2.1 to 11.8], p ≤ 0.001), ST-segment elevations (aOR = 3.2 [95% CI = 1.7 to 6.3], p < 0.001), and an initial shockable rhythm (aOR = 1.9 [95% CI = 1.0 to 3.4], p = 0.05)., Conclusions: Among survivors of OHCA receiving CAG, history of prearrest chest discomfort was significantly and independently associated with significant coronary artery lesions on postarrest CAG. This suggests that we may be able to use prearrest symptoms to better risk stratify patients following OHCA to decide who will benefit from invasive angiography., (© 2021 Society for Academic Emergency Medicine.)

Competing Interests: Funding Support and Author Disclosures This research was supported by the American College of Cardiology’s National Cardiovascular Data Registry. The National Cardiovascular Data Registry is an initiative of the American College of Cardiology Foundation. Dr Waldo has received unrelated investigator-initiated research support from Abiomed, Cardiovascular Systems Incorporated, Janssen, Merck Pharmaceuticals, National Institutes of Health, and Veterans Affairs Health Services Research and Development. Dr Yeh has received grants from AstraZeneca; has received consulting fees from Teleflex; and has served on advisory boards for Abbott, Boston Scientific, and Medtronic. Dr Fanaroff has received a career development grant and honoraria from the American Heart Association; and has received research funding from Boston Scientific. Dr Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Bristol Myers Squibb, Cryolife, Portola, and Regeneron; and has received consulting honoraria from AstraZeneca. Dr Giri has served on advisory boards for Boston Scientific, Inari Medical, and AstraZeneca; and has received research funds to the institution from Boston Scientific, Recor Medical, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Patients and other providers have access to few publicly available physician attributes that identify interventional cardiologists with better postprocedural outcomes, particularly in states without public reporting of outcomes. Interventional cardiology board certification, maintenance of certification, graduation from a US medical school, medical school ranking, and length of practice represent such publicly available attributes. Previous studies on these measures have shown mixed results., Methods and Results: We included interventional cardiologists practicing in New York State in the years 2011 to 2013. The primary outcome was 30-day risk-standardized mortality rate (RSMR) after percutaneous coronary intervention. Hierarchical regression modeling was used to analyze the physician attributes and was adjusted for provider caseload. A total of 356 providers were studied. The average 30-day RSMR was 1.1 (SD=0.1) deaths per 100 cases for all percutaneous coronary interventions and 0.7 (SD=0.1) deaths per 100 cases for nonemergent procedures. The primary outcome was slightly lower among providers with interventional cardiology board certification compared with noncertified providers (1.06 [SD=0.14] versus 1.14 [SD=0.14] deaths per 100 cases; P<0.001). In multivariable hierarchical regression modeling, after adjusting for provider caseload, none of the physician attributes were associated with the primary outcome. Provider caseload was significantly associated with 30-day RSMR independent of the other attributes., Conclusions: Interventional cardiology board-certified providers had a modestly lower 30-day RSMR before accounting for caseload. However, after adjusting for provider caseload, none of the examined publicly available physician attributes, including interventional cardiology board certification, were independently associated with 30-day RSMR.

Objectives: To develop a risk model that can be used to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge., Background: A high proportion of patients undergoing PCI are readmitted within 30 days of discharge., Methods: The sample comprised patients aged ≥65 years who underwent PCI at a CathPCI Registry®-participating hospital and could be linked with 100% Medicare fee-for-service claims between 01/2007 and 12/2009. The sample (n = 388,078) was randomly divided into risk score development (n = 193,899) and validation (n = 194,179) cohorts. We did not count as readmissions those associated with staged revascularization procedures. Multivariable logistic regression models using stepwise selection models were estimated to identify variables independently associated with all-cause 30-day readmission., Results: The mean 30-day readmission rates for the development (11.36%) and validation (11.35%) cohorts were similar. In total, 19 variables were significantly associated with risk of 30-day readmission (P < 0.05), and model c-statistics were similar in the development (0.67) and validation (0.66) cohorts. The simple risk score based on 14 variables identified patients at high and low risk of readmission. Patients with a score of ≥13 (15.4% of sample) had more than an 18.5% risk of readmission, while patients with a score ≤6 (41.9% of sample) had less than an 8% risk of readmission., Conclusion: Among PCI patients, risk of readmission can be estimated using clinical factors present at the time of the procedure. This risk score may guide clinical decision-making and resource allocation for PCI patients at the time of hospital discharge. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010., Methods and Results: We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups., Conclusions: We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification., (© 2015 American Heart Association, Inc.)

Supplemental Digital Content is available in the text. Background: Reported rates of acute kidney injury (AKI) after transcatheter aortic valve replacement in small observational studies vary widely. Methods: Patients who underwent transcatheter aortic valve replacement in the United States between January 1, 2016 and June 30, 2018, were included. Patients without reported baseline or peak creatinine values and those who were previously on hemodialysis were excluded. AKI was defined using AKI Network criteria from stages 0 to 3. Logistic regression was used to assess patient and clinical factors associated with incident in-hospital AKI. Among patients with available data from the Center for Medicare and Medicaid Services administrative files, we compared 1-year mortality among patients with and without AKI. Results: Of 107 814 study patients, 11 566 (10.7%) experienced postprocedural AKI. Among patients who developed AKI, 10 220 (9.5%) experienced stage 1 AKI, 134 (0.1%) stage 2 AKI, and 1212 (1.1%) stage 3 AKI. Race, baseline comorbidities, clinical presentation, and procedural factors were associated with the development of stage 3 AKI. In Center for Medicare and Medicaid Services–linked analyses of 62 757 (58.2%) patients, those with AKI had higher adjusted hazard ratio for mortality at 1 year compared with patients who did not experience AKI (stage 1 AKI: adjusted hazard ratio, 2.7 [95% CI, 2.5–2.8], P <0.001; stage 2 AKI: adjusted hazard ratio, 10.4 [95% CI, 7.0–15.4], P <0.001; stage 3 AKI: adjusted hazard ratio, 7.0 [95% CI, 6.0–8.2], P <0.001). Conclusions: Using data from the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry Transcatheter Valve Therapy Registry registry, we found that AKI is common after transcatheter aortic valve replacement, with over 10% of patients developing postprocedure AKI. Patients who developed stage 3 AKI had 7× higher adjusted 1-year mortality compared with patients who did not develop AKI. [ABSTRACT FROM AUTHOR]