| Autor: |
Bricker RS; University of Colorado School of Medicine Aurora CO., Glorioso TJ; Department of Medicine VA Eastern Colorado Health Care System Denver CO., Jawaid O; University of Colorado School of Medicine Aurora CO., Plomondon ME; Department of Medicine VA Eastern Colorado Health Care System Denver CO., Valle JA; University of Colorado School of Medicine Aurora CO.; Department of Medicine VA Eastern Colorado Health Care System Denver CO., Armstrong EJ; University of Colorado School of Medicine Aurora CO.; Department of Medicine VA Eastern Colorado Health Care System Denver CO., Waldo SW; University of Colorado School of Medicine Aurora CO.; Department of Medicine VA Eastern Colorado Health Care System Denver CO. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2019 Dec 17; Vol. 8 (24), pp. e014906. Date of Electronic Publication: 2019 Dec 07. |
| DOI: |
10.1161/JAHA.119.014906 |
| Abstrakt: |
Background Patients undergoing percutaneous coronary intervention (PCI) are older with greater medical comorbidities and anatomical complexity than ever before, resulting in an increased frequency of nonemergent high-risk PCI (HR-PCI). We thus sought to evaluate the temporal trends in performance of HR-PCI and utilization of mechanical circulatory support in the largest integrated healthcare system in the United States. Methods and Results A cohort of high-risk adult patients that underwent nonemergent PCI in the Veterans Affairs Healthcare System between January 2008 and June 2018 were identified by objective clinical, hemodynamic, and anatomic criteria. Temporal trends in the performance of HR-PCI, utilization of mechanical circulatory support, and site-level variation were assessed. Of 111 548 patients assessed during the study period, 554 met 3 high-risk criteria whereas 4414 met at least 2 criteria for HR-PCI. There was a significant linear increase in the proportion of interventions that met 3 ( P <0.001) or at least 2 ( P <0.001) high-risk criteria over time, with rates approaching 1.9% and 11.2% in the last full calendar year analyzed. A minority of patients who met all high-risk criteria received PCI with mechanical support (15.7%) without a significant increase over time ( P =0.193). However, there was significant site-level variation in the probability of performing HR-PCI (4.0-fold higher likelihood) and utilizing mechanical circulatory support (1.9-fold higher likelihood) between high and low utilization sites. Conclusions The proportion of cases categorized as HR-PCI has increased over time, with significant site-level variation in performance. The majority of HR-PCI cases did not utilize mechanical support, highlighting a discrepancy between current recommendations and clinical practice in an integrated healthcare system. |
| Databáze: |
MEDLINE |
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