Trends, Outcomes, and Predictive Score For Emergency Coronary Artery Bypass Graft Surgery After Elective Percutaneous Coronary Intervention (from a Nationwide Dataset)

Autor: Samir B. Pancholy, Tejas Patel, Dhara Patel, Mamas A. Mamas, Neil Patel, Anshul A. Verma, Purveshkumar Patel, Stuti M. Pandya, Gaurav Patel, Sanjay C. Shah
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Coronary Artery Disease
030204 cardiovascular system & hematology
Logistic regression
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Postoperative Complications
Risk Factors
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Hospital Mortality
Coronary Artery Bypass
Intraoperative Complications
Vascular Calcification
Aorta
Aged
Emergency coronary artery bypass graft
Framingham Risk Score
business.industry
Incidence (epidemiology)
Percutaneous coronary intervention
Middle Aged
Vascular System Injuries
Triage
Coronary Vessels
Surgery
Aortic Dissection
surgical procedures
operative
Logistic Models
Elective Surgical Procedures
Cohort
Conventional PCI
Female
Emergencies
Cardiology and Cardiovascular Medicine
business
Zdroj: The American journal of cardiology. 144
ISSN: 1879-1913
Popis: The temporal trends and preprocedural predictors of emergency coronary artery bypass graft surgery (ECABG) after elective percutaneous coronary intervention (PCI) in the contemporary era are largely unknown. From January 2003 to December 2014 elective hospitalizations with PCI as the primary procedure were extracted from the Nationwide Inpatient Sample. ECABG was identified as CABG within 24 hours of elective PCI. Temporal trends of elective PCI, ECABG, comorbidities, and in-hospital mortality were analyzed. Logistic regression model was used to identify preprocedural independent predictors of ECABG and post-PCI ECABG risk score was developed using the regression coefficients from the logistic regression model in the development cohort. The score was then validated in the validation cohort. Of 1,605,641 elective PCI procedures included in the final analysis, 5,561 (0.3%) patients underwent ECABG. The incidence of ECABG, co-morbidities and overall in-hospital mortality increased over the study period, whereas the in-hospital mortality after ECABG remained unchanged. An increasing trend of elective PCI performed at facilities without on-site CABG was noted, with a higher unadjusted in-hospital mortality in this cohort. ECABG risk score, performed well with a significantly higher risk of ECABG in those patients with a score in the highest tertile compared with those with lower ECABG score (0.6% vs 0.3%, p = 0.0005). In conclusion, an increasing trend of adverse outcomes after elective PCI is observed. We describe an easy-to-use predictive score using preprocedural variables that may allow the operator to triage the patient to an appropriate setting in an effort to improve outcomes.
Databáze: OpenAIRE
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