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1.
JACC Cardiovasc Interv ; 13(7): 846-856, 2020 04 13.
Article in English | MEDLINE | ID: mdl-32273096

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate institutional variability in high radiation doses during percutaneous coronary intervention (PCI). BACKGROUND: It is unknown whether radiation safety practices are optimally applied across institutions performing PCI. METHODS: Using data from a large statewide registry, PCI discharges between July 1, 2016, and March 31, 2018, with a procedural air kerma (AK) recorded were analyzed. PCI procedures were grouped by the performing hospital, and institutional frequency of procedural AK ≥5 Gy was calculated. Fitted hierarchical Bayesian modeling was performed to identify variables independently associated with an AK ≥5 Gy. The performing hospital was included as a random effect in the hierarchical model. RESULTS: Among 36,201 PCI procedures at 28 hospitals, procedural AK was ≥5 Gy in 1,477 cases (4.1%), ≥10 Gy in 185 (0.5%), and ≥15 Gy in 105 (0.3%). The institutional frequency of procedural AK ≥5 Gy ranged from 0.0% to 10.9%. Bayesian modeling identified body mass index, dyslipidemia, diabetes, prior coronary bypass surgery, use of mechanical circulatory support, and the performing hospital as independent predictors of an AK ≥5 Gy. The median odds ratio for the performing hospital, representing an estimate of the contribution of interhospital variability in determining the odds of having a procedural AK ≥5 Gy, was 3.08 (95% confidence interval: 3.01 to 3.16). CONCLUSIONS: Wide variability exists in the institutional frequency of procedural AK ≥5 Gy during PCI. After accounting for patient characteristics and procedural variables, the performing hospital appears to be a major factor in determining patient radiation dose in contemporary PCI.


Subject(s)
Healthcare Disparities/trends , Percutaneous Coronary Intervention/trends , Radiation Dosage , Radiation Exposure , Radiography, Interventional/trends , Aged , Female , Humans , Male , Michigan , Middle Aged , Quality Indicators, Health Care/trends , Registries , Retrospective Studies
2.
Tex Heart Inst J ; 47(4): 319-321, 2020 08 01.
Article in English | MEDLINE | ID: mdl-33472228

ABSTRACT

The radial artery approach for coronary angiography and intervention is rapidly replacing the femoral artery approach, largely because it reduces bleeding and vascular access site complications. However, complications associated with transradial access warrant attention, notably radial artery occlusion. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST (calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers.


Subject(s)
Amputation, Surgical/methods , Arterial Occlusive Diseases/surgery , CREST Syndrome/complications , Finger Phalanges/surgery , Animals , Arterial Occlusive Diseases/complications , Arterial Occlusive Diseases/diagnosis , Female , Finger Phalanges/blood supply , Humans , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Radial Artery
3.
Am J Cardiol ; 113(4): 626-30, 2014 Feb 15.
Article in English | MEDLINE | ID: mdl-24355309

ABSTRACT

Several factors contribute to the risk of percutaneous coronary intervention-related major entry site (MES) complications. We sought to examine the trends in MES among unselected patients during the stent era. Data from the Dynamic Registry including 5 distinct recruitment waves from 1997 to 2006 (n = 10,932) were used to assess baseline characteristics and MES among consecutive patients undergoing percutaneous coronary intervention. MES was defined as bleeding requiring transfusion, pseudoaneurysm, arterial thrombosis or dissection, vascular complication requiring surgery, or retroperitoneal bleed. Uncomplicated hematomas were not included. Several trends were observed in baseline characteristics including an increase from wave 1 to wave 5 in body mass index >30 kg/m(2) (30.2% to 40.4%), renal disease (3.5% to 9.1%), diabetes (28.0% to 34.1%), and hypertension (59.4% to 78%; ptrend <0.001 for all). The use of a thienopyridine increased significantly from wave 1 (49.7%) to wave 5 (84%), whereas glycoprotein IIb/IIIa inhibitor use peaked in wave 3 (53.1%) and then decreased (p <0.001). Access site was predominately femoral, but radial access increased over time (0.3% wave 1, 6.6% wave 5, p ≤0.0001). The rates of MES (2.8% to 2.2%, ptrend = 0.01) and MES requiring transfusion (2.0% to 0.74%, ptrend <0.001) were low and decreased with time. The trend in less risk for MES in later time periods remained after adjustment. In conclusion, MES has decreased over time; however, opportunity for bleeding avoidance strategies still exists.


Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Coronary Aneurysm/etiology , Hemorrhage/etiology , Myocardial Infarction/surgery , Thrombosis/etiology , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Registries
5.
Am J Kidney Dis ; 60(5): 821-2, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22950974

ABSTRACT

Alport syndrome is an inherited disorder of type IV collagen most commonly leading to glomerulonephritis and kidney failure. Various extrarenal manifestations have been reported, including a spectrum of aortic and aortic valve diseases. We report a case of a 34-year-old man with Alport syndrome presenting with chest pain. Work-up showed a dilated aortic root, bicuspid aortic valve, aortic insufficiency, and small ascending aortic dissection necessitating surgical repair. We provide a review of the literature describing aortic pathology in Alport syndrome and suggest that clinicians caring for patients with Alport syndrome have a high index of suspicion for such entities in patients presenting with symptoms of chest pain.


Subject(s)
Aortic Diseases/complications , Aortic Valve Insufficiency/complications , Aortic Valve/abnormalities , Nephritis, Hereditary/complications , Adult , Humans , Male
7.
Catheter Cardiovasc Interv ; 79(1): 84-9, 2012 Jan 01.
Article in English | MEDLINE | ID: mdl-21413133

ABSTRACT

OBJECTIVES: We sought to examine the determinants and outcomes of direct stenting (DS) compared to predilation with drug-eluting stents (DES). BACKGROUND: Limited data suggest that DS with DES is feasible and may reduce restenosis compared to predilation. Whether DS improves clinical outcomes in unselected patients treated with DES is unknown. METHODS: DEScover is a prospective, multicenter, observational study of percutaneous coronary intervention that enrolled patients in 2005. The analysis cohort included 4,210 patients who received a DES and had a single lesion treated with DS (n = 1,651) or predilation (n = 2,559) at the discretion of the operator. Multivariable analysis was performed for 1-year outcomes. RESULTS: DS was performed in 39.2% of patients. The direct stent patients were younger, less often male, and had a lesser extent of CAD. DS was performed less often in patients presenting with an acute myocardial infarction (MI) and more often in stable angina and elective procedures. Lesion characteristics differed with DS performed less often for calcified lesions, high-grade stenoses (>90%), and bifurcation lesions. Lesion postdilation was less common in direct stent patients (42.1% vs. 50.7%, P = 0.0001). Complete procedural success was similar (99.8% vs. predilation 99.7%, P = 0.46). At 1 year, there was no difference in the adjusted hazard ratios of death (0.67, 0.44-1.04, P = 0.08), MI (1.05, 0.66-1.67, P = 0.83), stent thrombosis (0.38, 0.13-1.14, P = 0.08), TLR (0.75, 0.48-1.17, P = 0.21), TVR (0.89, 0.64-1.23, P = 0.47), and major adverse coronary event (0.88, 0.71-1.09, P = 0.24). CONCLUSIONS: DS with DES is commonly performed in clinical practice and results in similar long-term outcomes as predilation.


Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coronary Stenosis/therapy , Drug-Eluting Stents , Aged , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Chi-Square Distribution , Coronary Stenosis/mortality , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Proportional Hazards Models , Prospective Studies , Prosthesis Design , Registries , Risk Assessment , Risk Factors , Severity of Illness Index , Thrombosis/etiology , Time Factors , Treatment Outcome , United States
8.
Open J Cardiovasc Surg ; 5: 1-4, 2012.
Article in English | MEDLINE | ID: mdl-26949339

ABSTRACT

We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.

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