Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern new england and comparison with similar procedures performed later.
"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immediately after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of an ad hoc strategy in a large regional population to determine its use and outcomes compared with staged procedures. A database from the 6 centers performing PCIs in northern New England and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 PCIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patients having ad hoc procedures were less likely to have peripheral vascular disease, renal failure, prior myocardial infarction, or coronary artery bypass surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitroglycerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein grafts. Adjusted rates of clinical success were not different between ad hoc and non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the incidence of death (0.6% vs 0.5%), emergency (0. 9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infarction (2.6% vs 2.0%). As currently practiced in our region, ad hoc intervention is used selectively with outcomes similar for ad hoc and non-ad hoc procedures.
Shubrooks
S J
SJ
Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. sshubroo@caregroup.harvard.edu
Malenka
D J
DJ
Piper
W D
WD
Bradley
W A
WA
Watkins
M W
MW
Ryan
T J
TJ
Hettleman
B D
BD
VerLee
P N
PN
O'Meara
J R
JR
Robb
J F
JF
Kellett
M A
MA
Hearne
M A
MA
McGrath
P D
PD
Wennberg
D E
DE
O'Rourke
D J
DJ
Silver
T M
TM
D000787:Angina Pectoris / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000592:standards* / Q000706:statistics & numerical data; D017225:Atherectomy, Coronary / Q000592:standards* / Q000706:statistics & numerical data; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery; D009511:New England / Q000453:epidemiology; D012307:Risk Factors; D012449:Safety; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome