Predictors and outcomes of ad hoc versus non-ad hoc percutaneous coronary interventions.
OBJECTIVE
Our aim was to compare longer-term outcomes for ad hoc percutaneous coronary intervention (PCI) and non-ad hoc PCI.


BACKGROUND
Ad hoc PCIs, whereby PCI is performed immediately after cardiac catheterization, has become the most common way of performing PCI. However, no studies have compared longer-term outcomes for ad hoc and non-ad hoc PCIs.


METHODS
A total of 46,565 New York State patients who underwent PCI in nonfederal New York State hospitals between January 1, 2003 and June 30, 2005 were followed through December 31, 2005, and in-hospital and longer-term outcomes were compared for ad hoc and non-ad hoc PCI patients after adjusting for differences in pre-procedural risk factors.


RESULTS
There was no difference in risk-adjusted in-hospital mortality (adjusted ad hoc/non-ad hoc odds ratio: 0.82, 95% confidence interval [CI]: 0.55 to 1.22). Ad hoc PCI patients had significantly lower 36-month mortality (adjusted hazard ratio [HR]: 0.76, 95% CI: 0.69 to 0.85, p < 0.0001). Ad hoc PCI patients had significantly higher 36-month subsequent revascularization (adjusted HR: 1.11, 95% CI: 1.01 to 1.21, p = 0.03), but after excluding subsequent PCIs that occurred within 30 days of the index PCI in another vessel, the difference was no longer significant (adjusted HR: 1.03, 95% CI: 0.95 to 1.12, p = 0.43).


CONCLUSIONS
On average, lower-risk patients undergo ad hoc PCI, and after risk-adjustment for differences in patient mix, ad hoc PCI patients have lower 3-year mortality rates.
Hannan
Edward L
EL
School of Public Health, University at Albany, State University of New York, Albany, New York 12144, USA. elh03@health.state.ny.us
Samadashvili
Zaza
Z
Walford
Gary
G
Holmes
David R
DR
Jacobs
Alice
A
Sharma
Samin
S
Katz
Stanley
S
King
Spencer B
SB
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome