title: Relation of Activated Clotting Times During Percutaneous Coronary Intervention to Outcomes.
abstract: Monitoring anticoagulation using the activated clotting time (ACT) in patients treated with heparin and undergoing percutaneous coronary intervention (PCI) is one of the most frequently used tests in invasive cardiology. However, despite its widespread use and guideline endorsement, uncertainty remains regarding the association of ACT with outcomes in contemporary practice. We reviewed all PCI procedures performed at the Mayo Clinic (Rochester, Minnesota) from October 2001 to December 2012 and evaluated the association between the ACT before device activation and in-hospital and 1-year outcomes. ACT values were grouped into tertiles for descriptive purposes and analyzed as a continuous variable for assessment of outcomes. We used logistic and Cox proportional hazards regression models to estimate the association of ACT and outcomes. Of the 12,055 patients who underwent PCI with an ACT value before device activation, 3,977 (33.0%) had an ACT <227, 4,046 (33.6%) had an ACT 227 to 285, and 4,032 (33.4%) had an ACT >285. Baseline and procedural characteristics were similar across ACT tertiles. In unadjusted analysis, higher ACT values were associated with death (p <0.001), bleeding (p = 0.024), procedural complication (p <0.001), and higher 1-year events (cardiac death, p <0.001; cardiac death/myocardial infarction, p = 0.022). After multivariable adjustment for baseline and procedural characteristics, ACT was not independently associated with in-hospital or 1-year ischemic, thrombotic, or bleeding outcomes. In conclusion, ACT values before device activation are not independently associated with clinically important outcomes in contemporary PCI practice.
authors.affiliation: Division of Cardiology, Department of Medicine, University of South Dakota, Sanford Cardiovascular Institute, Sioux Falls, South Dakota.
authors.forename: Naveen
authors.initials: N
authors.lastname: Rajpurohit
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Santrach
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Donato
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Karon
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Mayo Clinic Health System, La Crosse, Wisconsin.
authors.forename: Freddy
authors.initials: F
authors.lastname: Del-Carpio
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Mayo Clinic Health System, La Crosse, Wisconsin.
authors.forename: Tahir
authors.initials: T
authors.lastname: Tak
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Mayo Clinic Health System, Mankato, Minnesota.
authors.forename: Arashk
authors.initials: A
authors.lastname: Motiei
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Medicine, Mayo Clinic Health System, La Crosse, Wisconsin. Electronic address: gharacholou.shahyar@mayo.edu.
authors.forename: Shahyar Michael
authors.initials: SM
authors.lastname: Gharacholou
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009203:Myocardial Infarction / Q000097:blood / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control; D014914:Whole Blood Coagulation Time / Q000379:methods
chemical_list: D010975:Platelet Aggregation Inhibitors