Ad Hoc percutaneous coronary interventions in patients with stable coronary artery disease—A study of prevalence, safety, and variation in use from the American College of Cardiology National Cardiovascular Data Registry (ACC‐NCDR®)
- 25 October 2006
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 68 (5) , 696-703
- https://doi.org/10.1002/ccd.20910
Abstract
Objective: To utilize the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR®) to monitor the performance and safety of ad hoc PCIs. Background: The performance of ad hoc PCI remains controversial. Patients' preference, cost, and vascular access issues favor an ad hoc strategy. Adequate time for thoughtful decision-making, scheduling complexity, informed consent, and physician reimbursement favor PCI on a subsequent day. Methods: We analyzed results in 68,528 patients with stable angina entered in the ACC-NCDR from 2001–2003. Ad hoc PCI was evaluated in many clinical and nonclinical subgroups. A multivariable analysis was performed to determine whether ad hoc PCI had an independent relationship with complications or procedure success. Results: Overall, 60.6% of patients underwent ad hoc PCI. There was no difference in ad hoc PCI mortality, renal failure, or vascular complications from staged PCI. A lower percentage of patients at high vs. low risk and with vs. without renal failure underwent ad hoc PCIs (58.6% vs.63.0% and 50.7% vs. 60.9% respectively). There was wide variation in the performance of ad hoc PCIs according to payer (70.2–60.3%), hospital PCI volume (67–50.2%), hospital owner (89.7–59.6%), and geographic area (75.5–47.4%). Ad hoc PCI per se was not independently related to PCI success or complications. Conclusions: PCI success was related to patient/lesion related factors and not to the performance of ad hoc PCIs per se. Although ad hoc PCI can be performed in more patients than at present, this strategy will never be possible in all patients at all times.Keywords
This publication has 23 references indexed in Scilit:
- SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary interventionCatheterization and Cardiovascular Interventions, 2004
- ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary articleJournal of the American College of Cardiology, 2002
- Development of a risk adjustment mortality model using the American College of Cardiology–National Cardiovascular Data Registry (ACC–NCDR) experience: 1998–2000Journal of the American College of Cardiology, 2002
- The American College of Cardiology-National Cardiovascular Data Registry™ (ACC-NCDR™): building a national clinical data repositoryJournal of the American College of Cardiology, 2001
- Ad hoc coronary interventionCatheterization and Cardiovascular Interventions, 2000
- Thrombogenic Factors and Recurrent Coronary EventsCirculation, 1999
- One-stage coronary angiography and angioplastyThe American Journal of Cardiology, 1995
- Same-Day Angioplasty and Diagnostic Catheterization: Safe and Effective but Riskier in Unstable AnginaAngiology, 1991
- Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty).Circulation, 1988
- Coronary angioplasty at the time of initial cardiac catheterization: “Ad hoc” angioplasty possibilities and challengesCatheterization and Cardiovascular Diagnosis, 1986