Kumar L. Ravi

In‐hospital outcomes of contemporary percutaneous coronary interventions in the very elderly

Coronary heart disease is the leading cause of death among the elderly (> 65 years) and the very elderly (> 85 years). Little information is available regarding the outcome of very elderly patients referred for PCI in the current era of improved techniques, devices, and pharmacotherapy. The objective of the current study was to evaluate the clinical characteristics and outcomes of very elderly patients ≥ 85 years of age in a large, contemporary, multi‐institutional PCI database. Five hospitals in the New York City metropolitan area contributed these prospectively defined data elements on consecutive patients undergoing PCI from 1 January 1998 to 1 October 1999. Of 10,847 patients, 5,341 (49%) were younger than 65 years, 3,342 (31%) were 65–74 years, 1,885 (17%) were 75–84 years, and 279 (2.6%) were at least 85 years of age. Following PCI, the very elderly developed stroke (P < 0.001) and renal failure requiring dialysis (P = 0.002) more commonly than younger patients following PCI. The very elderly had a significantly increased in‐hospital mortality rate at 2.5% (P < 0.001). However, on multivariate analysis, age ≥ 85 years was not an independent predictor of in‐hospital mortality (OR = 1.22; 95% CI = 0.37–4.07). The very elderly should not be refused PCI on the basis of advanced age alone. Cathet Cardiovasc Intervent 2003;58:351–357.

Outpatient coronary stenting: femoral approach with vascular sealing.

Miniaturized devices and pressures for increased patient convenience and lowered cost have shortened length of stay for coronary interventions.A cohort of 60 patients was recruited to assess the feasibility of outpatient stenting with vascular sealing. Patients with stable and unstable angina or myocardial infarction > 24 hours were considered for this strategy.Mean time to hemostasis, ambulation and discharge were 6.1, 256 and 296 minutes, respectively, for the 6F group, and 11.0, 351 and 489 minutes for the 7 to 8F group. No acute procedural complications occurred, and there were no ischemic complications at 24 hours or 1 month. There was 1 pseudoaneurysm requiring surgical correction, but no other access site requiring treatment. The cost saved using the 6F approach is estimated at

A Propensity Analysis of the Impact of Platelet Glycoprotein IIb/IIIa Inhibitor Therapy on In-Hospital Outcomes After Percutaneous Coronary Intervention

478 and using the 8F approach,

A randomized trial of stenting with or without balloon predilation for the treatment of coronary artery disease

437.Outpatient stenting using vascular sealing is feasible and safe, and may lead to significant nationwide cost reductions in the range of

Effect of diabetes mellitus on long-term survival following contemporary percutaneous coronary intervention

40,000,000 yearly.ZusammenfassungDie zunehmende Miniaturisierung der interventionellen Geräte und der steigende Patientenwunsch nach komfortablen äußeren Umständen sowie die reduzierte Kostenerstattung haben die Dauer des stationären Aufenthaltes nach Koronarinterventionen verkürzt.Wir haben bei 60 Patienten die Durchführbarkeit und Sicherheit der ambulanten PTCA mit Stentimplantation unter Verwendung arterieller Verschlußsysteme untersucht. Eingeschlossen wurden Patienten mit stabiler und instabiler Angina pectoris sowie Zustand nach Myokardinfarkt (> 24 Stunden).Die mittlere Hämostasezeit, Mobilisationszeit und Entlassungszeit waren 6,1,256 und 296 Minuten in der Gruppe mit 6F-Schleusen und 11,351 und 498 Minuten in der mit 7F–8F-Schleusen. Akute Komplikationen während der Koronarintervention traten nicht auf. Nach 24 Stunden und einem Monat wurden keine ischämischen Komplikationen beobachtet. Bei einem Patienten trat ein Pseudoaneurysma auf, welches eine operative Korrektur erforderlich machte, ansonsten war keine spezielle Behandlung der arteriellen Punktionsstelle erforderlich. Die Kostenersparnis bei 6F betrug im Durchschnitt US-

Impact of chronic renal insufficiency on long-term survival following percutaneous coronary intervention

478, bei 8F US-

Effect of creatine kinase elevation following percutaneous coronary intervention on long-term mortality

437.Die ambulante PTCA mit Stentimplantation unter Verwendung eines arteriellen Verschlußsystems ist durchführbar und sicher. Dieses Vorgehen könnte in den USA jährlich Kosten von 40 Mio US-

Gender-based differences in long-term outcome following percutaneous coronary intervention

einsparen.

Effect of treatment with platetet glycoprotein IIb/IIIa inhibitors on in-hospital outcomes of patients treated with primary angioplasty for acute myocardial infarction

It is unknown whether the benefits of parenteral platelet glycoprotein (GP) IIb/IIIa inhibitors as an adjunct to percutaneous coronary intervention (PCI) demonstrated in randomized clinical trials extend to patients treated outside the setting of clinical trials. A contemporary registry of 10,847 consecutive PCI procedures was analyzed to determine the effect of GP IIb/IIIa inhibitor treatment on in-hospital major adverse coronary events ([MACEs] composite of death, urgent coronary artery bypass surgery, periprocedural myocardial infarction, abrupt closure, and stent thrombosis). In this registry, GP IIb/IIIa inhibitors were administered to 20.1% of patients. These patients were younger, more often men, and less often hypertensive than untreated patients. GP IIb/IIIa inhibitor-treated patients were more likely to present with acute myocardial infarction or unstable angina. Stents were placed in 79% of patients treated with GP IIb/IIIa inhibitors. MACEs occurred in 7.8% of GP IIb/IIIa inhibitor-treated patients compared with 3.8% of untreated patients (p <0.001). After multivariable adjustment for the propensity of GP IIb/IIIa inhibitor treatment as well as other possible confounders and interactions known to influence MACEs, GP IIb/IIIa inhibitor treatment was associated with a 57% increase in the risk of a MACE (odds ratio 1.57, 95% confidence interval 1.22 to 2.03; p = 0.0004). In a data set consisting of patients with a high degree of acuity predominantly treated with stent placement, GP IIb/IIIa inhibitor treatment is associated with an increase in thrombotic complications of PCI.