Praneet Sharma

Association of Smoking Status With Health-Related Outcomes After Percutaneous Coronary Intervention

Background—Patients who smoke at the time of percutaneous coronary intervention (PCI) would ideally have a strong incentive to quit, but most do not. We sought to compare the health status outcomes of those who did and did not quit smoking after PCI with those who were not smoking before PCI. Methods and Results—A cohort of 2765 PCI patients from 10 US centers were categorized into never, past (smoked in the past but had quit before PCI), quitters (smoked at time of PCI but then quit), and persistent smokers. Health status was measured with the disease-specific Seattle Angina Questionnaire and the EuroQol 5 dimensions, adjusted for baseline characteristics. In unadjusted analyses, persistent smokers had worse disease-specific and overall health status when compared with other groups. In fully adjusted analyses, persistent smokers showed significantly worse health-related quality of life when compared with never smokers. Importantly, of those who smoked at the time of PCI, quitters had significantly better adjusted Seattle Angina Questionnaire angina frequency scores (mean difference, 2.73; 95% confidence interval, 0.13–5.33) and trends toward higher disease specific (Seattle Angina Questionnaire quality of life mean difference, 1.97; 95% confidence interval, −1.24 to 5.18), and overall (EuroQol 5 dimension visual analog scale scores mean difference, 2.45; 95% confidence interval, −0.58 to 5.49) quality of life when compared with persistent smokers at 12 months. Conclusions—Smokers at the time of PCI have worse health status at 1 year than those who never smoked, whereas smokers who quit after PCI have less angina at 1 year than those who continue smoking.

Bleeding risk following percutaneous coronary intervention in patients with diabetes prescribed dual anti-platelet therapy

BACKGROUND Patients with diabetes mellitus (DM) experience higher rates of in-stent restenosis and greater benefit from drug-eluting stents implant at the time of percutaneous coronary intervention (PCI), necessitating prolonged dual anti-platelet therapy (DAPT). While DAPT reduces risk of ischemic events post-PCI, it also increases risk of bleeding. Whether bleeding rates differ among patients with and without DM, receiving long-term DAPT is unknown. METHODS Among patients who underwent PCI and were maintained on DAPT for 1 year in a multicenter US registry, we assessed patient-reported bleeding over one year following PCI in patients with and without DM. Multivariable, hierarchical Poisson regression was used to evaluate the association of DM with bleeding during follow-up. RESULTS Among 2334 PCI patients from 10 US hospitals (mean age 64, 54% ACS), 32.6% had DM. In unadjusted analyses, patients with DM had fewer bleeding events over the year following PCI (DM vs no DM: BARC = 1: 78.0% vs 87.7%, P < .001; BARC ≥2: 4.3% vs 5.3%, P = .33). Following adjustment, patients with (vs without DM) had a lower risk of BARC ≥1 bleeding during follow-up (relative risk [RR] 0.89, 95% CI 0.83-0.96). This decreased bleeding risk persisted after removing bruising from the endpoint definition. CONCLUSIONS In a real-world PCI registry, patients with DM experienced lower risk of bleeding risk on DAPT. As patients with DM also derive greater ischemic benefit from drug-eluting stents, which requires prolonged DAPT, our findings suggest that the balance between benefit and risk of this therapeutic approach may be even more favorable in patients with DM than previously considered.

Predicting long-term bleeding after percutaneous coronary intervention

To construct a model to predict long‐term bleeding events following percutaneous coronary intervention (PCI).

Multivessel Versus Culprit Vessel–Only Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction: Insights From the TRANSLATE‐ACS Observational Study

Background Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality‐of‐life outcomes compared with culprit‐only intervention. We sought to compare clinical and quality‐of‐life outcomes between multivessel and culprit‐only PCI. Methods and Results Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE‐ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability‐weighted propensity adjustment to study the associations between multivessel and culprit‐only intervention during the index PCI and major adverse cardiovascular events, unplanned all‐cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit‐only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non–ST‐segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit‐only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72–0.99), whereas long‐term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84–1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82–1.24). Similar associations were seen when patients with ST‐segment elevation MI and non–ST‐segment elevation MI were examined separately. Conclusions Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all‐cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short‐ and long‐term angina frequencies were noted.

ASSOCIATION OF SMOKING STATUS WITH HEALTH-RELATED OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION

Patients who smoke at the time of percutaneous coronary intervention (PCI) would ideally have a strong incentive to quit, but most do not. Showing how smoking cessation may be associated with the benefits of PCI, in terms of symptoms, function and quality of life, might provide a stronger incentive

OBESITY PARADOX AND ANGINA FREQUENCY IN PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION

An “obesity paradox” of better long-term survival is reported in obese patients after acute myocardial infarction (AMI). The association of obesity and angina burden after AMI is not known. We prospectively enrolled 6,838 AMI patients from 31 US sites and categorized them by BMI into normal

PROVIDER VARIABILITY AND CHARACTERISTICS ASSOCIATED WITH BIVALIRUDIN USE FOR BLEEDING AVOIDANCE IN PERCUTANEOUS CORONARY INTERVENTION AFTER IMPLEMENTATION OF A DECISION SUPPORT TOOL

0.58 (0.35, 0.95) PROVIDER VARIABILITY AND CHARACTERISTICS ASSOCIATED WITH BIVALIRUDIN USE FOR BLEEDING AVOIDANCE IN PERCUTANEOUS CORONARY INTERVENTION AFTER IMPLEMENTATION OF A DECISION SUPPORT TOOL Timothy Fendler, MD; Philip G. Jones, MS; Henry H. Ting, MD MBA; Faraz Kureshi, MD; Adam Salisbury, MD; Praneet Sharma, MD; Adnan K. Chhatriwalla, MD; John A. Spertus, MD MPH Saint Luke’s Mid America Heart Institute/UMKC, Kansas City, MO; Mayo Clinic College of Medicine, Rochester, MN