Susan Fitzgerald

The American College of Cardiology-National Cardiovascular Data Registry™ (ACC-NCDR™): Building a National Clinical Data Repository

Diagnostic cardiac catheterization and percutaneous coronary interventions (PCIs) are critical components of the diagnosis and treatment of patients with coronary artery disease. As the prevalence of heart disease increases in our aging population and increasingly aggressive invasive approaches are

A Contemporary View of Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention in the United States: A Report From the CathPCI Registry of the National Cardiovascular Data Registry, 2010 Through June 2011

OBJECTIVES This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry. BACKGROUND The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratories in the United States. METHODS Data were summarized for 6 consecutive calendar quarters beginning January 1, 2010, and ending June 30, 2011. This report includes 1,110,150 patients undergoing only diagnostic cardiac catheterization and 941,248 undergoing percutaneous coronary intervention (PCI). RESULTS Some notable findings include, for example, that on-site cardiac surgery was not available in 83% of facilities performing fewer than 200 PCIs annually, with these facilities representing 32.6% of the facilities reporting, but performing only 12.4% of the PCIs in this data sample. Patients 65 years of age or older represented 38.7% of those undergoing PCI, with 12.3% being 80 years of age or older. Almost 80% of PCI patients were overweight (body mass index ≥25 kg/m(2)), 80% had dyslipidemia, and 27.6% were current or recent smokers. Among patients undergoing elective PCI, 52% underwent a stress study before the procedure, with stress myocardial perfusion being used most frequently. Calcium scores and coronary computed tomography angiography were used very infrequently (<3%) before diagnostic or PCI procedures. Radial artery access was used in 8.3% of diagnostic and 6.9% of PCI procedures. Primary PCI was performed with a median door-to-balloon time of 64.5 min for nontransfer patients and 121 min for transfer patients. In-hospital risk-adjusted mortality in ST-segment elevation myocardial infarction patients was 5.2% in this sample. CONCLUSIONS Data from the CathPCI Registry provide a contemporary view of the current practice of invasive cardiology in the United States.

An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry.

OBJECTIVES This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. BACKGROUND New knowledge about the importance of periprocedural bleeding combined with techniques to mitigate its occurrence and the inclusion of new data in the updated CathPCI Registry data collection forms encouraged us to develop a new bleeding definition and risk model to improve the monitoring and safety of PCI. METHODS Detailed clinical data from 1,043,759 PCI procedures at 1,142 centers from February 2008 through April 2011 participating in the CathPCI Registry were used to identify factors associated with major bleeding complications occurring within 72 h post-PCI. Risk models (full and simplified risk scores) were developed in 80% of the cohort and validated in the remaining 20%. Model discrimination and calibration were assessed in the overall population and among the following pre-specified patient subgroups: females, those older than 70 years of age, those with diabetes mellitus, those with ST-segment elevation myocardial infarction, and those who did not undergo in-hospital coronary artery bypass grafting. RESULTS Using the updated definition, the rate of bleeding was 5.8%. The full model included 31 variables, and the risk score had 10. The full model had similar discriminatory value across pre-specified subgroups and was well calibrated across the PCI risk spectrum. CONCLUSIONS The updated bleeding definition identifies important post-PCI bleeding events. Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.

Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry.

BACKGROUND The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES This report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers. METHODS The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared. RESULTS Comparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%. CONCLUSIONS The TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.

ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy A Report of the ACC/AHA Task Force on Performance Measures (Work Group to Address the Challenges of Performance Measurement and Reperfusion Therapy)

Frederick A. Masoudi, MD, MSPH, FACC, Chair; Elizabeth DeLong, PhD; N.A. Mark Estes III, MD, FACC, FAHA; David C. Goff, Jr, MD, PhD, FAHA, FACP; Kathleen Grady, PhD, RN, FAHA, FAAN; Lee A. Green, MD, MPH; Ann R. Loth, RN, MS, CNS; Eric D. Peterson, MD, MPH, FACC, FAHA; Martha J. Radford, MD, FACC,

ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy

This document is an official document of the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Performance Measures. The task force formed a work group to address the challenges of performance measurement and reperfusion therapy. Acute reperfusion therapy, either with fibrinolytic therapy or percutaneous coronary intervention (PCI), is one of the most important treatments for patients with ST-segment elevation myocardial infarction (STEMI). Randomized clinical trials have shown that reperfusion therapy provided to eligible patients reduces the risk of death due to all causes.1 The timeliness of reperfusion therapy is of central importance, because the benefits of therapy diminish rapidly with delays in treatment. Thus, ACC/AHA guidelines recommend that fibrinolysis be provided within 30 minutes of first medical system contact and that primary PCI be provided within 90 minutes of first medical system contact for patients presenting with STEMI.1 These …

COMPOSITE PERFORMANCE MEASURES FOR DISCHARGE MEDICATION PRESCRIBING FOR PATIENTS UNDERGOING PCI OR ICD IMPLANT PROCEDURES IN THE NATIONAL CARDIOVASCULAR DATA REGISTRY

The NCDR® ICD RegistryTM and CathPCI Registry® have identified important gaps in appropriate discharge medication prescribing for patients undergoing ICD and PCI procedures. American College of Cardiology Foundation recently submitted medication-prescribing measures from these registries to