Cath Lab Digest - October 2007 - (Page 51)

51 flow 0–2. Patients with prolonged fluoroscopy time had higher rates of in-hospital death (3.3% vs. 0.3%; p <0.0001), emergent CABG (2.1% vs. 0.3%; p = 0.0001), stent thrombosis (2.9% vs. 1.3%; p = 0.17), retroperitoneal hematoma (0.9% vs. 0.2%; p = 0.01), and contrast-induced nephropathy (6.7% vs. 4.5%; p = 0.03). Resource utilization was significantly higher (p <0.0001) in patients with prolonged fluoroscopy time. By multivariate analysis, prolonged fluoroscopy time was most strongly associated with prior CABG (OR = 2.39), ostial lesion (OR = 2.87), severe lesion calcification (OR = 2.14), baseline TIMI flow 0–2 (OR = 3.71) (all p <0.0001), lesion eccentricity (OR = 1.96; p = 0.0063), and peripheral arterial disease (OR = 1.91; p = 0.0068). Conclusions. Prolonged fluoroscopy time is associated with higher complexity of treated lesions and increased rates of periprocedural complications including early mortality, emergent CABG, contrastinduced nephropathy, and increased resource utilization. J INVAS CARDIOL 2007;19(5):208-213. door-to-balloon time (median 298 [IQR 395 to 180] minutes in the rPCI group vs. 131 [IQR 215 to 90] minutes in the PPCI group; p 5 times the ULN (7.3% versus 1.9%) was nonsignificantly lower in the group treated with bivalirudin. Conclusions. Bivalirudin-based therapy can be safely used in selected patients undergoing rotational atherectomy. Further studies are warranted to confirm our findings. J INVAS CARDIOL 2007;19(5):225-228. Validation of a Predictive Risk Score for Radiocontrast-Induced Nephropathy following Percutaneous Coronary Intervention Skelding KA, Best PJM, Bartholomew BA, et al. Objective. We sought to externally validate the William Beaumont Hospital (WBH) risk score for radiocontrast-induced nephropathy (RCIN) following percutaneous coronary intervention (PCI). Background. RCIN is associated with increased mortality and morbidity following PCI and accounts for increased hospital costs and length of stay. Methods. A total of 4,814 PCI procedures were used for validation of the WBH risk score, using a >1.0 mg/dl increase in serum creatinine (Cr) as the definition of RCIN. Clinical and procedural details were identified within the Mayo Clinic PCI registry. Multiple imputation was used to impute values where missing. Five imputation sets were created and averaged to compute the final estimate. Results. Follow-up Cr was available in 3,213 (67%) of procedures and RCIN occurred in 1.9% of cases. Baseline Cr clearance was missing in 13%. All other risk factors used to calculate the risk score were missing in ≤5% of the procedures. The risk score has the ability to discriminate well between patients at low and high risk of post-PCI RCIN; c-statistic = 0.86. In-hospital mortality occurred in 6.6% (4/61) with RCIN vs. 1.2% (37/3152) without RCIN. The odds ratio for in-hospital mortality is 5.3 (95% CI, 1.9, 15.0; p = 0.002) for those with RCIN vs. those without. Conclusions. The WBH risk score can identify patients at high and low risk of RCIN following PCI. Use of this risk score can identify patients at high risk of RCIN development and direct the use of preventative measures to the highest-risk Should Patients in Cardiogenic Shock Undergo Rescue Angioplasty after Failed Fibrinolysis? Comparison of Primary versus Rescue Angioplasty in Cardiogenic Shock Patients Kunadian B, Vijayalakshmi K, Dunning J, et al. Background. Trials of rescue angioplasty (rPCI) following failed fibrinolysis have excluded patients with cardiogenic shock and the benefit of rPCI in this setting is unknown. We compared the clinical, angiographic characteristics, 30-day and 1-year outcomes of cardiogenic shock patients undergoing rPCI with those undergoing primary percutaneous coronary intervention (PPCI). Methods. Of the 171 patients undergoing PCI for cardiogenic shock between 1994 and 2005 at our institution, the indication was for PPCI in 65 and rPCI in 59 patients. Clinical, procedural, 30-day and 1year mortality data were compared. Results. There were no differences between the cohorts with regard to clinical and pre-PCI angiographic variables, except that patients who underwent rPCI were more likely to be interhospital transfers (64% vs. 43%; p = 0.02) and had a longer Rescue angioplasty in the setting of cardiogenic shock was found be an independent predictor of mortality. unsuccessful. One-year mortality in patients >70 years old with cardiogenic shock undergoing rPCI was 100% (n = 15) and 70% (n = 14) with PPCI. Rescue angioplasty, anterior myocardial infarction, multivessel disease and postprocedure TIMI flow grade 75 years) may be a futile treatment. Efforts should be made to improve reperfusion and survival in these patients, possibly by either adopting PPCI for all patients presenting with ST-elevation acute myocardial infarction or, if this is not logistically possible, adopting PPCI for selected nary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy. Methods. We analyzed all patients undergoing rotational atherectomy at our institution from 2001 to 2004, and compared periprocedural outcome among those treated with a bivalirudin-based regimen compared to those treated with a heparinbased regimen. Results. A total of 253 patients were treated with rotational atherectomy during this period. Bivalirudin-based therapy was used in 56 patients, while the remainder were treated with a heparin-based approach. Patients treated with heparin were significantly more likely to be treated with GP IIb/IIIa inhibitors (91% vs 25%; p = 0.001). There was no difference in the two groups with respect to gender, diabetes, peripheral vascular disease or incidence of renal dysfunction. While there was no statistical difference in the incidence of any myonecrosis (32% versus 34%; p = 0.87), the incidence of creatine kinase-MB was greater than 3 times the upper limit of normal (ULN)

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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