Prevalence of Ad Hoc PCI
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{{SK}} delayed PCI
{{SK}} delayed PCI
==Overview==
==Overview==
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Staged PCI or delayed PCI is referred to the performance of a [[percutaneous coronary intervention]] ([[PCI]]) at a later date separate from the performance of the diagnostic catheterization or the performance of an initial PCI. Ad hoc PCI is defined as performance of the PCI procedure
at the time of the
diagnostic catheterization
Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventions http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ
.
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'''
Staged PCI
'''
or
'''
delayed PCI
'''
is referred to the performance of a [[percutaneous coronary intervention]] ([[PCI]]) at a later date separate from the performance of the diagnostic catheterization or the performance of an initial PCI.
'''
Ad hoc PCI
'''
is defined as performance of the PCI procedure
immediately following
diagnostic catheterization
Ad Hoc Percutaneous Coronary Intervention: A Consensus Statement From the Society for Cardiovascular Angiography and Interventions http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CDkQFjAB&url=http%3A%2F%2Fwww.scai.org%2Fasset.axd%3Fid%3Dc985cb20-a31b-4e82-a688-2f82be854b21&ei=FD7KUMXwKKay0AHEp4CACg&usg=AFQjCNH2rTxEcgSgaigX_lYvSvML2u7E-A&bvm=bv.1355272958,d.dmQ
. '''Same day PCI''' is defined as removing the patient from the cardiac catheterization laboratory following the procedure, and then performing the PCI procedure later in the day. Databases usually do not allow a distinction between "Ad hoc PCI" and "Same day PCI". As a result there is no data regarding the prevalence or the impact of same day PCI
.
==Historical Perspective==
==Historical Perspective==
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==Advantages of Staged PCI==
==Advantages of Staged PCI==
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More detailed informed consent can be provided regarding the proposed revascularization procedure and the potential alternatives such as CABG. Patients who are at risk of [[contrast induced acute tubular necrosis]] (patients over age 65, patients with [[diabetes]], patients with [[impaired renal function]]), may benefit from a staged PCI procedure by minimizing the dye load required during two separate procedures.
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More detailed informed consent can be provided regarding the proposed revascularization procedure and the potential alternatives such as CABG. Patients who are at risk of [[contrast induced acute tubular necrosis]] (patients over age 65, patients with [[diabetes]], patients with [[impaired renal function]]), may benefit from a staged PCI procedure by minimizing the dye load required during two separate procedures.
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===Risk Factors for Contrast Induced Nephropathy===
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Three factors have been associated with an increased risk of contrast-induced nephropathy: ''pre-existing [[renal insufficiency]]'' (such as [[Creatinine clearance]]
{{cite journal | author=McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW | title=Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality | journal=Am J Med | year=1997 | pages=368-75 | volume=103 | issue=5 | id=PMID 9375704}}
{{cite journal | author=Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, Legako RD, Leon DF, Murray JA, Nissen SE, Pepine CJ, Watson RM, Ritchie JL, Gibbons RJ, Cheitlin MD, Gardner TJ, Garson A Jr, Russell RO Jr, Ryan TJ, Smith SC Jr | title=ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions | journal=J Am Coll Cardiol | year=1999 | pages=1756-824 | volume=33 | issue=6 | id=PMID 10334456}}
A '''[[clinical prediction rule]]''' is available to estimate probability of nephropathy (increase ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 h)
{{cite journal |author=Mehran R, Aymong ED, Nikolsky E, ''et al'' |title=A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation |journal=J. Am. Coll. Cardiol. |volume=44 |issue=7 |pages=1393–9 |year=2004 |pmid=15464318 |doi=10.1016/j.jacc.2004.06.068}}
based upon the following risk factors:
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* [[Systolic blood pressure]]
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* Intraarterial balloon pump - 5 points
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* [[Congestive heart failure]] (Class III-IV or history of pulmonary edema) - 5 points
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* Age >75 y - 4 points
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* [[Hematocrit]] level
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* [[Diabetes]] - 3 points
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* Contrast media volume - 1 point for each 100 mL
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* [[Renal insufficiency]]:
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** Serum creatinine level >1.5 g/dL - 4 points ''OR''
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** Estimated [[Glomerular filtration rate]] ([http://www.intmed.mcw.edu/clincalc/creatinine.html online calculator])
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::* 2 for 40–60 mL/min/1.73 m2
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::* 4 for 20–40 mL/min/1.73 m2
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::* 6 for
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====Scoring:====
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'''5 or less points'''
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*Risk of CIN - 7.5
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*Risk of Dialysis - 0.04%
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'''6–10 points'''
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*Risk of CIN - 14.0
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*Risk of Dialysis - 0.12%
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'''11–16 points'''
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*Risk of CIN - 26.1*
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*Risk of Dialysis - 1.09%
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'''>16 points'''
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*Risk of CIN - 57.3
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*Risk of Dialysis - 12.8%
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==Disadvantages of Staged PCI==
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The disadvantages of staged PCI include the following:
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#The patient must be instrumented twice with the attendant risk of bleeding and trauma to the vessel.
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#The patient must return to the hospital for the procedure on a separate occasion which is inconvenient.
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# A payor must pay for a separate procedure.
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== Efficacy and Safety of Staged PCI==
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There are no randomized trials of staged versus ad hoc PCI and only registry data is available for comparison. it should be noted that registry data does not adjust for unidentified confounders. There are seven registry is that compare ad hoc and staged PCI and there are no differences in the angiographic success rates either in the era of conventional balloon angioplasty
O’Keefe JH, Reeder GS, Miller GA, Bailey KR, Holmes DR. Safety and efficacy of percutaneous transluminal coronary angioplasty performed at time of diagnostic catheterization compared with that performed at other times. Am J Cardiol 1989;63:27–29.
O’Keefe JH, Gernon C, McCallister BD, Ligon RW, Hartzler GO. Safety and cost effectiveness of ad hoc coronary angiography and angioplasty. Am Heart J 1991;122:50–54.
Lund GK, Nienaber CA, Hamm CW, Terres W, Kuck KH. One session diagnostic heart catheterization and balloon dilatation (‘‘prima-vista’’-PTCA): Results and risks. Dtsch Med Wochenschr 1994;119:169–174.
Rozenman Y, Gilon D, Zelingher J, Lotan C, Mosseri M, Geist M, Weiss AT, Hasin Y, Gotsman MS. One-stage coronary angiography and angioplasty. Am J Cardiol 1995;75:30–33.
Kimmel SE, Berlin JE, Hennessy S, Strom BL, Krone RJ, Laskey WK. Risk of major complications from coronary angioplasty performed immediately after diagnostic coronary angiography: Results from the Registry of the Society for Cardiac Angiography
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and Interventions. J Am Coll Cardiol 1997;30:193–200.
Le Feuvre C, Helft G, Beygui F, Zerah T, Fonseca E, Catuli D, Batisse JP, Metzger JP. Safety, efficacy, and cost advantages of combined coronary angiography and angioplasty. J Interv Cardiol 2003;16:195–199.
Panchamukhi V, Flaker GC. Should interventional cardiac catheterization procedures take place at the time of diagnostic procedures? Clin Cardiol 2000;23:332–334.
or in the era of stenting
Shubrooks SJ, Malenka DJ, Piper WD, Bradley WA, Watkins MW, Ryan TJ, Hettleman BD, VerLee PN, O’Meara JR, Robb JF, Kellett MA, Hearne MA, McGrath PD, Wennberg DE, O’Rourke DJ, Silver TM. Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern New England and comparison with will Isimilar procedures performed later. Am J Cardiol 2000;86:41–45.
Goldstein CL, Racz M, Hannan EL. Impact of cardiac catheterization-percutaneous coronary intervention timing on in-hospital mortality. Am Heart J 2002;144:561–567.
Feldman DN, Minutello RM, Gade CL, Wong SC. Outcomes following immediate (ad hoc) versus staged percutaneous coronary interventions (Report from the 2000 to 2001 New York State Angioplasty Registry). Am J Cardiol 2007;99:446–449.
Krone RJ, Shaw RE, Klein LW, Blankenship JC, Weintraub WS; American College of Cardiology. Ad hoc percutaneous coronary interventions in patients with stable coronary artery
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disease—a study of prevalence, safety, and variation in use from the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR). Catheter Cardiovasc Interv 2006;68:696–703.
Hannan EL, Samadashvili Z, Walford G, Holmes DR, Jacobs A, Sharma S, Katz S, King SB. Predictors and outcomes of ad hoc versus non-ad hoc percutaneous coronary interventions. JACC Cardiovasc Interv 2009;2:350–356.
Good CW, Blankenship JC, Scott TD, Skelding KA, Berger PB, Wood GC. Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era. J Invasive Cardiol 2009;21:194–200.
In one registry experience, the rates of vascular complications were lower in the patients undergoing ad hoc PCI
Shubrooks SJ, Malenka DJ, Piper WD, Bradley WA, Watkins MW, Ryan TJ, Hettleman BD, VerLee PN, O’Meara JR, Robb JF, Kellett MA, Hearne MA, McGrath PD, Wennberg DE, O’Rourke DJ, Silver TM. Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern New England and comparison with will Isimilar procedures performed later. Am J Cardiol 2000;86:41–45.
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==Prevalence of Ad Hoc PCI==
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Ad hoc PCI is currently performed in approximately 60% to 80% of patients and the proportion of patients continues to increase.
Shubrooks SJ, Malenka DJ, Piper WD, Bradley WA, Watkins MW, Ryan TJ, Hettleman BD, VerLee PN, O’Meara JR, Robb JF, Kellett MA, Hearne MA, McGrath PD, Wennberg DE, O’Rourke DJ, Silver TM. Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern New England and comparison with will Isimilar procedures performed later. Am J Cardiol 2000;86:41–45.
Goldstein CL, Racz M, Hannan EL. Impact of cardiac catheterization-percutaneous coronary intervention timing on in-hospital mortality. Am Heart J 2002;144:561–567.
Feldman DN, Minutello RM, Gade CL, Wong SC. Outcomes following immediate (ad hoc) versus staged percutaneous coronary interventions (Report from the 2000 to 2001 New York State Angioplasty Registry). Am J Cardiol 2007;99:446–449.
Krone RJ, Shaw RE, Klein LW, Blankenship JC, Weintraub WS; American College of Cardiology. 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). Catheter Cardiovasc Interv 2006;68:696–703.
Hannan EL, Samadashvili Z, Walford G, Holmes DR, Jacobs A, Sharma S, Katz S, King SB. Predictors and outcomes of ad hoc versus non-ad hoc percutaneous coronary interventions. JACC Cardiovasc Interv 2009;2:350–356.
Good CW, Blankenship JC, Scott TD, Skelding KA, Berger PB, Wood GC. Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era. J Invasive Cardiol 2009;21:194–200.
==Guidelines Regarding Staged PCI==
==Guidelines Regarding Staged PCI==