TY - JOUR
T1 - Predictors and Outcomes of Ad Hoc Versus Non-Ad Hoc Percutaneous Coronary Interventions
AU - Hannan, Edward L.
AU - Samadashvili, Zaza
AU - Walford, Gary
AU - Holmes, David R.
AU - Jacobs, Alice
AU - Sharma, Samin
AU - Katz, Stanley
AU - King, Spencer B.
N1 - Funding Information:
Dr. Sharma received a research grant from Boston Scientific, Inc. and was on the Speakers' Bureaus for Boston Scientific, Inc., Abbott Vascular, and Lilly. Dr. Katz was an expert witness for MMIC and was on the advisory boards for GE, Boston Scientific, and Medtronic. Dr. King received royalties from Cordis, was on the advisory board for Medtronic, and was a consultant for Abbott. William O'Neill, MD, served as Guest Editor for this paper.
PY - 2009/4
Y1 - 2009/4
N2 - Objectives: Our aim was to compare longer-term outcomes for ad hoc percutaneous coronary intervention (PCI) and non-ad hoc PCI. Background: Ad hoc PCIs, whereby PCI is performed immediately after cardiac catheterization, has become the most common way of performing PCI. However, no studies have compared longer-term outcomes for ad hoc and non-ad hoc PCIs. Methods: A total of 46,565 New York State patients who underwent PCI in nonfederal New York State hospitals between January 1, 2003 and June 30, 2005 were followed through December 31, 2005, and in-hospital and longer-term outcomes were compared for ad hoc and non-ad hoc PCI patients after adjusting for differences in pre-procedural risk factors. Results: There was no difference in risk-adjusted in-hospital mortality (adjusted ad hoc/non-ad hoc odds ratio: 0.82, 95% confidence interval [CI]: 0.55 to 1.22). Ad hoc PCI patients had significantly lower 36-month mortality (adjusted hazard ratio [HR]: 0.76, 95% CI: 0.69 to 0.85, p < 0.0001). Ad hoc PCI patients had significantly higher 36-month subsequent revascularization (adjusted HR: 1.11, 95% CI: 1.01 to 1.21, p = 0.03), but after excluding subsequent PCIs that occurred within 30 days of the index PCI in another vessel, the difference was no longer significant (adjusted HR: 1.03, 95% CI: 0.95 to 1.12, p = 0.43). Conclusions: On average, lower-risk patients undergo ad hoc PCI, and after risk-adjustment for differences in patient mix, ad hoc PCI patients have lower 3-year mortality rates.
AB - Objectives: Our aim was to compare longer-term outcomes for ad hoc percutaneous coronary intervention (PCI) and non-ad hoc PCI. Background: Ad hoc PCIs, whereby PCI is performed immediately after cardiac catheterization, has become the most common way of performing PCI. However, no studies have compared longer-term outcomes for ad hoc and non-ad hoc PCIs. Methods: A total of 46,565 New York State patients who underwent PCI in nonfederal New York State hospitals between January 1, 2003 and June 30, 2005 were followed through December 31, 2005, and in-hospital and longer-term outcomes were compared for ad hoc and non-ad hoc PCI patients after adjusting for differences in pre-procedural risk factors. Results: There was no difference in risk-adjusted in-hospital mortality (adjusted ad hoc/non-ad hoc odds ratio: 0.82, 95% confidence interval [CI]: 0.55 to 1.22). Ad hoc PCI patients had significantly lower 36-month mortality (adjusted hazard ratio [HR]: 0.76, 95% CI: 0.69 to 0.85, p < 0.0001). Ad hoc PCI patients had significantly higher 36-month subsequent revascularization (adjusted HR: 1.11, 95% CI: 1.01 to 1.21, p = 0.03), but after excluding subsequent PCIs that occurred within 30 days of the index PCI in another vessel, the difference was no longer significant (adjusted HR: 1.03, 95% CI: 0.95 to 1.12, p = 0.43). Conclusions: On average, lower-risk patients undergo ad hoc PCI, and after risk-adjustment for differences in patient mix, ad hoc PCI patients have lower 3-year mortality rates.
KW - ad hoc PCI
KW - in-hospital mortality
KW - long-term mortality
KW - non-ad hoc PCI
KW - subsequent revascularization
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U2 - 10.1016/j.jcin.2009.01.006
DO - 10.1016/j.jcin.2009.01.006
M3 - Article
C2 - 19463449
AN - SCOPUS:64749084645
SN - 1936-8798
VL - 2
SP - 350
EP - 356
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 4
ER -