Relation of activated clotting times during percutaneous coronary intervention to outcomes

Naveen Rajpurohit, Rajiv Gulati, Ryan J. Lennon, Mandeep Singh, Charanjit Rihal, Paula J. Santrach, Leslie J. Donato, Brad S. Karon, Freddy Del-Carpio, Tahir Tak, Arashk Motiei, Renato D. Lopes, Shahyar Gharacholou

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Monitoring anticoagulation using the activated clotting time (ACT) in patients treated with heparin and undergoing percutaneous coronary intervention (PCI) is one of the most frequently used tests in invasive cardiology. However, despite its widespread use and guideline endorsement, uncertainty remains regarding the association of ACT with outcomes in contemporary practice. We reviewed all PCI procedures performed at the Mayo Clinic (Rochester, Minnesota) from October 2001 to December 2012 and evaluated the association between the ACT before device activation and in-hospital and 1-year outcomes. ACT values were grouped into tertiles for descriptive purposes and analyzed as a continuous variable for assessment of outcomes. We used logistic and Cox proportional hazards regression models to estimate the association of ACT and outcomes. Of the 12,055 patients who underwent PCI with an ACT value before device activation, 3,977 (33.0%) had an ACT <227, 4,046 (33.6%) had an ACT 227 to 285, and 4,032 (33.4%) had an ACT >285. Baseline and procedural characteristics were similar across ACT tertiles. In unadjusted analysis, higher ACT values were associated with death (p <0.001), bleeding (p = 0.024), procedural complication (p <0.001), and higher 1-year events (cardiac death, p <0.001; cardiac death/myocardial infarction, p = 0.022). After multivariable adjustment for baseline and procedural characteristics, ACT was not independently associated with in-hospital or 1-year ischemic, thrombotic, or bleeding outcomes. In conclusion, ACT values before device activation are not independently associated with clinically important outcomes in contemporary PCI practice.

Original languageEnglish (US)
Pages (from-to)703-708
Number of pages6
JournalAmerican Journal of Cardiology
Volume117
Issue number5
DOIs
StatePublished - Mar 1 2016

Fingerprint

Percutaneous Coronary Intervention
Equipment and Supplies
Hemorrhage
Cardiology
Proportional Hazards Models
Uncertainty
Heparin
Myocardial Infarction
Outcome Assessment (Health Care)
Guidelines

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Relation of activated clotting times during percutaneous coronary intervention to outcomes. / Rajpurohit, Naveen; Gulati, Rajiv; Lennon, Ryan J.; Singh, Mandeep; Rihal, Charanjit; Santrach, Paula J.; Donato, Leslie J.; Karon, Brad S.; Del-Carpio, Freddy; Tak, Tahir; Motiei, Arashk; Lopes, Renato D.; Gharacholou, Shahyar.

In: American Journal of Cardiology, Vol. 117, No. 5, 01.03.2016, p. 703-708.

Research output: Contribution to journalArticle

Rajpurohit, N, Gulati, R, Lennon, RJ, Singh, M, Rihal, C, Santrach, PJ, Donato, LJ, Karon, BS, Del-Carpio, F, Tak, T, Motiei, A, Lopes, RD & Gharacholou, S 2016, 'Relation of activated clotting times during percutaneous coronary intervention to outcomes', American Journal of Cardiology, vol. 117, no. 5, pp. 703-708. https://doi.org/10.1016/j.amjcard.2015.12.003
Rajpurohit, Naveen ; Gulati, Rajiv ; Lennon, Ryan J. ; Singh, Mandeep ; Rihal, Charanjit ; Santrach, Paula J. ; Donato, Leslie J. ; Karon, Brad S. ; Del-Carpio, Freddy ; Tak, Tahir ; Motiei, Arashk ; Lopes, Renato D. ; Gharacholou, Shahyar. / Relation of activated clotting times during percutaneous coronary intervention to outcomes. In: American Journal of Cardiology. 2016 ; Vol. 117, No. 5. pp. 703-708.
@article{4302d200c57e4c55ade76abb681fd2c6,
title = "Relation of activated clotting times during percutaneous coronary intervention to outcomes",
abstract = "Monitoring anticoagulation using the activated clotting time (ACT) in patients treated with heparin and undergoing percutaneous coronary intervention (PCI) is one of the most frequently used tests in invasive cardiology. However, despite its widespread use and guideline endorsement, uncertainty remains regarding the association of ACT with outcomes in contemporary practice. We reviewed all PCI procedures performed at the Mayo Clinic (Rochester, Minnesota) from October 2001 to December 2012 and evaluated the association between the ACT before device activation and in-hospital and 1-year outcomes. ACT values were grouped into tertiles for descriptive purposes and analyzed as a continuous variable for assessment of outcomes. We used logistic and Cox proportional hazards regression models to estimate the association of ACT and outcomes. Of the 12,055 patients who underwent PCI with an ACT value before device activation, 3,977 (33.0{\%}) had an ACT <227, 4,046 (33.6{\%}) had an ACT 227 to 285, and 4,032 (33.4{\%}) had an ACT >285. Baseline and procedural characteristics were similar across ACT tertiles. In unadjusted analysis, higher ACT values were associated with death (p <0.001), bleeding (p = 0.024), procedural complication (p <0.001), and higher 1-year events (cardiac death, p <0.001; cardiac death/myocardial infarction, p = 0.022). After multivariable adjustment for baseline and procedural characteristics, ACT was not independently associated with in-hospital or 1-year ischemic, thrombotic, or bleeding outcomes. In conclusion, ACT values before device activation are not independently associated with clinically important outcomes in contemporary PCI practice.",
author = "Naveen Rajpurohit and Rajiv Gulati and Lennon, {Ryan J.} and Mandeep Singh and Charanjit Rihal and Santrach, {Paula J.} and Donato, {Leslie J.} and Karon, {Brad S.} and Freddy Del-Carpio and Tahir Tak and Arashk Motiei and Lopes, {Renato D.} and Shahyar Gharacholou",
year = "2016",
month = "3",
day = "1",
doi = "10.1016/j.amjcard.2015.12.003",
language = "English (US)",
volume = "117",
pages = "703--708",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Relation of activated clotting times during percutaneous coronary intervention to outcomes

AU - Rajpurohit, Naveen

AU - Gulati, Rajiv

AU - Lennon, Ryan J.

AU - Singh, Mandeep

AU - Rihal, Charanjit

AU - Santrach, Paula J.

AU - Donato, Leslie J.

AU - Karon, Brad S.

AU - Del-Carpio, Freddy

AU - Tak, Tahir

AU - Motiei, Arashk

AU - Lopes, Renato D.

AU - Gharacholou, Shahyar

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Monitoring anticoagulation using the activated clotting time (ACT) in patients treated with heparin and undergoing percutaneous coronary intervention (PCI) is one of the most frequently used tests in invasive cardiology. However, despite its widespread use and guideline endorsement, uncertainty remains regarding the association of ACT with outcomes in contemporary practice. We reviewed all PCI procedures performed at the Mayo Clinic (Rochester, Minnesota) from October 2001 to December 2012 and evaluated the association between the ACT before device activation and in-hospital and 1-year outcomes. ACT values were grouped into tertiles for descriptive purposes and analyzed as a continuous variable for assessment of outcomes. We used logistic and Cox proportional hazards regression models to estimate the association of ACT and outcomes. Of the 12,055 patients who underwent PCI with an ACT value before device activation, 3,977 (33.0%) had an ACT <227, 4,046 (33.6%) had an ACT 227 to 285, and 4,032 (33.4%) had an ACT >285. Baseline and procedural characteristics were similar across ACT tertiles. In unadjusted analysis, higher ACT values were associated with death (p <0.001), bleeding (p = 0.024), procedural complication (p <0.001), and higher 1-year events (cardiac death, p <0.001; cardiac death/myocardial infarction, p = 0.022). After multivariable adjustment for baseline and procedural characteristics, ACT was not independently associated with in-hospital or 1-year ischemic, thrombotic, or bleeding outcomes. In conclusion, ACT values before device activation are not independently associated with clinically important outcomes in contemporary PCI practice.

AB - Monitoring anticoagulation using the activated clotting time (ACT) in patients treated with heparin and undergoing percutaneous coronary intervention (PCI) is one of the most frequently used tests in invasive cardiology. However, despite its widespread use and guideline endorsement, uncertainty remains regarding the association of ACT with outcomes in contemporary practice. We reviewed all PCI procedures performed at the Mayo Clinic (Rochester, Minnesota) from October 2001 to December 2012 and evaluated the association between the ACT before device activation and in-hospital and 1-year outcomes. ACT values were grouped into tertiles for descriptive purposes and analyzed as a continuous variable for assessment of outcomes. We used logistic and Cox proportional hazards regression models to estimate the association of ACT and outcomes. Of the 12,055 patients who underwent PCI with an ACT value before device activation, 3,977 (33.0%) had an ACT <227, 4,046 (33.6%) had an ACT 227 to 285, and 4,032 (33.4%) had an ACT >285. Baseline and procedural characteristics were similar across ACT tertiles. In unadjusted analysis, higher ACT values were associated with death (p <0.001), bleeding (p = 0.024), procedural complication (p <0.001), and higher 1-year events (cardiac death, p <0.001; cardiac death/myocardial infarction, p = 0.022). After multivariable adjustment for baseline and procedural characteristics, ACT was not independently associated with in-hospital or 1-year ischemic, thrombotic, or bleeding outcomes. In conclusion, ACT values before device activation are not independently associated with clinically important outcomes in contemporary PCI practice.

UR - http://www.scopus.com/inward/record.url?scp=84958865493&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958865493&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2015.12.003

DO - 10.1016/j.amjcard.2015.12.003

M3 - Article

C2 - 26762725

AN - SCOPUS:84958865493

VL - 117

SP - 703

EP - 708

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -