Rates of Intraprocedural Adverse Events and Supportive Interventions During Percutaneous Coronary Interventions: A Single-Center, Retrospective Analysis

Ryan Quinn, MD, FRCPC; Aiman Alak, MD, FRCPC; Madhu Natarajan, MD, FRCPC, MSc;,,Ahmad Alshatti, MD, MRCP; Hussain Alzayer, MD, FRCPC; Matthew Sibbald, MD, FRCPC, MSc, PhD,,,,McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Ontario, Canada,,,,

Single-Center Study

Rates of Intraprocedural Adverse Events and Supportive Interventions During Percutaneous Coronary Interventions: A Single-Center, Retrospective Analysis

Ryan Quinn, MD, FRCPC; Aiman Alak, MD, FRCPC; Madhu Natarajan, MD, FRCPC, MSc;
Ahmad Alshatti, MD, MRCP; Hussain Alzayer, MD, FRCPC; Matthew Sibbald, MD, FRCPC, MSc, PhD

McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Ontario, Canada

July 2021

Editor's note: A pdf of this article is available for download at right (look for red pdf icon).

Abstract

Background: In percutaneous coronary intervention (PCI) literature, major adverse events such as stroke, myocardial infarction (MI), bleeding, or death have been well studied. However, no studies have evaluated the types and rates of adverse events requiring intraprocedural supportive interventions that occur during PCI. We believe these may represent harbingers of future major adverse cardiovascular events (MACE).

Methods: We performed a retrospective chart review of 474 patients who received PCI from January to December 2017 at a single tertiary care center in Ontario, Canada. The primary outcome was a composite of any pharmacologic or mechanical intraprocedural supportive interventions. Secondary outcomes included the composite of any pharmacologic intraprocedural supportive interventions, the composite of any mechanical intraprocedural supportive interventions, and each intraprocedural supportive intervention analyzed separately. A univariate and multivariate regression analysis was performed on demographic and procedural variables.

Results: Over half (51.3%) of all patients received some form of intraprocedural supportive intervention, either pharmacologic or mechanical. One out of every six patients (16.0%) required two or more intraprocedural supportive interventions during their procedure. Compared to patients with elective PCI, those presenting with a non ST-elevation MI (NSTEMI) had a higher risk of requiring intraprocedural supportive interventions, with an odds ratio (OR) of 1.962 (confidence interval [CI] 1.021 to 3.771, P=.043) and those presenting with ST-elevation MI (STEMI) had an OR of 3.304 (CI 1.747 to 6.246, P<.001).

Conclusion: During PCI, there is a high rate of events that require some form of intraprocedural supportive intervention. Those who present with NSTEMI and STEMI are at a higher risk of requiring intraprocedural supportive interventions. These may represent sentinel events for major adverse patient events and the anticipation of cases that have a higher chance of requiring intraprocedural supportive interventions may improve coordinated team dynamics.

Please Log In To View

Lorem ipsum dolor sit amet consectetur, adipiscing elit diam ad laoreet dignissim, placerat dis per hac. Ex enim quis luctus hendrerit accumsan mauris vivamus etiam dolor, est aptent tortor lacinia feugiat porta aenean pellentesque tincidunt, condimentum massa sapien faucibus senectus curae consectetur nisl. Dis ac faucibus vitae porta pellentesque semper, erat vivamus curae amet lacus nascetur, pulvinar non sit natoque ex. Maximus nisl volutpat consequat in nisi placerat ad semper fames metus pulvinar nec conubia inceptos, class magnis feugiat dolor hendrerit convallis himenaeos taciti orci proin netus rutrum. Mauris auctor facilisis ullamcorper non lorem vulputate ante elit libero, dui id tortor porta aenean potenti curabitur conubia, himenaeos sit diam ipsum donec aliquam duis nisi.

Amet erat vestibulum convallis luctus non sit habitasse a nascetur sapien dignissim diam, interdum varius nisi pharetra primis nibh ultrices magnis dapibus laoreet. Donec semper sit elit parturient ad rhoncus dis commodo vehicula aliquet vivamus platea, nascetur feugiat finibus natoque velit lacus fusce proin vestibulum nec. Ipsum congue vehicula aliquam bibendum dapibus volutpat at cursus quis, hac natoque porttitor iaculis vel mauris dolor aliquet, purus nulla varius id inceptos taciti lacinia velit. Commodo taciti tempor consequat etiam suscipit netus, vehicula imperdiet tellus justo lacinia convallis metus, vulputate ad leo sodales ante. Elementum ridiculus vitae ex massa dolor leo erat malesuada nulla bibendum congue vel, ut pulvinar nisi molestie primis mattis dignissim conubia tortor nec vestibulum. Egestas eu vestibulum et maecenas urna integer nullam facilisis primis, tincidunt himenaeos feugiat nascetur tempor convallis morbi elementum dolor aliquet, velit praesent fringilla maximus ultrices consectetur congue sociosqu. Suspendisse velit interdum fames eros lectus donec adipiscing vehicula, class cursus pharetra lorem sodales sit consequat mi porttitor, bibendum facilisi libero auctor blandit conubia luctus.

Vivamus tempus vestibulum imperdiet per lorem, congue habitant dictumst montes, primis venenatis vitae maximus. Ante senectus nec interdum urna felis et cras dui a tortor augue pretium sodales, vestibulum maecenas lectus hendrerit leo semper litora potenti imperdiet tristique placerat. Scelerisque torquent vivamus venenatis natoque id nulla et, porta eros molestie mattis efficitur sagittis dignissim, ante accumsan augue inceptos elit ad. Purus rutrum mus curae facilisi vel taciti accumsan netus, turpis dui sollicitudin egestas luctus nulla hac vivamus dolor, imperdiet molestie quisque libero venenatis nunc aliquam. Diam primis ultrices vehicula massa sapien fermentum pellentesque nam, donec auctor eleifend eros nostra netus class proin malesuada, fringilla ante duis volutpat sem interdum efficitur. Ullamcorper massa quis aenean sollicitudin turpis curae, pretium etiam donec pharetra faucibus habitant felis, feugiat elit cursus facilisi placerat. Iaculis laoreet potenti elit commodo amet ipsum tellus ad, sed sociosqu velit a magnis dolor per ante posuere, maximus consequat ultrices quis vivamus sodales mi.

Vestibulum maecenas magnis tempor hac mattis tempus libero nisi iaculis, donec in ex aptent dictumst tincidunt finibus suspendisse. Varius velit a finibus aliquet placerat ante natoque praesent lectus, platea mauris consectetur hendrerit netus lacinia nec consequat sapien egestas, quam fames suscipit adipiscing tellus rutrum proin sollicitudin. Dui leo accumsan convallis pharetra malesuada etiam sagittis vel congue dapibus, quam pellentesque interdum tempus mus potenti aptent venenatis orci suscipit parturient, sit rutrum nisi eget ut odio adipiscing feugiat gravida. Ultricies commodo primis luctus maecenas rhoncus id, dui aptent etiam quam suspendisse natoque arcu, vivamus proin volutpat euismod faucibus. Mus efficitur netus cras ut suscipit non himenaeos accumsan vulputate laoreet enim fringilla posuere pellentesque vitae, eros curabitur condimentum hac torquent eget etiam magnis varius natoque turpis aliquet suspendisse.

Quis metus consectetur nisl condimentum a proin fermentum scelerisque est malesuada aptent libero habitasse, porta eleifend dolor senectus magna mus diam nascetur pulvinar enim rhoncus amet. Leo nisi netus pretium mus placerat torquent rhoncus bibendum ut, tincidunt blandit molestie ante adipiscing quisque massa nibh accumsan, curae posuere fermentum suscipit condimentum lacinia orci est. Ultricies tortor iaculis proin primis mi massa pretium praesent, scelerisque natoque egestas hac feugiat mattis accumsan litora, bibendum erat cras interdum ante nascetur nunc. Tempus proin nulla dapibus hac volutpat condimentum purus ac, tincidunt gravida quam netus cras feugiat elit vitae aptent, conubia fringilla pellentesque donec metus montes praesent. Vulputate ut ullamcorper primis vitae conubia quisque, varius morbi dignissim dapibus hac. Imperdiet volutpat sit est et ad class eget nascetur tempor, curabitur odio venenatis vestibulum nunc posuere lacinia inceptos parturient nec, bibendum netus dui leo sollicitudin consectetur massa conubia. Tempus ut facilisi netus rhoncus suspendisse auctor ridiculus, augue quam facilisis diam sociosqu volutpat orci, nibh eget lacus vitae venenatis tempor.

Sodales nec fermentum nibh elit augue interdum eleifend tempus, ultricies curabitur placerat id egestas congue sollicitudin vitae aliquam, inceptos cursus sapien ultrices rutrum et pharetra. Elit inceptos finibus etiam mi diam cubilia, primis ultrices ornare himenaeos lorem mattis class, ad senectus malesuada sed fusce.

Cubilia ad eros gravida fermentum finibus libero urna facilisi massa lacus eget molestie donec interdum, vitae rutrum tellus etiam curae habitant feugiat ridiculus condimentum arcu scelerisque enim ultricies. Augue elit aliquam nostra urna blandit bibendum, facilisis volutpat morbi habitant condimentum pharetra metus, etiam euismod dis sed posuere. Taciti nunc pulvinar interdum in morbi a sem sollicitudin, iaculis diam curabitur consectetur duis nisl. Adipiscing potenti nisl a vitae ut semper sem fames sodales, iaculis montes etiam leo orci felis suspendisse pretium mattis, vehicula vulputate hac eleifend malesuada netus per parturient. Dignissim fringilla a non conubia justo pulvinar maximus, efficitur nibh donec metus luctus pellentesque facilisi orci, nisl ad mi class sapien augue. Tristique ante pulvinar natoque magnis nascetur posuere faucibus sollicitudin conubia, et proin duis taciti semper in dis accumsan rhoncus, dui curae rutrum dapibus suspendisse pharetra himenaeos congue. Ridiculus suscipit auctor mus natoque ex integer, mi elementum habitant rhoncus pulvinar vestibulum, proin ultrices nascetur bibendum commodo. Mattis morbi sed dui consectetur per tincidunt, at finibus dictumst diam.

References

1. Chan PS, Klein LW, Krone RJ, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011; 306(1): 53-61.

2. Serruys P, Morice M, Kappetein A. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360(10): 961-972.

3. Farkouh ME, Domanski M, Sleeper LA. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2018; 367(25): 2375-2384. doi:10.1056/NEJMoa1211585

4. Joner M, Schunkert H, Kastrati A, Byrne RA. Percutaneous coronary intervention vs coronary artery bypass grafting in patients with left main coronary artery stenosis: a systematic review and meta-analysis. JAMA Cardiol. 2017 Oct 1; 2(10): 1079-1088.

5. Kirtane AJ, Doshi D, Leon MB, et al. Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention. Circulation. 2016 Aug 2; 134(5): 422-31. doi: 10.1161/CIRCULATIONAHA.116.022061

6. Badheka AO, Patel NJ, Grover P, et al. Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes: A 5-year United States experience (2005-2009). Circulation. 2014; 130(16): 1392-1406. doi:10.1161/CIRCULATIONAHA.114.009281

7. Dehmer GJ, Weaver D, Roe MT, et al. 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. J Am Coll Cardiol. 2012; 60(20): 2017-2031. doi:10.1016/j.jacc.2012.08.966

8. Iverson A, Stanberry LI, Tajti P, et al. Prevalence, trends, and outcomes of higher-risk percutaneous coronary interventions among patients without acute coronary syndromes. Cardiovasc Revasc Med. 2019 Apr; 20(4): 289-292. doi: 10.1016/j.carrev.2018.07.017

9. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775): 1409-1420. doi:10.1016/S0140-6736(11)60404-2

10. Macrae C. Making risks visible: Identifying and interpreting threats to airline flight safety. J Occup Organ Psychol. 2009; 82(2): 273-293. doi:10.1348/096317908X314045

11. Barach P, Small SD. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. BMJ. 2000; 320(7237): 759-763.

12. Sardar P, Abbott J, Kundu A, et al. Impact of artificial intelligence on interventional cardiology. JACC Cardiovasc Interv. 2019; 12(14): 1293-1303. doi:10.1016/j.jcin.2019.04.048

13. Roshanov PS, Sheth T, Duceppe E, et al. Relationship between perioperative hypotension and perioperative cardiovascular events in patients with coronary artery disease undergoing major noncardiac surgery. Anesthesiology. 2019 May; 130(5): 756-766. doi: 10.1097/ALN.0000000000002654

14. Monk T, Bronsert M, Henderson W, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015 Aug; 123(2): 307-319. doi: 10.1097/ALN.0000000000000756

15. Wesselink EM, Kappen TH, Torn HM, et al. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018; 121(4): 706-721. doi:10.1016/j.bja.2018.04.036

16. Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators; Devereaux PJ, Chan MTV, Alonso-Coello P, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012 Jun 6; 307(21): 2295-304. doi: 10.1001/jama.2012.5502.

17. Eikelboom JW, Mehta SR, Anand SS, et al. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006; 114(8): 774-782. doi:10.1161/CIRCULATIONAHA.106.612812

18. Daugherty SL, Thompson LE, Kim S, et al. Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013 May 21;61(20):2070-8. doi: 10.1016/j.jacc.2013.02.030

19. Dauerman HL, Rao SV, Resnic FS, Applegate RJ. Bleeding avoidance strategies. Consensus and controversy. J Am Coll Cardiol. 2011 Jun 28; 58(1): 1-10. doi: 10.1016/j.jacc.2011.02.039

20. Göras C, Nilsson U, Ekstedt M, et al. Managing complexity in the operating room: a group interview study. BMC Health Serv Res. 2020 May 19; 20(1): 440. doi: 10.1186/s12913-020-05192-8

21. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360(5): 491-499. doi:10.1056/NEJMsa0810119

22. Lindsay AC, Bishop J, Harron K, et al. Use of a safe procedure checklist in the cardiac catheterisation laboratory. BMJ Open Qual. 2018; 7(3): e000074. doi:10.1136/bmjoq-2017-000074

23. Cahill TJ, Clarke SC, Simpson IA, Stables RH. A patient safety checklist for the cardiac catheterisation laboratory. Heart. 2015; 101(2): 91-93. doi:10.1136/heartjnl-2014-306927