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.

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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