Document Detail


Three-year survival after percutaneous coronary intervention according to appropriateness criteria for revascularization.
MedLine Citation:
PMID:  19901407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to compare 3-year outcomes of percutaneous coronary intervention (PCI) according to recently published appropriateness criteria for PCI. BACKGROUND: The choice of revascularization between PCI and coronary artery bypass grafting (CABG) remains uncertain in many patients despite numerous randomized clinical trials and meta-analyses. METHODS: Consecutive patients undergoing a first PCI at a single, large-volume institution were included if they did not have prior CABG and did not need emergency PCI. Patients were classified according to PCI indication into the following groups: Appropriate (A) - 1- or 2-vessel coronary artery disease (CAD), Uncertain (U) - 3-vessel CAD and Inappropriate (I) - left main coronary artery stenosis. Survival was assessed with the Social Security Death Index. RESULTS: A total of 2,134 patients fulfilled the study criteria: 1,706 (80%) with "appropriate" PCI, 414 (19.4%) with "uncertain" PCI and only 14 (0.6%) with "inappropriate" PCI. In-hospital outcomes were very favorable, with 99.3%, 98.6% and 100% of the three groups, respectively, experiencing no complications (p = 0.31). The estimated survival in the three categories at 900 days was 92.6% (95% confidence interval 91-94%) for Group A, 91.3% (88-4%) for Group U and 66.9% (33-87%) for Group I; p = 0.014. The only predictors of mortality were advanced age and comorbidities, but not "appropriateness level" (p = 0.26). CONCLUSION: The majority of PCIs performed would were classified as "appropriate." The patients classified as "uncertain" had similarly favorable outcomes, as those considered "appropriate" both during initial hospitalization and during the 3-year follow up. If confirmed, these data suggest that anatomically-based appropriateness criteria are not sufficient to inform choice of revascularization method.
Authors:
Sorin J Brener; Salman A Haq; Sanjay Bose; Terrence J Sacchi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  21     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-10     Completed Date:  2010-02-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  554-7     Citation Subset:  IM    
Affiliation:
NY Methodist Hospital, Division of Cardiology, Brooklyn, NY 11215, USA. sjb9005@nyp.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / mortality*
Comorbidity
Coronary Artery Disease / mortality*,  therapy*
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care)*
Predictive Value of Tests
Social Security / statistics & numerical data
United States
Comments/Corrections
Comment In:
J Invasive Cardiol. 2009 Nov;21(11):558-62   [PMID:  19901408 ]

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