Guidelines recommend maximal antianginal medical therapy before attempted coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The degree to which this occurs in contemporary practice is unknown. We aimed to characterize the frequency and variability of preprocedural use of antianginal therapy and stress testing within 3 months before PCI of CTO (CTO PCI) across a nationally integrated health care system.
In patients with atrial fibrillation, there is an increased risk of stroke associated with diabetes mellitus.There is little known about the association between elevated hemoglobin A1c and stroke risk in these patients.This analysis from Danish registries evaluated the effect of glycemic status measured by hemoglobin A1c on the risk of thromboembolism.Increasing levels of hemoglobin A1c were associated with a higher risk of thromboembolism, suggesting a more graded association of stroke risk and diabetes control; however, no association was found in patients with diabetes mellitus duration ≥10 years.
Intra-aortic balloon pumps (IABP) support nonemergent and emergent percutaneous coronary intervention (PCI). Recent studies have not showed a routine benefit to this practice. We sought to evaluate the temporal trends in balloon pump utilization and site-level variation within a large integrated healthcare system.We identified all patients that underwent PCI in the Veterans Affairs Healthcare System between 1 January 2008 and 31 December 2015. Procedural information was ascertained from the medical record and stratified by the concomitant use of an IABP. Site-specific variation was determined with mixed logistic regression models and reported as a median odds ratio.There were 88 851 interventions performed on 71 529 patients across 71 hospitals with 1289 (1.5%) of these utilizing an IABP. Patients that underwent an intervention with this device had more medical comorbidities, as reflected by an increase in the median National Cardiovascular Data Registry CathPCI mortality score (34 vs. 15, P<0.001). The overall utilization of balloon pumps was constant throughout the study period (P=0.446). However, there was a significant decline (P=0.027) in its use during emergent cases with a significant increase (P=0.009) during nonemergent cases. Furthermore, there was site variation in use independent of patient or procedural characteristics (median odds ratio: 1.82, 95% confidence interval: 1.58-2.16).In the largest integrated healthcare system in the USA, there was a significant decline in IABP use among emergent cases and a significant increase during nonemergent cases. Residual site variation suggests an opportunity to standardize a procedural approach consistent with currently available data.
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