Andrew J. DooreyZoltan G. TuriElizabeth H. LazzaraMolly Casey...
10页
查看更多>>摘要：Abstract Closed‐loop communication (CLC) is a fundamental aspect of effective communication, critical in the cardiac catheterization laboratory (cath lab) where physician orders are verbal. Complete CLC is typically a hospital and national mandate. Deficiencies in CLC have been shown to impair quality of care. Single center observational study, CLC for physician verbal orders in the cath lab were assessed by direct observation during a 5‐year quality improvement effort. Performance feedback and educational efforts were used over this time frame to improve CLC, and the effects of each intervention assessed. Responses to verbal orders were characterized as complete (all important parameters of the order repeated, the mandated response), partial, acknowledgment only, or no response. During the first observational period of 101 cases, complete CLC occurred in 195 of 515 (38%) medication orders and 136 of 235 (50%) equipment orders. Complete CLC improved over time with various educational efforts, (p?<?0.001) but in the final observation period of 117 cases, complete CLC occurred in just 259 of 328 (79%) medication orders and 439 of 581 (76%) equipment orders. Incomplete CLC was associated with medication and equipment errors.?CLC of physician verbal orders was used suboptimally in this medical team setting. Baseline data indicate that physicians and staff have normalized weak, unreliable communication methods. Such lapses were associated with errors in order implementation. A subsequent 5‐year quality improvement program resulted in improvement but a sizable minority of unacceptable responses. This represents an opportunity to improve patient safety in cath labs.
Lars JakobsenEvald H. ChristiansenPhillip FreemanJohnny Kahlert...
11页
查看更多>>摘要：Abstract Objectives To compare the efficacy and safety of the dual therapy CD34 antibody‐covered sirolimus‐eluting Combo stent (DTS) and the sirolimus‐eluting Orsiro stent (SES) in patients with and without diabetes mellitus (DM) included in the Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) X study. Background The incidence of target lesion failure (TLF) after treatment with modern drug‐eluting stents has been reported to be significantly higher in patients with DM when compared to patients without DM. Thus, whether the results from the SORT OUT X study apply to patients with and without DM remains unknown. Methods In total 3146 patients were randomized to stent implantation with DTS (n?=?1578; DM: n?=?279) or SES (n?=?1568; DM: n?=?271). The primary end point, TLF, was a composite of cardiac death, target‐lesion myocardial infarction (MI), or target lesion revascularization (TLR) within 1 year. Results At 1 year, the rate of TLF was increased in the DTS group compared to the SES group, both among patients with DM (9.3% vs. 4.8%; risk difference: 4.5%; incidence rate ratio: 1.99, 95% confidence interval [CI]: 1.02–3.90) and without DM (5.7% vs. 3.5%; incidence rate ratio: 1.67, 95% CI: 1.15–2.42). The differences were mainly explained by higher rates of TLR. Conclusion Compared to the SES, the DTS was associated with an increased risk of TLF at 12 months in patients with and without DM. The differences were mainly explained by higher rates of TLR, whereas rates of cardiac death and target lesion MI did not differ significantly between the two stent groups in patients with or without DM.
查看更多>>摘要：Abstract Background In contemporary Cardiac Intensive Care Unit (CICU), bedside intra‐aortic balloon pump (IABP) insertion under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock (CS). Currently available data on this approach are limited. Aim This study aimed to assess the feasibility and safety of bedside IABP insertion, as compared to fluoroscopic‐guided insertion in the Catheterization Laboratory (CathLab), and to describe the clinical features of patients receiving bedside IABP insertion using a standardized technique in real‐world CICU practice. Methods We prospectively evaluated all patients admitted the CICU who received transfemoral IABP between June 2020 and October 2021. The overall study cohort was divided according to implant strategy in bedside and CathLab groups. The primary outcome was correct radiographic IABP positioning at the first bedside chest X‐ray obtained after insertion. Secondary outcomes included IABP‐related complications. Results Among 115 patients, bedside IABP insertion was performed in 35 (30.4%) cases, mainly presenting with CS‐related to acute decompensated heart failure (ADHF) (68.6 vs 33.8%; p?<?0.001), with lower LVEF, higher proportion of right ventricular involvement and higher need of inotropes/vasopressors, compared to those receiving CathLab insertion. Bedside IABP insertion resulted feasible and safe, with similar rates of correct IABP positioning (82.9 vs. 82.5%; p?=?0.963) and IABP‐related major vascular complications (5.7 vs. 5.0%; p?=?0.874), as compared to CathLab positioning. Conclusion This study suggests the feasibility and safety of bedside IABP insertion, which could be of relevant interest in patients with ADHF‐related CS who may not need coronary angiography or other urgent CathLab procedures.
Mamas A. MamasJinnette Dawn AbbottMohammed OsmanMoinuddin Syed...
12页
查看更多>>摘要：Abstract Background There is a lack of data on age‐stratified sex differences in the incidence, treatment, and outcomes of cardiogenic shock (CS). We sought to study these differences from a contemporary database. Methods Patients admitted with CS (2004–2018) were identified from the United States National Inpatient Sample. We compared CS (acute myocardial infarction‐related cardiogenic shock [AMI‐CS] and non‐acute myocardial infarction‐related cardiogenic shock [Non‐AMI‐CS]) incidence, management, and outcomes in males and females, stratified into four age groups (20–44, 45–64, 65–84, and ≥85 years of age). Propensity score matching (PSM) was used for adjustment. Results A total of 1,506,281 weighted hospitalizations for CS were included (AMI‐CS, 39%; Non‐AMI‐CS, 61%). Across all age groups, females had a lower incidence of CS compared with males. After PSM and among the AMI‐CS cohort, higher mortality among females compared with males was observed in the age groups 45–64?(28.5% vs. 26.3%) and 65–84 years?(39.3% vs. 37.9%) (p?<?0.01, for all). Among the Non‐AMI‐CS cohort, higher mortality among females compared with males was observed in the age groups?20–44 (33.5% vs. 30.5%), 45–64?(35.1% vs. 31.9%), and 65–84 years?(41.7% vs. 40.3%) (p?<?0.01, for all). Similar age‐dependent differences in the management of CS were also observed between females and males. Conclusions Females have a lower incidence of CS regardless of age. Significant disparities in the management and outcomes of CS were observed based on sex. However, these disparities varied by age and etiology of CS (AMI‐CS vs. Non‐AMI‐CS) with pronounced disparity among females in the age range of 45–84 years.
Kazuhiro DanSukhdeep BhogalKayode O. KukuGebremedhin D. Melaku...
8页
查看更多>>摘要：Abstract Objectives We aimed to compare bare‐metal stents (BMS), durable‐polymer everolimus‐eluting stents (DP‐EES), and abluminal biodegradable‐polymer sirolimus‐eluting stents (ABP‐SES) in the bifurcation model setup. Background The mechanism of thrombogenicity, which differs among second‐generation stents implanted using double‐kissing (DK) crush?or culotte stenting techniques, remains unclear. We have shown previously that setting up a porcine arteriovenous shunt model is feasible and useful to assess thrombogenicity at vessel bifurcation points. Methods Six porcine shunt models were prepared for the comparison between DK crush?and culotte stenting techniques using BMS, DP‐EES, and ABP‐SES. Intracoronary imaging with high‐resolution optical coherence tomography (OCT) was performed to evaluate the thrombogenicity in different stent types in the bifurcation stenting model and was evaluated by a core lab. Results Culotte stenting demonstrated more thrombogenicity at the proximal main branch (MB) with DP‐EES, side branch (SB) with BMS, and the bifurcation site irrespective of the stent type, while DK crush technique exhibited thrombogenicity only at SB with BMS and ABP‐SES. OCT analysis revealed malapposition of DP‐EES in the proximal MB with culotte stenting. Stent expansion was generally larger in ABP‐SES than BMS and DP‐EES. Conclusions The study provides hypothesis‐generating findings in distinct thrombogenicity of bifurcation stenting with DP‐ or ABP‐coated drug‐eluting stents.
Estefania Fernández‐PeregrinaHuzaifa AhmadGary S. MintzHector M. Garcia‐Garcia...
8页
查看更多>>摘要：Abstract Background Discordant physiology and anatomy may occur when nonsevere angiographic stenosis has positive physiology as well as the opposite situation. Aim To underline the reasons behind the discrepancy in physiology and anatomy and to summarize the information that coronary imaging may add to physiology. Methods A review of the published literature on physiology and intravascular imaging assessment of intermediate lesions was carried out. Results The limitations of angiography, the possibility of an underlying diffuse disease, the presence of a “grey zone” in both techniques, the amount of myocardial mass that subtends the stenosis, and plaque vulnerability may play a role in such discrepancy. Intracoronary imaging has a poor diagnostic accuracy compared to physiology. However, it may add information about plaque vulnerability that might be useful in deciding whether to treat or not a certain lesion. Conclusions Coronary revascularization is recommended for patients with ischemia based on physiology. Intracoronary imaging adds information on plaque vulnerability and can help on the decision whether to revascularize or not a lesion.
NSTL
Wiley