The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry
Background Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high‐risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting. Methods and Results We assessed the frequency, c...
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| Veröffentlicht in: | Journal of the American Heart Association 2014-05, Vol.3 (3), p.e000388-n/a |
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| creator | Muthappan, Palaniappan Smith, Dean Aronow, Herbert D. Eagle, Kim Wohns, David Fox, James Share, David Gurm, Hitinder S. |
| description | Background
Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high‐risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.
Methods and Results
We assessed the frequency, characteristics, and in‐hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P |
| doi_str_mv | 10.1161/JAHA.113.000388 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4309038</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1524343571</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4384-85a495cbbedb559378de97a8d927e7e9360a3d9adbbbb3df53d06fc5d464f6ec3</originalsourceid><addsrcrecordid>eNqFksFO3DAURaOqVUHAurvKS7oYcGI7ibuoNBNBBwQFAV1Hjv2SuE3iqe1MNbt-Qr-RL6mjUERX9cYv8r3HN88vit7F-CSO0_j0crlehoqcYIxJnr-K9hNMswXnOX79ot6Ljpz7FjQ4TTLC-NtoL6F5glNG96PHhxbQ2UYr6LXpTLNDYlDoZvTS9OCQqdEtWDl6MYAZHSqMNYOwO3QxeLBbGLw2A1pBbSygtW7ax1-_77T7jr6YQQqrtJDofrQNBIsegj3Y-o2xE-LWCum1hI8B5oLVO3RuTY98SLTqRkCFNc7N5X2roVNTnGstW92IwJrwZiucHDthJ7Qz1uuxR8er6yL5gO6g0c7b3WH0phadg6On_SD6en72UKwXVzefL4rl1UJSktNFzgTlTFYVqIoxTrJcAc9ErniSQQacpFgQxYWqwiKqZkThtJZM0ZTWKUhyEH2auZux6kHJ0BwrunJjdR9-tzRCl_-eDLotG7MtKcE8PGAAHD8BrPkxgvNlr52ErpubX8YsoYQSlsVBejpL5dQjC_XzNTEup-Eop-EIFSnn4QiO9y_TPev_jkIQ0FnwU3ew-x9v-iYspPkDbb3L6A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1524343571</pqid></control><display><type>article</type><title>The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry</title><source>MEDLINE</source><source>Wiley Online Library Open Access</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Muthappan, Palaniappan ; Smith, Dean ; Aronow, Herbert D. ; Eagle, Kim ; Wohns, David ; Fox, James ; Share, David ; Gurm, Hitinder S.</creator><creatorcontrib>Muthappan, Palaniappan ; Smith, Dean ; Aronow, Herbert D. ; Eagle, Kim ; Wohns, David ; Fox, James ; Share, David ; Gurm, Hitinder S.</creatorcontrib><description>Background
Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high‐risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.
Methods and Results
We assessed the frequency, characteristics, and in‐hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P<0.0001) and had a greater burden of comorbidity. Patients undergoing PCI before HRNCS had an increase in unadjusted major adverse cardiovascular events, postprocedure transfusion, contrast‐induced nephropathy, nephropathy requiring dialysis, and same‐admission coronary artery bypass graft surgery, but there was no difference in mortality (0.27% versus 0.14%, P=0.11). However, in propensity score–matched samples, there was a significant difference only in nephropathy requiring dialysis.
Conclusions
The incidence of PCI performed in preparation for high‐risk noncardiac surgery is low, and these procedures are currently being performed on a highly selected high‐risk patient population.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.113.000388</identifier><identifier>PMID: 24820654</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; angioplasty ; Blue Cross Blue Shield Insurance Plans - statistics & numerical data ; Cardiovascular Diseases - surgery ; epidemiology ; Female ; Humans ; Male ; Michigan - epidemiology ; Middle Aged ; Original Research ; Outcome and Process Assessment (Health Care) ; Percutaneous Coronary Intervention - statistics & numerical data ; Practice Patterns, Physicians' - statistics & numerical data ; Preoperative Care - adverse effects ; Preoperative Care - methods ; preoperative revascularization ; Registries ; Risk Reduction Behavior ; stents ; Surgical Procedures, Operative - adverse effects ; Surgical Procedures, Operative - methods ; Treatment Outcome</subject><ispartof>Journal of the American Heart Association, 2014-05, Vol.3 (3), p.e000388-n/a</ispartof><rights>2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.</rights><rights>2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4384-85a495cbbedb559378de97a8d927e7e9360a3d9adbbbb3df53d06fc5d464f6ec3</citedby><cites>FETCH-LOGICAL-c4384-85a495cbbedb559378de97a8d927e7e9360a3d9adbbbb3df53d06fc5d464f6ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309038/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309038/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,11541,27901,27902,46027,46451,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24820654$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muthappan, Palaniappan</creatorcontrib><creatorcontrib>Smith, Dean</creatorcontrib><creatorcontrib>Aronow, Herbert D.</creatorcontrib><creatorcontrib>Eagle, Kim</creatorcontrib><creatorcontrib>Wohns, David</creatorcontrib><creatorcontrib>Fox, James</creatorcontrib><creatorcontrib>Share, David</creatorcontrib><creatorcontrib>Gurm, Hitinder S.</creatorcontrib><title>The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry</title><title>Journal of the American Heart Association</title><addtitle>J Am Heart Assoc</addtitle><description>Background
Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high‐risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.
Methods and Results
We assessed the frequency, characteristics, and in‐hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P<0.0001) and had a greater burden of comorbidity. Patients undergoing PCI before HRNCS had an increase in unadjusted major adverse cardiovascular events, postprocedure transfusion, contrast‐induced nephropathy, nephropathy requiring dialysis, and same‐admission coronary artery bypass graft surgery, but there was no difference in mortality (0.27% versus 0.14%, P=0.11). However, in propensity score–matched samples, there was a significant difference only in nephropathy requiring dialysis.
Conclusions
The incidence of PCI performed in preparation for high‐risk noncardiac surgery is low, and these procedures are currently being performed on a highly selected high‐risk patient population.</description><subject>Aged</subject><subject>angioplasty</subject><subject>Blue Cross Blue Shield Insurance Plans - statistics & numerical data</subject><subject>Cardiovascular Diseases - surgery</subject><subject>epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Michigan - epidemiology</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Percutaneous Coronary Intervention - statistics & numerical data</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Preoperative Care - adverse effects</subject><subject>Preoperative Care - methods</subject><subject>preoperative revascularization</subject><subject>Registries</subject><subject>Risk Reduction Behavior</subject><subject>stents</subject><subject>Surgical Procedures, Operative - adverse effects</subject><subject>Surgical Procedures, Operative - methods</subject><subject>Treatment Outcome</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNqFksFO3DAURaOqVUHAurvKS7oYcGI7ibuoNBNBBwQFAV1Hjv2SuE3iqe1MNbt-Qr-RL6mjUERX9cYv8r3HN88vit7F-CSO0_j0crlehoqcYIxJnr-K9hNMswXnOX79ot6Ljpz7FjQ4TTLC-NtoL6F5glNG96PHhxbQ2UYr6LXpTLNDYlDoZvTS9OCQqdEtWDl6MYAZHSqMNYOwO3QxeLBbGLw2A1pBbSygtW7ax1-_77T7jr6YQQqrtJDofrQNBIsegj3Y-o2xE-LWCum1hI8B5oLVO3RuTY98SLTqRkCFNc7N5X2roVNTnGstW92IwJrwZiucHDthJ7Qz1uuxR8er6yL5gO6g0c7b3WH0phadg6On_SD6en72UKwXVzefL4rl1UJSktNFzgTlTFYVqIoxTrJcAc9ErniSQQacpFgQxYWqwiKqZkThtJZM0ZTWKUhyEH2auZux6kHJ0BwrunJjdR9-tzRCl_-eDLotG7MtKcE8PGAAHD8BrPkxgvNlr52ErpubX8YsoYQSlsVBejpL5dQjC_XzNTEup-Eop-EIFSnn4QiO9y_TPev_jkIQ0FnwU3ew-x9v-iYspPkDbb3L6A</recordid><startdate>20140512</startdate><enddate>20140512</enddate><creator>Muthappan, Palaniappan</creator><creator>Smith, Dean</creator><creator>Aronow, Herbert D.</creator><creator>Eagle, Kim</creator><creator>Wohns, David</creator><creator>Fox, James</creator><creator>Share, David</creator><creator>Gurm, Hitinder S.</creator><general>Blackwell Publishing Ltd</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140512</creationdate><title>The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry</title><author>Muthappan, Palaniappan ; Smith, Dean ; Aronow, Herbert D. ; Eagle, Kim ; Wohns, David ; Fox, James ; Share, David ; Gurm, Hitinder S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4384-85a495cbbedb559378de97a8d927e7e9360a3d9adbbbb3df53d06fc5d464f6ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>angioplasty</topic><topic>Blue Cross Blue Shield Insurance Plans - statistics & numerical data</topic><topic>Cardiovascular Diseases - surgery</topic><topic>epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Michigan - epidemiology</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Percutaneous Coronary Intervention - statistics & numerical data</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Preoperative Care - adverse effects</topic><topic>Preoperative Care - methods</topic><topic>preoperative revascularization</topic><topic>Registries</topic><topic>Risk Reduction Behavior</topic><topic>stents</topic><topic>Surgical Procedures, Operative - adverse effects</topic><topic>Surgical Procedures, Operative - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Muthappan, Palaniappan</creatorcontrib><creatorcontrib>Smith, Dean</creatorcontrib><creatorcontrib>Aronow, Herbert D.</creatorcontrib><creatorcontrib>Eagle, Kim</creatorcontrib><creatorcontrib>Wohns, David</creatorcontrib><creatorcontrib>Fox, James</creatorcontrib><creatorcontrib>Share, David</creatorcontrib><creatorcontrib>Gurm, Hitinder S.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Muthappan, Palaniappan</au><au>Smith, Dean</au><au>Aronow, Herbert D.</au><au>Eagle, Kim</au><au>Wohns, David</au><au>Fox, James</au><au>Share, David</au><au>Gurm, Hitinder S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry</atitle><jtitle>Journal of the American Heart Association</jtitle><addtitle>J Am Heart Assoc</addtitle><date>2014-05-12</date><risdate>2014</risdate><volume>3</volume><issue>3</issue><spage>e000388</spage><epage>n/a</epage><pages>e000388-n/a</pages><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>Background
Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high‐risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.
Methods and Results
We assessed the frequency, characteristics, and in‐hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P<0.0001) and had a greater burden of comorbidity. Patients undergoing PCI before HRNCS had an increase in unadjusted major adverse cardiovascular events, postprocedure transfusion, contrast‐induced nephropathy, nephropathy requiring dialysis, and same‐admission coronary artery bypass graft surgery, but there was no difference in mortality (0.27% versus 0.14%, P=0.11). However, in propensity score–matched samples, there was a significant difference only in nephropathy requiring dialysis.
Conclusions
The incidence of PCI performed in preparation for high‐risk noncardiac surgery is low, and these procedures are currently being performed on a highly selected high‐risk patient population.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24820654</pmid><doi>10.1161/JAHA.113.000388</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged angioplasty Blue Cross Blue Shield Insurance Plans - statistics & numerical data Cardiovascular Diseases - surgery epidemiology Female Humans Male Michigan - epidemiology Middle Aged Original Research Outcome and Process Assessment (Health Care) Percutaneous Coronary Intervention - statistics & numerical data Practice Patterns, Physicians' - statistics & numerical data Preoperative Care - adverse effects Preoperative Care - methods preoperative revascularization Registries Risk Reduction Behavior stents Surgical Procedures, Operative - adverse effects Surgical Procedures, Operative - methods Treatment Outcome |
| title | The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry |
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