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APPROPRIATENESS OF MULTI-VESSEL PERCUTANEOUS CORONARY INTERVENTION IN MYOCARDIAL INFARCTION – A TERTIARY RURAL HEALTHCARE CENTER PERSPECTIVE
E1820 JACC March 27, 2012 Volume 59, Issue 13
Quality of Care and Outcomes Assessment APPROPRIATENESS OF MULTI-VESSEL PERCUTANEOUS CORONARY INTERVENTION IN MYOCARDIAL INFARCTION - A TERTIARY RURAL HEALTHCARE CENTER PERSPECTIVE ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Optimizing Diagnostic Testing Abstract Category: 31. Quality of Care and Outcomes Assessment Presentation Number: 1252-114 Authors: Sudhakar Sattur, Sreekanth Kondareddy, Mukesh Garg, Guthrie- Robert Packer Hospital, Sayre, PA, USA Background: Recent literature suggests that Percutaneous Coronary Intervention (PCI) in the setting of ST segment Elevation Myocardial Infarction (STEMI) and Non - ST segment Elevation Myocardial Infarction (NSTEMI) is appropriate in more than 98% of these cases. As per the American College of Cardiology Foundation (ACCF) 2009 appropriateness criteria document, multi-vessel PCI in the setting of STEMI and NSTEMI is considered inappropriate, unless there is evidence of recurrent or provokable ischemia or unstable ventricular arrhythmias during index hospitalization. We evaluated the appropriateness of multi-vessel PCI in STEMI and NSTEMI patients in a large tertiary rural healthcare center. Methods: We retrospectively evaluated medical records of STEMI and NSTEMI patients who underwent multi-vessel PCI during index hospitalization. After reviewing clinical and angiographic information, we classified multi-vessel PCI as appropriate and inappropriate as per the ACCF appropriateness criteria document. Results: A total of 1228 patients who had undergone PCI for STEMI and NSTEMI were identified. Out of these, we included 112 patients, who had undergone multi-vessel PCI during index hospitalization in our study. Sixty four (57.1%) patients were classified as appropriate and 48 (42.9%) patients were classified as inappropriate. In 48 of the 64 appropriate PCI patients, a culprit vessel could not be identified on angiogram. The remainder 12 appropriate PCI patients had evidence of recurrent or provokable ischemia or unstable ventricular arrhythmias during index hospitalization. Conclusions: Although majority of PCI in MI patients have been found to be appropriate, a significant proportion of these patients who had multivessel PCI during index hospitalization were classified as inappropriate. The current ACCF PCI appropriateness criteria indicate that intervening on multiple vessels in acute MI patients are more likely to be inappropriate than single vessel interventions.
Quality of Care and Outcomes Assessment APPROPRIATENESS OF MULTI-VESSEL PERCUTANEOUS CORONARY INTERVENTION IN MYOCARDIAL INFARCTION - A TERTIARY RURAL HEALTHCARE CENTER PERSPECTIVE ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Optimizing Diagnostic Testing Abstract Category: 31. Quality of Care and Outcomes Assessment Presentation Number: 1252-114 Authors: Sudhakar Sattur, Sreekanth Kondareddy, Mukesh Garg, Guthrie- Robert Packer Hospital, Sayre, PA, USA Background: Recent literature suggests that Percutaneous Coronary Intervention (PCI) in the setting of ST segment Elevation Myocardial Infarction (STEMI) and Non - ST segment Elevation Myocardial Infarction (NSTEMI) is appropriate in more than 98% of these cases. As per the American College of Cardiology Foundation (ACCF) 2009 appropriateness criteria document, multi-vessel PCI in the setting of STEMI and NSTEMI is considered inappropriate, unless there is evidence of recurrent or provokable ischemia or unstable ventricular arrhythmias during index hospitalization. We evaluated the appropriateness of multi-vessel PCI in STEMI and NSTEMI patients in a large tertiary rural healthcare center. Methods: We retrospectively evaluated medical records of STEMI and NSTEMI patients who underwent multi-vessel PCI during index hospitalization. After reviewing clinical and angiographic information, we classified multi-vessel PCI as appropriate and inappropriate as per the ACCF appropriateness criteria document. Results: A total of 1228 patients who had undergone PCI for STEMI and NSTEMI were identified. Out of these, we included 112 patients, who had undergone multi-vessel PCI during index hospitalization in our study. Sixty four (57.1%) patients were classified as appropriate and 48 (42.9%) patients were classified as inappropriate. In 48 of the 64 appropriate PCI patients, a culprit vessel could not be identified on angiogram. The remainder 12 appropriate PCI patients had evidence of recurrent or provokable ischemia or unstable ventricular arrhythmias during index hospitalization. Conclusions: Although majority of PCI in MI patients have been found to be appropriate, a significant proportion of these patients who had multivessel PCI during index hospitalization were classified as inappropriate. The current ACCF PCI appropriateness criteria indicate that intervening on multiple vessels in acute MI patients are more likely to be inappropriate than single vessel interventions.