- Email: [email protected]
TREATMENT RECOMMENDED AND RECEIVED FOLLOWING DIAGNOSTIC CATHETERIZATION FOR CORONARY ARTERY DISEASE IN BC, 2001-2012
S92
dose less than weight but 2% of patients had dose reduction as low as 0.75mg/kg. At the SJRH tertiary care center, 60% of patients with mild renal insufficiency had reduced dose Lovenox with 40% having a dose of 0.75mg/kg. Only 3 patients had severe renal impairment (Creatine-clearance <30 mL/min), 2/3 were deferred Lovenox or prescribed Lovenox at a reduced dose as per CCS recommendations one case a patient received Lovenox at a dose higher than recommended. 2% out of the 350 patients on Lovenox were concurrently on two types of heparin during hospitalization. 6% of patients received Lovenox doses greater than the maximum recommendation. Fondaparinux, was prescribed once within the study population. CONCLUSION: Adopting a provincial anticoagulation protocol based on current CCS anticoagulation guidelines would decrease physician dosing errors resulting in a decrease in adverse events and in hospital stays thus decreasing the healthcare cost burden in the province of NB. HPRF
Canadian Journal of Cardiology Volume 30 2014
within 90 days were very closely tied, on average 95.1%. The proportion of being recommended for CABG was consistently higher than the proportion of patients actually receiving CABG within 180 days. The average proportion of patients who were referred for CABG but did not undergo a surgery was 26.3%. The proportion of patients who were referred for CABG but refused and opted to receive PCI within 90 days was 6.5%. CONCLUSION: We described the treatment recommended and received longitudinally for a large cohort of patients undergoing DiagCath. The majority of patients received the treatment that was recommended at DiagCath. From 2011 to 2012, a large decrease in PCI and increase in medical management of both recommended and received treatments were observed. Surgical turndowns are known to have significant worse outcomes. The reasons for large percent of surgical turndown are unknown and warrant further investigation. This study provides a valuable picture of cardiac procedure used following DiagCath and indicates a clear need for close monitoring and more comprehensive study of the recommendation and treatment process.
070 TREATMENT RECOMMENDED AND RECEIVED FOLLOWING DIAGNOSTIC CATHETERIZATION FOR CORONARY ARTERY DISEASE IN BC, 2001-2012 R Zhang, L Ding Vancouver, British Columbia BACKGROUND:
Coronary revascularization procedures including percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) are important elements in the treatment of patients with coronary artery disease (CAD). Tracking the procedures that patients received after diagnostic catheterization (DiagCath) provides insight on how CAD patients have been managed. The Cardiac Servives BC Registry allows a unique opportunity to explore trends over a decade of population-based longitudinal clinical data. This study describes the recommended and received revascularization Methods after DiagCath in BC from 2001 to 2012. METHODS AND RESULTS: On average more than 16,000 DiagCaths were performed each year from 2001 to 2012 in BC. Cases with age 20, non-BC residents, indications other than ACS/stable angina, and with normal angiograms were excluded. Overall the proportion of patients recommended after DiagCath to undergo PCI was 47.6%, 19.4% for CABG, 25.4% for medical management, and 7.6% didn’t have recommendation. However, the proportion of patients who actually received PCI within 90 days post DiagCath was 53.6%, received CABG within 180 days was 15.9% and 30.5% was managed by medications. Among patients with treatment recommendations from DiagCath, most (89.1%) received the recommended treatments, and the proportion of patients receiving recommended treatments has significantly increased over time (p-value<.001) from 85.0% in 2001 to 91.6% in 2012 (Figure 1). Figure 1 shows that proportions of being recommended for a PCI and actually receiving PCI
071 SUCCESSIVE TRANSRADIAL APPROACH IS ASSOCIATED WITH AN ACCEPTABLE SUCCESS RATE AND A LOWER RISK OF VASCULAR COMPLICATIONS COMPARED TO THE TRANSFEMORAL APPROACH IN PATIENTS UNDERGOING REPEAT PERCUTANEOUS CORONARY INTERVENTION P Dehghani, E Rezaei, A Bagai, S Al Nasser, H Al Lawati, AN Cheema Regina, Saskatchewan BACKGROUND:
A transradial (TR) approach for percutaneous coronary intervention (PCI) significantly reduces bleeding and vascular complications compared to the transfemoral (TF) approach. However, many patients undergoing PCI return for repeat procedures over time and limited data is available to guide the choice of TR vs TF approach in these patients. The present study compared procedural success and adverse outcomes of TR and TF approach in patients undergoing successive PCI procedures.
dose less than weight but 2% of patients had dose reduction as low as 0.75mg/kg. At the SJRH tertiary care center, 60% of patients with mild renal insufficiency had reduced dose Lovenox with 40% having a dose of 0.75mg/kg. Only 3 patients had severe renal impairment (Creatine-clearance <30 mL/min), 2/3 were deferred Lovenox or prescribed Lovenox at a reduced dose as per CCS recommendations one case a patient received Lovenox at a dose higher than recommended. 2% out of the 350 patients on Lovenox were concurrently on two types of heparin during hospitalization. 6% of patients received Lovenox doses greater than the maximum recommendation. Fondaparinux, was prescribed once within the study population. CONCLUSION: Adopting a provincial anticoagulation protocol based on current CCS anticoagulation guidelines would decrease physician dosing errors resulting in a decrease in adverse events and in hospital stays thus decreasing the healthcare cost burden in the province of NB. HPRF
Canadian Journal of Cardiology Volume 30 2014
within 90 days were very closely tied, on average 95.1%. The proportion of being recommended for CABG was consistently higher than the proportion of patients actually receiving CABG within 180 days. The average proportion of patients who were referred for CABG but did not undergo a surgery was 26.3%. The proportion of patients who were referred for CABG but refused and opted to receive PCI within 90 days was 6.5%. CONCLUSION: We described the treatment recommended and received longitudinally for a large cohort of patients undergoing DiagCath. The majority of patients received the treatment that was recommended at DiagCath. From 2011 to 2012, a large decrease in PCI and increase in medical management of both recommended and received treatments were observed. Surgical turndowns are known to have significant worse outcomes. The reasons for large percent of surgical turndown are unknown and warrant further investigation. This study provides a valuable picture of cardiac procedure used following DiagCath and indicates a clear need for close monitoring and more comprehensive study of the recommendation and treatment process.
070 TREATMENT RECOMMENDED AND RECEIVED FOLLOWING DIAGNOSTIC CATHETERIZATION FOR CORONARY ARTERY DISEASE IN BC, 2001-2012 R Zhang, L Ding Vancouver, British Columbia BACKGROUND:
Coronary revascularization procedures including percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) are important elements in the treatment of patients with coronary artery disease (CAD). Tracking the procedures that patients received after diagnostic catheterization (DiagCath) provides insight on how CAD patients have been managed. The Cardiac Servives BC Registry allows a unique opportunity to explore trends over a decade of population-based longitudinal clinical data. This study describes the recommended and received revascularization Methods after DiagCath in BC from 2001 to 2012. METHODS AND RESULTS: On average more than 16,000 DiagCaths were performed each year from 2001 to 2012 in BC. Cases with age 20, non-BC residents, indications other than ACS/stable angina, and with normal angiograms were excluded. Overall the proportion of patients recommended after DiagCath to undergo PCI was 47.6%, 19.4% for CABG, 25.4% for medical management, and 7.6% didn’t have recommendation. However, the proportion of patients who actually received PCI within 90 days post DiagCath was 53.6%, received CABG within 180 days was 15.9% and 30.5% was managed by medications. Among patients with treatment recommendations from DiagCath, most (89.1%) received the recommended treatments, and the proportion of patients receiving recommended treatments has significantly increased over time (p-value<.001) from 85.0% in 2001 to 91.6% in 2012 (Figure 1). Figure 1 shows that proportions of being recommended for a PCI and actually receiving PCI
071 SUCCESSIVE TRANSRADIAL APPROACH IS ASSOCIATED WITH AN ACCEPTABLE SUCCESS RATE AND A LOWER RISK OF VASCULAR COMPLICATIONS COMPARED TO THE TRANSFEMORAL APPROACH IN PATIENTS UNDERGOING REPEAT PERCUTANEOUS CORONARY INTERVENTION P Dehghani, E Rezaei, A Bagai, S Al Nasser, H Al Lawati, AN Cheema Regina, Saskatchewan BACKGROUND:
A transradial (TR) approach for percutaneous coronary intervention (PCI) significantly reduces bleeding and vascular complications compared to the transfemoral (TF) approach. However, many patients undergoing PCI return for repeat procedures over time and limited data is available to guide the choice of TR vs TF approach in these patients. The present study compared procedural success and adverse outcomes of TR and TF approach in patients undergoing successive PCI procedures.