Score System Determines PCI Readmission

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According to a study published online in Circulation: Cardiovascular Quality and Outcomes, a new 30-day readmission risk predication model for patients undergoing percutaneous coronary intervention (PCI) demonstrated that it indeed possible to predict risk using known data prior to PCI.

After several adjustments, the 10 pre-PCI variables that predicted 30-day readmission were older age (average age 68), female, insurance type (Medicare, state, or unknown), GFR category (less than 30 and 30-60 mL/min per 1.73m2), current or history of heart failure, chronic lung disease, peripheral vascular disease, cardiogenic shock at presentation, admit source (acute and non-acute care facility or emergency department), and previous coronary artery bypass graft surgery.pci score system

Moreover, important determinants post-discharge that determined 30-day readmission were beta-blocker prescribed at discharge, post-PCI vascular or bleeding complications, discharge location, race, diabetes status and modality of treatment, any drug-eluting stent during the index procedure, and extended length of stay.

Robert W. Yeh, MD, MSc, of Massachusetts General Hospital in Boston, and peers say a risk score calculator using pre-PCI variables would soon be accessible online.

Imaging the cardiac sympathetic function with a radiotracer helps cardiologists to determine the long-term probability of survival in heart failure patients, free of BNP and ejection fraction, a patient-level analysis of six individual studies, grouped together confirmed.

The gathered analysis of scintigraphic imaging using iodine-labeled metaiodobenzylguanidine (MIBG), with follow-up of more than 10 years, revealed that patients with a heart-to-mediastinum ratio (HMR) greater than 1.95 had less than a 2% annual death rate, while those with an HMR less than 1.25 had an annual death rate greater than 7%, according to Tomoaki Nakata, MD, of the Sapporo Medical University School of Medicine in Sapporo, Japan, and colleagues.

Individual patient risk for HMR levels were low (HMR greater than 2.10), intermediate (HMR 1.40-2.10), and high (HMR less than 1.40).

"Although the MIBG imaging technique has been readily available in Japan for 2 decades, the new insights provided by this pooled analysis should expand understanding of the importance of the sympathetic nerve findings," researchers noted in their study published in JACC: Cardiovascular Imaging.

By recognizing patients at high risk of death, physicians can better select those patients who would benefit the most from an implantable cardioverter defibrillator, the researchers added.

According to Bruce L. Wilkoff, MD, of the Cleveland Clinic, and peers the safety and overall efficiency of transvenous extraction of recalled leads from implantable cardioverter defibrillators (ICDs) is comparable to non-recalled leads.

Furthermore, a study published online in Heart Rhythm drew a comparison between 430 patients with recalled leads (Riata and Sprint Fidelis) and 649 with non-recalled leads and yielded no significant differences in minor or major complication issues.

"The FDA and the Heart Rhythm Society do not currently recommend prophylactic extraction of recalled Riata or Fidelis ICD leads. Our study contributes to the existing body of knowledge by showing that in our high-volume center, extraction of recalled Riata and Fidelis ICD leads was performed with comparable safety and efficacy to non-recalled ICD leads,” said the researchers.

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