Author + information
- Navin Chandra1,
- Peter Moore2,
- Imad Nadra2,
- David Wood3,
- Sean Hardiman4,
- Lilian Ding4,
- Anthony Fung5,
- Eve Aymong6,
- Albert Chan7,
- Steven Hodge8,
- Kevin Horgan2,
- Adeera Levin9,
- Simon Robinson2 and
- Anthony Della Siega2
- 1Royal Jubilee Hospital, VICTORIA, British Columbia, Canada
- 2Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 3Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
- 4Provincial Health Services Authority, Vancouver, British Columbia, Canada
- 5Vancouver General Hospital, Vancouver, British Columbia, Canada
- 6St. Paul's Hospital, Vancouver, British Columbia, Canada
- 7Royal Columbian Hospital, new westminster, British Columbia, Canada
- 8Kelowna General Hospital, Winnipeg, British Columbia, Canada
- 9St Paul's Hospital, Vancouver, British Columbia, Canada
Current guidelines recommend using the lowest possible contrast volume (CV) for percutaneous coronary intervention (PCI). Patients requiring complex PCI, may undergo single high CV procedures or separate low CV staged procedures. We determined the optimal threshold for CV:glomerular filtration rate (GFR) ratio (R) where the prognostic benefit of a high CV procedure is offset by low CV staged procedure.
We analyzed 34036 PCI patients (excluding STEMI) from the British Columbia Cardiac Registry. We determined R for each patient and adjusted mortality rates using logistic regression analysis to define probability distribution functions. A decision analysis model was constructed comparing a) single high CV procedure versus b) lower CV staged procedures (within 30 days). We examined 1-year mortality and used one-way sensitivity and probabilistic sensitivity analyses to define Rthreshold.
The unadjusted 1-year mortality for total, ACS and stable cohort were 4.5%, 5.2% and 3.5%. Sensitivity analyses indicated Rthreshold values for the total cohort, ACS and stable cohort were 5.13, 4.75 and 4.72. Probabilistic sensitivity analyses using Monte Carlo simulation (106 simulations/analysis) indicated a single high CV procedure was the optimal strategy in 71%, 65% and 66% of the total, ACS and stable cohorts.
This analysis incorporating real world data indicates that a higher CV for PCI may be tolerated compared to using lower CV but staged procedures. These data have important implications in current PCI era where increasing burden and complexity of PCI may require a greater CV.
CORONARY: PCI Outcomes