Impact of call-to-balloon time on 30-day mortality in contemporary practice.

OBJECTIVE: Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service. METHODS: We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours. RESULTS: The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients. CONCLUSION: CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays

Briefing: Towards exploring profession-specific BIM challenges in the UK

Building information modelling (BIM) has been proposed as an enabler for greater efficiency and effectiveness within the UK construction industry, providing digital management of construction data throughout the project life cycle. The potential benefits of BIM have been widely discussed in published literature but relatively less attention has been paid to the discipline/profession-specific challenges of wider industry adoption. Further studies, such as the authors' ongoing research, could help to remedy this

Retroperitoneal Hemorrhage After Percutaneous Coronary Intervention: Incidence, Determinants, and Outcomes as Recorded by the British Cardiovascular Intervention Society.

BACKGROUND: Retroperitoneal hemorrhage (RH) is a rare bleeding complication of percutaneous coronary intervention, which can result as a consequence of femoral access or can occur spontaneously. This study aims to evaluate temporal changes in RH, its predictors, and clinical outcomes in a national cohort of patients undergoing percutaneous coronary intervention in the United Kingdom. METHODS AND RESULTS: We analyzed RH events in patients who underwent percutaneous coronary intervention between 2007 and 2014. Multiple logistic regression models were used to identify factors associated with RH and to quantify the association between RH and 30-day mortality and major adverse cardiovascular events. A total of 511 106 participants were included, and 291 in hospital RH events were recorded (0.06%). Overall, rates of RH declined from 0.09% to 0.03% between 2007 and 2014. The strongest independent predictors of RH events were femoral access (odds ratio [OR], 19.66; 95% confidence interval [CI], 11.22-34.43), glycoprotein IIb/IIIa inhibitor (OR, 2.63; 95% CI, 1.99-3.47), and warfarin use (OR, 2.53; 95% CI, 1.07-5.99). RH was associated with a significant increase in 30-day mortality (OR, 3.59; 95% CI, 2.19-5.90) and in-hospital major adverse cardiovascular events (OR, 5.76; 95% CI, 3.71-8.95). A legacy effect was not observed; patients with RH who survived 30 days did not have higher 1-year mortality compared with those without this complication (hazard ratio, 0.97; 95% CI, 0.49-1.91). CONCLUSIONS: Our results suggest that RH is a rare event that is declining in the United Kingdom, related to transition to transradial access site utilization, but remains a clinically important event associated with increased 30-day mortality but no long-term legacy effect

Sex differences in clinical profile and outcome after percutaneous coronary intervention for chronic total occlusion.

BACKGROUND: There are limited data around sex differences in the risk profile, treatments and outcomes of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lesions in contemporary interventional practice. We investigated the impact of sex on clinical and procedural characteristics, complications and clinical outcomes in a national cohort. METHODS & RESULTS: We created a longitudinal cohort (2006-2018, n = 30,605) of patients with stable angina who underwent CTO PCI in the British Cardiovascular Intervention Society (BCIS) database. Clinical, demographic, procedural and outcome data were analysed in two groups stratified by sex: male (n = 24,651), female (n = 5954). Female patients were older (68 vs 64 years, P < 0.001), had higher prevalence of diabetes mellitus (DM), hypertension (HTN) and prior stroke. Utilization of intravascular ultrasound (IVUS), drug eluting stents (DES), radial or dual access and enabling strategies during CTO PCI were higher in male compared to female patients. Following multivariable analysis, there was no significant difference in in-patient mortality (adjusted odds ratio (OR):1.40, 95 % CI: 0.75-2.61, P = 0.29) and major cardiovascular and cerebrovascular events (MACCE) (adjusted OR: 1.01, 95 % CI: 0.78-1.29, P = 0.96). The crude and adjusted rates of procedural complications (adjusted OR: 1.37, 95 % CI: 1.23-1.52, P < 0.001), coronary artery perforation (adjusted OR: 1.60, 95 % CI: 1.26-2.04, P < 0.001) and major bleeding (adjusted OR: 2.06, 95 % CI: 1.62-2.61, P < 0.001) were higher in women compared with men. CONCLUSION: Female patients treated by CTO PCI were older, underwent lesser complex procedures, but had higher adjusted risk of procedural complications with a similar adjusted risk of mortality and MACCE compared with male patients

组织际关系治理不同影响因素下策略选择的实证研究

组织际关系治理是以企业间的竞争合作为基点,以提高组织间关系的治理绩效、保护专用性投入、增强企业核心技术为目的,是企业获得竞争优势的重要来源。而寻找影响组织际关系治理的关键因素,是提高治理绩效的关键所在,是选择治理策略的重要依据。在相关文献基础上,从多视角出发系统总结了影响组织际关系治理的几年关键因素。实践中可行的治理策略有关系治理,正式治理,以及关系治理下的事前联合计划和事后联合解决问题,正式治理下的股权契约治理手段,提出了一种不同影响因素下的治理策略选择模型,通过因子分析验证问卷设计的信度和效度,通过结构方程和二元逻辑回归得出不同影响因素的治理策略选择

The sternal wire code; Solving the problem of missing coronary artery bypass graft records during cardiac catheterization.

Background: The sternal wire code records details of coronary artery bypass surgery (CABG) inside patients, based on the orientation of wires used for sternal closure. Visible on X-ray, the code overcomes the problem of missing graft-notes needed before repeat angiography. We determined (i) the potential value (ii) acceptability and (iii) accuracy of the code in practice. Methods: (i) Consecutive coronary angiogram reports (2015-2016 Barts, London) were reviewed to identify patients with previous CABG and those with and without graft-notes before angiography. (ii) UK surgeons were surveyed on whether they would insert the code during CABG. (iii) A clinician, blinded to operative details, interpreted 16 post-CABG X-rays, 8 with the code and 8 without. Results: (i) Of 6483 angiography patients, 559 had previous CABG (9.2% (8.5-10%)). Graft-notes were missing in 91/559 (15.1% (12-18%)); almost all (88/91) among patients with acute myocardial infarction. (ii) In the survey, 66/71surgeons (93% (84-98%)) were willing to use the code. (iii) In the accuracy test, all coded X-rays were identified and 28/28 grafts correctly interpreted (p < 0.001). Conclusions: About 1 in 6 patients with previous CABG, who require emergency coronary angiography, undergo this procedure without graft-notes and would benefit from the sternal wire code which appears clinically acceptable and accurate

Coronary physiological assessment in the catheter laboratory: haemodynamics, clinical assessment and future perspectives

No abstract available