Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: Insights from a national database
Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: Insights from a national database
AIMS: Pre-procedural ventilation is a marker of high risk in PCI patients. Causes include out-of-hospital cardiac arrest (OHCA) and cardiogenic shock. OHCA occurs in approximately 60,000 patients in the UK per annum. No consensus exists regarding the need/timing of coronary angiography ± revascularization without ST elevation. The aim was to describe the national variation in the rate of emergency PCI in ventilated patients.
METHODS AND RESULTS: Using the UK national database for PCI in 2013, we identified all procedures performed as 'emergency' or 'salvage' for whom ventilation had been initiated before the PCI. Of the 92,589 patients who underwent PCI, 1342 (5.5%) fulfilled those criteria. There was wide variation in practice. There was no demonstrable relationship between the number of emergency PCI patients with pre-procedure ventilation per annum and (i) total number of PPCIs in a unit (r=-0.186), and (ii) availability of 24h PCI, (iii) on-site surgical cover.
CONCLUSION: We demonstrated a wide variation in practice across the UK in rates of pre-procedural ventilation in emergency PCI. The majority of individuals will have suffered an OHCA. In the absence of a plausible explanation for this discrepant practice, it is possible that (a) some patients presenting with OHCA that may benefit from revascularization are being denied treatment and (b) procedures may be being undertaken that are futile. Further prospective data are needed to aid in production of guidelines aiming at standardized care in OHCA.
Aged, Databases, Factual, Emergencies, Female, Healthcare Disparities/trends, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/diagnosis, Percutaneous Coronary Intervention/adverse effects, Practice Patterns, Physicians'/trends, Process Assessment (Health Care)/trends, Respiration, Artificial/adverse effects, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United Kingdom
250-254
Rawlins, John
f3a7a25c-c8b2-477a-b441-ce9704a7a331
Ludman, Peter F.
ed96bc44-311b-4a55-88d9-ce83bab3e791
O'Neil, Darragh
759f9dad-0fb9-40da-9be3-04716c4fe432
Mamas, Mamas A.
41515b72-75ff-4922-bb9f-8f9c63f9f5af
de Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Redwood, Simon
8797e4d9-0d8c-4b41-83be-e47d3e8c23c1
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Whittaker, Andrew
15b90577-3082-44e2-b238-d33da58bad1e
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
June 2017
Rawlins, John
f3a7a25c-c8b2-477a-b441-ce9704a7a331
Ludman, Peter F.
ed96bc44-311b-4a55-88d9-ce83bab3e791
O'Neil, Darragh
759f9dad-0fb9-40da-9be3-04716c4fe432
Mamas, Mamas A.
41515b72-75ff-4922-bb9f-8f9c63f9f5af
de Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Redwood, Simon
8797e4d9-0d8c-4b41-83be-e47d3e8c23c1
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Whittaker, Andrew
15b90577-3082-44e2-b238-d33da58bad1e
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Rawlins, John, Ludman, Peter F., O'Neil, Darragh, Mamas, Mamas A., de Belder, Mark, Redwood, Simon, Banning, Adrian, Whittaker, Andrew and Curzen, Nick
(2017)
Variation in emergency percutaneous coronary intervention in ventilated patients in the UK: Insights from a national database.
Cardiovascular Revascularization Medicine : including molecular interventions, 18 (4), .
(doi:10.1016/j.carrev.2017.02.005).
Abstract
AIMS: Pre-procedural ventilation is a marker of high risk in PCI patients. Causes include out-of-hospital cardiac arrest (OHCA) and cardiogenic shock. OHCA occurs in approximately 60,000 patients in the UK per annum. No consensus exists regarding the need/timing of coronary angiography ± revascularization without ST elevation. The aim was to describe the national variation in the rate of emergency PCI in ventilated patients.
METHODS AND RESULTS: Using the UK national database for PCI in 2013, we identified all procedures performed as 'emergency' or 'salvage' for whom ventilation had been initiated before the PCI. Of the 92,589 patients who underwent PCI, 1342 (5.5%) fulfilled those criteria. There was wide variation in practice. There was no demonstrable relationship between the number of emergency PCI patients with pre-procedure ventilation per annum and (i) total number of PPCIs in a unit (r=-0.186), and (ii) availability of 24h PCI, (iii) on-site surgical cover.
CONCLUSION: We demonstrated a wide variation in practice across the UK in rates of pre-procedural ventilation in emergency PCI. The majority of individuals will have suffered an OHCA. In the absence of a plausible explanation for this discrepant practice, it is possible that (a) some patients presenting with OHCA that may benefit from revascularization are being denied treatment and (b) procedures may be being undertaken that are futile. Further prospective data are needed to aid in production of guidelines aiming at standardized care in OHCA.
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e-pub ahead of print date: 13 February 2017
Published date: June 2017
Keywords:
Aged, Databases, Factual, Emergencies, Female, Healthcare Disparities/trends, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/diagnosis, Percutaneous Coronary Intervention/adverse effects, Practice Patterns, Physicians'/trends, Process Assessment (Health Care)/trends, Respiration, Artificial/adverse effects, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United Kingdom
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Local EPrints ID: 435642
URI: http://eprints.soton.ac.uk/id/eprint/435642
ISSN: 1878-0938
PURE UUID: b0f46e6e-e483-48c2-870d-be74d01db08c
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Date deposited: 15 Nov 2019 17:30
Last modified: 17 Mar 2024 03:02
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Author:
John Rawlins
Author:
Peter F. Ludman
Author:
Darragh O'Neil
Author:
Mamas A. Mamas
Author:
Mark de Belder
Author:
Simon Redwood
Author:
Adrian Banning
Author:
Andrew Whittaker
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