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NCDR Research Network™ News
The latest in NCDR Research
Dual Chamber ICD Selection is Associated with Increased Complication Rates and Mortality Among Patients Enrolled in the NCDR® ICD Registry™
Findings from a recent paper based on NCDR data show that dual chamber implantable cardioverter-defibrillator (ICD) implantation is associated with both increased periprocedural complications and in-hospital mortality when compared to single chamber ICD implantation.
Seeking to better understand implantation and complication rates associated with single versus dual chamber ICDs, researchers examined 104,049 patient records captured by the ICD Registry™ between January 2006 and December 2007.
Published in the Journal of the American College of Cardiology, the findings show that dual chamber devices were implanted in 62% of patients, with 40% of these patients having fulfilled an indication for dual chamber pacing. Adverse events were more frequent with dual versus single chamber device implantation (3.17% vs. 2.11%, P < 0.001), as was the rate of in-hospital mortality (0.40% vs. 0.23%, P < 0.001). After adjusting for demographics, medical comorbidities, diagnostic test data and ICD indication, the odds of any complication (OR, 1.40; 95% confidence interval (CI) 1.28 – 1.52, P < 0.001) and in-hospital mortality (OR, 1.45; 95% CI 1.20 – 1.74, P < 0.001) were increased with dual versus single chamber ICD implantation.
“In addition to demonstrating the risks associated with dual chamber devices, this investigation highlights the large number of patients in the United States who are receiving dual chamber ICDs without a simultaneous indication for a pacemaker — suggesting that even in the absence of a need for cardiac pacing implanting physicians currently view the addition of an atrial lead as beneficial,” said lead author Thomas A. Dewland, MD.
“We believe this investigation demonstrates the need for further study of the clinical benefit of dual chamber ICDs and that in the absence of such data, routine use of dual chamber ICDs should be reevaluated,” concluded Dewland.
To read the article abstract, click here. For a Journal Scan Summary, visit CardioSource.org. Click here to register for a free CardioSource account.
Percutaneous Coronary Intervention in Native Arteries vs. Bypass Grafts in Prior Coronary Bypass Grafting Patients: A Report from the CathPCI Registry®
Findings from a recent paper published in JACC: Cardiovascular Interventions show that most interventions in post coronary artery bypass graft surgery (CABG) patients are performed in native coronary arteries and that patients undergoing bypass graft interventions had higher mortality compared to those who underwent native coronary artery intervention.
Researchers analyzed CathPCI Registry data captured for 1,721,046 CABG patients who underwent percutaneous coronary intervention (PCI) between January of 2004 and June of 2009 to identify the vessel most frequently targeted for during the procedure; uncover predictors of PCI in native coronary arteries vs. bypass grafts; and compare the clinical characteristics and outcomes of prior CABG patients who underwent native coronary artery vs. bypass graft PCI.
During the study period, PCI in prior CABG patients represented 17.5% of the total PCI volume. The PCI target was a native coronary artery in 62.5% of patients and a bypass graft in 37.5%: saphenous vein grafts (SVGs) (104,678 - 34.9%), arterial grafts (7,517 - 2.5%) or both arterial grafts and SVGs (718, 0.2%). Compared with prior CABG patients who underwent native coronary artery PCI, those who underwent bypass graft PCI had higher risk characteristics and more procedural complications. On multivariable analysis, several parameters (including the presence of graft stenosis and longer interval from CABG) were associated with performing bypass graft rather than native coronary PCI and bypass graft PCI was associated with higher in-hospital mortality (adjusted odds ratio 1.22, 95% CI 1.12, 1.32).
“Our findings suggest that meticulous imaging of both native coronary arteries and bypass grafts is important for post CABG patients who require coronary angiography and that non-invasive coronary artery imaging may not be optimal in such patients because it cannot always adequately visualize the frequently heavily diseased native coronary arteries,” said lead author Emmanouil S. Brilakis, MD, PhD, FACC.
“Moreover, our study shows that post CABG patients who underwent native coronary artery intervention had lower in-hospital mortality than those who underwent bypass graft intervention. This finding supports the current empiric rule that intervention of a native coronary artery is preferable to intervention in a bypass graft, especially a saphenous vein graft, if technically feasible,” concluded Dr. Brilakis.
To read the article abstract, click here. For a Journal Scan Summary, visit CardioSource.org. Click here to register for a free CardioSource account.
Practice-Level Variation in Warfarin Use Among Outpatients With Atrial Fibrillation (from the NCDR® PINNACLE Registry®)
A new paper published in the American Journal of Cardiology shows notable variations in the use of warfarin in the treatment of moderate to high-risk atrial fibrillation (AF) patients.
While prior studies have examined use of warfarin — a treatment considered to be complex but highly effective in decreasing thromboembolic risk in AF patients — researchers set out to better understand the extent of practice-level variation in warfarin use and contemporary warfarin treatment rates in AF before the expected introduction of newer anticoagulants.
Using data from the PINNACLE Registry, researchers identified 9,113 outpatients with nonvalvular AF who were at moderate to high risk for stroke (congestive heart failure, hypertension, age, diabetes, stroke score >1) and would be optimally treated with warfarin. Overall rate of warfarin treatment was only 55.1% (5,018 of 9,913). Untreated patients and treated patients had mean congestive heart failure, hypertension, age, diabetes, stroke scores of 2.5 (p = 0.38) and similar rates of heart failure, hypertension, diabetes mellitus, and previous stroke, suggesting an almost “random” pattern of treatment. At the practice level, however, there was substantial variation in treatment ranging from 25% to 80% (interquartile range for practices 50 to 65), with a median rate ratio of 1.31 (1.22 to 1.55, p <0.001).
“The findings suggest important opportunities for practice-level improvement in stroke prevention for outpatients with AF and define a benchmark treatment rate before the introduction of newer anticoagulant agents,” stated the authors.
Despite being a performance measure for AF as outlined in the ACCF/AHA/AMA PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension, these large observed variations highlight the need for future studies to identify specific provider or practice-level factors that may be responsible for variations in warfarin use across practices.
“These findings may prompt further investigation as to why some practices perform better than others in providing effective anticoagulation to patients with atrial fibrillation,” said lead author Paul Chan, MD, FACC.
To read the article abstract, click here. For a Journal Scan Summary, visit CardioSource.org.
A free subscription is required to view CardioSource Journal Scan Summaries. Please click here to register for a free CardioSource.org account.
For more information about how analysis of NCDR data is being used to answer healthcare delivery and clinical questions, visit www.ncdr.com/research.
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