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NCDR Research Network™ News
The latest in NCDR Research
Fourteen abstracts based on data from the NCDR accepted for presentation at AHA Scientific Sessions in Orlando
The NCDR® is pleased to announce that 14 abstracts based on NCDR data have been accepted to the AHA Scientific Sessions 2011, taking place in Orlando November 12-16. Further demonstrating the importance of registries in lifesaving cardiovascular research, these scientific abstracts showcase the breadth and versatility of NCDR data.
The accepted abstracts include one from the NCDR’s practice-based registry − the PINNACLE Registry®; three from ACTION Registry®-GWTG™; seven from the CathPCI Registry®; one from the ICD Registry™; and two from the CARE Registry®. The abstracts are comprised of six posters and eight oral presentations that will be showcased Sunday through Wednesday.
The attached Guide to NCDR Research Posters and Presentations at AHA Scientific Sessions 2011 lists the date, time and location of each presentation. If you will be onsite during the sessions, we invite you to stop by ACC Central, booth 1308, to learn more about NCDR research and to pick up a printed copy of the abstract guide.
Congratulations to Nicholas J. Ruggiero II, MD, FACC and colleagues, whose CathPCI
Registry abstract titled “The Impact of Timing on Carotid
Artery Stenting in the Symptomatic Population” has received special recognition as a Hot Topics Listing.
The NCDR would also like to congratulate Brian Hynes, MD, who has been named poster award winner for his research based on data from the CARE Registry. Dr. Hynes abstract titled, “Outcomes of Carotid Artery Stenting for Recurrent Carotid Artery Restenosis Following Prior Ipsilateral Carotid Artery Endarterectomy or Stenting,” received the highest score among all the abstracts accepted as a poster presentation under Core 6: Catheter-Based and Surgical Interventions.
Recently Published Manuscripts
The following papers based on NCDR data have recently been published in peer-reviewed journals.
Safety and Efficacy of Drug-Eluting Stents in Older Patients with Chronic Kidney Disease, Journal of the American College of Cardiology (JACC)
Comparing the safety and efficacy of drug-eluting stents (DES) with bare-metal stents (BMS) in older patients with chronic kidney disease (CKD), researchers concluded that the safety of DES was similar to BMS for all patients regardless of renal function – and that DES was associated with reduced rates of myocardial infarction (MI) and death in some subsets of patients with CKD.
Researchers analyzed CathPCI Registry data, estimating the glomerular filtration rate (GFR) of 283,593 patients 65 years of age and older who underwent stent implantation between 2004 and 2007. In propensity-matched cohorts grouped by GFR, the association between DES and BMS and the risk of death, MI, revascularization, and major bleeding was examined.
Results showed that a total of 121,446 (42.8%) of these patients had CKD (GFR<60 ml/min/1.73m2). The 30-month mortality rate for patients on long-term dialysis was 52.2% after stent implantation. In propensity-matched pairs, placement of a DES compared with a BMS in patients with normal renal function was associated with significant reductions in 30-month revascularization, MI and death but no difference in bleeding. In patients with baseline CKD, a DES compared with a BMS was associated with significant reductions in MI and death but not revascularization.
“Physicians can take some comfort in knowing that there does not appear to be a detectable increase in follow-up risk of hard endpoints such as death, MI and bleeding if they choose to use a DES instead of a BMS in this patient population,” said Lead Author Thomas Tsai, MD.
Click here to read more.
Characteristics and In-hospital Outcomes of Patients with Non-ST-segment Elevation Myocardial Infarction and Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention, JACC Cardiovascular Interventions
It is known that in patients with acute coronary syndrome, the presence of renal dysfunction is associated with an increased risk of death and major bleeding.
Seeking to evaluate the characteristics, therapies, and outcomes of patients with chronic kidney disease (CKD) presenting with non–ST-segment elevation myocardial infarction (NSTEMI) and managed with percutaneous coronary intervention (PCI), researchers examined data from the ACTION Registry-GWTG for 40,074 NSTEMI patients managed with PCI.
Findings from the study showed that CKD patients presenting with NSTEMI and managed with PCI have more comorbidities and receive guideline-recommended therapies less frequently than do patients without CKD. CKD is strongly associated with in-hospital mortality and bleeding in NSTEMI patients undergoing PCI.
Click here to read more.
Left Circumflex Occlusion in Acute Myocardial Infarction (from the NCDR), American Journal of Cardiology
Compared to occlusions of other major coronary arteries, patients presenting with acute left circumflex (LCx) occlusion usually have ST-segment elevation on the electrocardiogram <50% of the time, potentially delaying treatment and resulting in worse outcomes.
With this knowledge, researchers sought to better understand the clinical outcomes of patients with LCx territory occlusion without ST-segment elevation myocardial infarction (STEMI). Analyzing CathPCI Registry data captured between April 2004 and June 2009, researchers identified patients with myocardial infarction treated with percutaneous coronary intervention (PCI) for culprit LCx territory occlusion, excluding those with previous coronary artery bypass grafting.
The research showed that patients with STEMI were more likely to have a proximal LCx culprit lesion and had greater risk-adjusted in-hospital mortality compared to patients with NSTEMI. Findings also showed that acute LCx territory occlusion often presents as NSTEMI, but patients with NSTEMI and occlusion have a lower mortality risk than those with STEMI, possibly because of factors such as the amount of myocardium involved, the lesion location along the vessel, and/or a dual blood supply.
Click here for the full abstract.
Use of Early Clopidogrel by Reperfusion Strategy Among Patients Presenting With ST-Segment Elevation Myocardial Infarction, Circulation Cardiovascular Quality and Outcomes
Seeking to understand how practice has been affected by the 2007 update of the ACC/AHA Guidelines for STEMI patients recommending the addition of clopidogrel to aspirin regardless of reperfusion strategy, with a bolus dose in patients under 75 years of age, researchers evaluated use and dose of early clopidogrel among 52,140 STEMI patients enrolled in 368 hospitals participating in ACTION Registry-GWTG between January 2007 and September 2009.
Clopidogrel was administered early to 97% of primary PCI, 18% of fibrinolytic, and 6% of non-reperfused patients. Among patients receiving clopidogrel, a loading dose (≥300 mg) was often used in primary PCI (91%) but less frequently among fibrinolysis-treated (83%) and non-reperfused patients (74%). Use of clopidogrel was associated with a significant increase in major bleeding only among older patients in the no-reperfusion group. A significantly lower risk of in-hospital death was associated with clopidogrel use across all reperfusion strategies.
These findings indicate that early clopidogrel use has not yet extended to the routine care of STEMI patients treated with fibrinolysis or to those not receiving reperfusion as recommended in the guideline update.
Click here for the full abstract.
For more information about NCDR research and how analysis of NCDR data can be used to answer healthcare delivery and clinical questions, visit www.ncdr.com/research.
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