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Study: Heart Patients who Undergo Angioplasty Immediately After Heart Catheterization Live Longer than Patients who Wait
Patients who undergo angioplasty immediately after heart catheterization live longer than patients who delay the procedure, according to a recent UAlbany study.
ALBANY, N.Y. (June 9, 2009) -- Heart patients who undergo angioplasty immediately after catheterization live longer than patients who delay the procedure, according to a recent study at the University at Albany School of Public Health published in the Journal of the American College of Cardiology.
Angioplasty, known as percutaneous coronary intervention (PCI), is a procedure involving inflatable balloons that widen narrow or obstructed blood vessels. The number of PCIs in the U.S. has risen dramatically, from some 400,000 procedures in 2000 to 1,265,000 in 2005. Immediate PCI following heart catheterization, or ad hoc PCI, is today the most common method of performing the procedure. Until now, no studies have compared longer-term outcomes for ad hoc and non-ad hoc PCIs.
Study lead author Edward L. Hannan, associate dean for research at the School of Public Health, monitored 46,565 patients who underwent PCI in New York State hospitals between January 1, 2003 and June 30, 2005. Patients receiving ad hoc procedures were of lower risk on average -- they were younger, with stronger heartbeats, less likely to have suffered a previous heart attack, and less likely to have other conditions or diseases. The patients were followed through December 2005, and in-hospital and longer-term outcomes were compared for ad hoc and non-ad hoc PCI patients, after adjusting for differences in pre-procedural risk factors.
The study concluded there was no difference in risk-adjusted in-hospital mortality for ad hoc and non-ad hoc patients, but that ad hoc PCI patients had a significantly lower three-year mortality rate than did non-ad hoc patients. Patients not undergoing ad hoc PCI were 32 percent more likely to die within three years than ad hoc PCI patients. Although ad hoc PCI patients had high instances of additional angioplasties within the first three years, most of those subsequent PCIs occurred in another blood vessel within 30 days of the first PCI.
Potential advantages of performing ad hoc PCI include:
• reduction in medical resources due to the single catheterization laboratory visit and the patient's potentially shorter length of stay
• greater patient satisfaction because performing both procedures at the same time is simpler, less time consuming, and creates less anxiety
• lower risk of kidney damage
• easier access and site management for the cardio surgery team
Potential disadvantages include:
• abbreviated informed patient consent process
• need for immediate decision making by medical professionals regarding the appropriateness of the procedure
• difficulties obtaining surgical backup, particularly on nights and weekends
"There is still a need to carefully monitor the use of ad hoc PCI because since the procedure is usually performed without multidisciplinary consultation or decision making, there is a potential danger that some ad hoc PCI procedures might be rushed or unnecessary," said Hannan.
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