Publications

We sought to examine whether statin therapy before percutaneous coronary intervention results in reduction in contrast-induced nephropathy (CIN). Intravascular administration of contrast media can have nephrotoxic effects, particularly in patients with baseline renal insufficiency. Along with lowering serum cholesterol, statins have pleiotropic effects in the vasculature. The effect of statin use on CIN is unknown.

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous cardiovascular procedures. Heightened interest in procedural outcomes has led to the development of regional, state, and national databases for outcome assessment and, in some cases, for public reporting. In particular, the development and validation of risk-adjustment models for coronary artery bypass graft surgery (CABG) mortality has led to the development of report cards for cardiac surgery.

We evaluated the frequency and prognosis of emergency coronary artery bypass grafting (CABG) after percutaneous coronary intervention (PCI) for acute myocardial infarction in a large, multicenter registry of contemporary PCI. In this study, emergency CABG occurred in 2% of cases, and was associated with high in-hospital mortality (20%) and with a high incidence of stroke (8%), renal failure requiring dialysis (8.3%), and bleeding (63.3%).

Prediction of individual patient outcomes can be of particular value during discussions with patients and families of prognosis before and after percutaneous coronary interventions (PCI), and in clinical decision making. Recently, risk-adjustment models for PCI mortality were developed and used to compare specific, aggregate outcomes of operators. However, application of these models to prediction of individual patient outcomes remains untested.

Blood transfusions are a relatively common occurrence after performing any percutaneous coronary intervention (PCI). Although guidelines for blood transfusion have been previously specified, retrospective analysis of transfusion practices have suggested that these guidelines are rarely applied. We describe a model for the application of a continuous quality improvement program including benchmarking and available guidelines for blood transfusion, aimed toward reducing transfusion rates among patients undergoing PCI.

Studies have shown poor prognostic implications of anemia in patients with myocardial infarction (MI) and in patients undergoing percutaneous coronary intervention (PCI). The impact of blood transfusion in these populations remains controversial. The objective of this study was to examine the effect of transfusion on in-hospital mortality in anemic patients undergoing PCI for MI. Data from 67,051 PCIs (June 1, 1997 to January 31, 2004) were prospectively collected in a multicenter registry (Blue Cross Blue Shield of Michigan Cardiovascular Consortium).

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group.