Validation of the academic research consortium high bleeding risk definition in Thai PCI registry.

BACKGROUND: Bleeding following percutaneous coronary intervention (PCI) has important prognostic implications. The Academic Research Consortium (ARC) have identified a set of clinical criteria to standardize the definition of a high bleeding risk (HBR). Current study sought to externally validate the ARC definition for HBR patients in a contemporary real-world cohort. METHOD: This post hoc analysis included 22,741 patients undergoing PCI between May 2018 and August 2019 enrolled in Thai PCI Registry. The primary endpoint was the incidence of major bleeding at 12 months post index PCI. RESULTS: In total, 8678 (38.2%) and 14,063 (61.8%) patients were stratified to the ARC-HBR and non-ARC-HBR groups, respectively. Incidence of major bleeding was 3.3 and 1.1 per 1000 patients per month in the ARC-HBR group and the non-ARC-HBR group (HR 2.84 [95% CI: 2.39-3.38]; p < 0.001). Advanced age and heart failure met the 1-year major criteria performance goal of ≥4% major bleeding. The impact of HBR risk factors was incremental. HBR patients also experienced significantly higher rates of all-cause mortality (19.1% versus 5.2%, HR 4.00 [95% CI: 3.67-4.37]; p < 0.001) and myocardial infarction. The ARC-HBR score fairly performed in discriminating bleeding with C-statistic (95% CI) of 0.674 (0.649, 0.698). Updating the ARC-HBR by adding heart failure, prior myocardial infarction, non-radial access, female in the model significantly improved C-statistic of 0.714 (0.691, 0.737). CONCLUSIONS: The ARC-HBR definition could identify patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria unveiled additive prognostic value.

Comparison on the efficacy and the safety of transradial approach versus conventional transfemoral approach for cardiac catheterization procedures.

OBJECTIVE: To compare the efficacy and safety of transradial approach (TR) and conventional transfemoral approach (TF) for cardiac catheterization procedures. MATERIAL AND METHOD: The data were collected retrospectively of all patients that received cardiac catheterization at Thammasat University Cardiac Center between September 1, 2010 and August 31, 2011 (the first year ofTR approach). RESULTS: Cardiac catheterization was performed on 597 patients. TR approach was performed about one-sixth of all procedures compared to conventional TF approach, 93 (15.58%) vs. 504 (84.42%). Safety of TR approach at the beginning was similar to conventional TF approach including in-hospital complication rate 5.4% vs. 4.6%, p = 0.788, volume of contrast media used 90.63±66.83 vs. 97.89±64.52 milliliters, p = 0.323, radiation exposure defined as median/min-max estimate skin entrance radiation dose 833.35/133.15-8,913.42 vs. 910.00/76.78-13,719.88 mGy, p = 0.599, and dose-area product 63.03/7.87-494.52 vs. 70.85/5.77-829.16 Gy x cm2, p = 0.586. The efficacy defined as procedural success rate was significantly higher in the conventional TF approach 90.3% vs. 97.8%, p = 0.001, as well as the procedural time that showed insignificantly longer 54.03±39.40 vs. 47.37?39.86 minutes, p = 0.139. This statistical diference in the procedural success rate was clear only in the first 62 TR. After this learning curve period, the procedural success rate was similar 96.8% vs. 97.6%, p = 0.575. Both the procedural success rate and the procedural time in TR approach showed trend to achieve better outcomes according to the increasing number of TRprocedures; 87.1% vs. 87.1% vs. 96.8%, p = 0.331 and 64.68±51.90 vs. 52.45±31.94 vs. 44.97±29.04 minutes, p = 0.139 in the first 31 vs. the 32nd to the 62nd, and the 63rd to the 93" cases respectively. CONCLUSION: The safety of the transradial approach for cardiac catheterization procedures was similar to conventional transfemoral approach. The learning curve period was needed but its length is acceptable before the same efficacy rate as the conventional transfemoral procedure was achieved.

Using digital ECG consultation system to facilitate cases for ST-elevation MI in Saraburi Hospital.

OBJECTIVE: To study the efficacy of fast track managed care and in-hospital outcomes after applying the Applied Digital 12 leads ECG Consultation System (ADECS) to the routine ST segment elevation myocardial infarction (STEMI) fast track guideline in Saraburi Hospital. MATERIAL AND METHOD: The data were collected from a prospective registry of all chest discomfort patients who were admitted by STEMI fast track care between January 1, 2008 and October 31, 2010. RESULTS: Two hundred forty eight STEMI patients were divided into two groups (before; n = 123 and after applying ADECS; n = 125). Mean age was 62.35 +/- 12.85 years and 70.2% were male. Common atherosclerosis risk factors were dyslipidemia (80.2%), hypertension (71.8%) and smoking (40.7%). The agreement of STEMI diagnosis between emergency department (ED) and ward improved from moderate to good level (Kappa value = 0.602; p < 0.001 vs. 0.718; p < 0.001). Mean/median of door to needle time (DTNT) and percentage of STEMI patients receiving thrombolytic therapy who achieved DTNT within 30 minutes were significantly improved, showing 73.24 +/- 54.78/65 vs. 46.05 +/- 33.88/30 minutes; p < 0.001 and 6% vs. 50.6%; p < 0.001 respectively. Mean/median of total ischemic time (TIT) was not different, 250.13 +/- 139.09/225 vs. 254.21 +/- 163.12/226 minutes; p = 0.873 due to long symptom onset to hospital arrival time (SHAT), 176.90 +/- 130.08/145 vs. 208.16 +/- 167.38/165 minutes; p = 0.218, which corresponded to the same of all in-hospital outcomes. Only the TIT within 180 minutes could show decreasing mortality rate but statistically insignificant, 13.5% vs. 20.7%; p = 0.369. Major bleeding complication was not different between thrombolytic infusion at ward or at ED, 4.1% vs. 4.8%; p = 1.00. CONCLUSION: ADECS should be included in routine fast track care and thrombolysis should be initiated infusion in Emergency Department for all STEMI patients. Short DTNT was not enough to improve in-hospital outcomes. The continuous improvement should be focused on the SHAT and routine practice with quality assessment process.