ABSTRACT
BACKGROUND: Coronary heart disease remains one of the leading causes of mortality and morbidity in New Zealand (NZ) and globally. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme includes the CathPCI registry which records all those referred for diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) in NZ. We present the methods and three-years of data from the ANZACS-QI CathPCI registry. METHODS: The data was extracted from the ANZACS QI CathPCI registry from 01/09/2014 to 24/09/2017. The ANZACS-QI data dictionary defines all the clinical, procedural and outcomes variables collected, and standard statistical analyses were applied. RESULTS: 40,870 patients underwent cardiac catheterisation, with a mean age of 65 years, and males making up 67% of the cohort. Indications included acute coronary syndrome 55%, angina with suspected stable coronary disease 28%, valve surgery workup 8%, planned PCI 3%, heart failure/cardiomyopathy 3%, arrhythmia 1% and other 2%. For those undergoing DCA alone, radial access was used in 85% and two-thirds had at least one major artery with >50% stenosis. PCI was performed in 39% of patients. Drug-eluting stents were used in 97%. CONCLUSION: The CathPCI registry records the characteristics and outcomes of all patients undergoing DCA and PCI in NZ hospitals. As part of the ANZACS-QI programme the registry provides an important platform for quality improvement, research and to inform clinical practice.
Subject(s)
Acute Coronary Syndrome , Percutaneous Coronary Intervention , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/epidemiology , Aged , Coronary Angiography , Humans , Male , New Zealand/epidemiology , Quality Improvement , RegistriesABSTRACT
BACKGROUND: Approximately 5% of coronary angiographies detect LMS disease >50%. Recent randomized trials showed PCI has comparable outcomes to coronary artery bypass grafting (CABG) in low or intermediate risk candidates. In clinical practice, PCI is frequently utilized in those with prohibitive surgical risk. We reviewed contemporary national results of percutaneous coronary intervention (PCI) for left main coronary disease (LMS) disease in New Zealand. METHODS: All patients undergoing PCI for LMS disease from 01/09/2014-24/09/2017 were extracted from the All New Zealand Acute Coronary Syndrome-Quality Improvement registry with national dataset linkage, analyzing characteristics and in-hospital outcomes. RESULTS: The cohort included 469 patients, mean age 70.8⯱â¯10.7â¯years, male 331 (71%), and the majority 339 (72%) were unprotected LMS. Indications include ST-elevation myocardial infarction (STEMI) 83 (18%) and NSTEMI or unstable angina 229 (49%). Compared with protected LMS, unprotected LMS were more likely to present with an acute coronary syndrome (73% versus 48%, Pâ¯<â¯0.001), and to die in-hospital (9.4% versus 3.9%, Pâ¯=â¯0.045). In those with unprotected LMS, in-hospital mortality after acute STEMI PCI was higher than for other indications (21.1% versus 6.1%, Pâ¯<â¯0.001). Independent predictors of in-hospital death and major adverse cardiovascular events included STEMI, femoral access and worse renal function. CONCLUSION: Our LMS PCI cohort had high mortality rates, especially those presenting with STEMI and an unprotected LMS. This reflects the contemporary real-world practice of LMS PCI being predominantly performed in high risk patients which differs from randomized trial populations, and this should be considered before comparing with CABG outcomes.
Subject(s)
Acute Coronary Syndrome/therapy , Angina, Unstable/therapy , Coronary Artery Disease/therapy , Non-ST Elevated Myocardial Infarction/therapy , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/therapy , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/mortality , Aged , Aged, 80 and over , Angina, Unstable/diagnostic imaging , Angina, Unstable/mortality , Coated Materials, Biocompatible , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , New Zealand , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Non-ST Elevated Myocardial Infarction/mortality , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/mortality , Prospective Studies , Recurrence , Registries , Risk Factors , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/mortality , Stents , Time Factors , Treatment OutcomeSubject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Disease/therapy , Electrocardiography , Lithotripsy , Vascular Calcification/therapy , Aged , Angioplasty, Balloon, Coronary/instrumentation , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Drug-Eluting Stents , Female , Humans , Predictive Value of Tests , Severity of Illness Index , Treatment Outcome , Vascular Calcification/diagnosis , Vascular Calcification/physiopathologyABSTRACT
Laparoscopic cholecystectomy is one of the most commonly performed operations in New Zealand. Unretrieved peritoneal gallstones occur in 2% of people and abscess formation is the most common resulting complication. This is the first time unretrieved peritoneal gallstones have been reported to cause a complex collection involving the pleural space and soft tissues of the back.
