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BACKGROUND:Techniques for percutaneous coronary intervention (PCI) have evolved over the last decade. However, there is not enough data on recent trends among high-risk groups, particularly patients with a Coronary Artery Bypass Graft (CABG). This study examines current PCI outcomes in older patients with Acute Coronary Syndrome (ACS) and a history of CABG. It aims to provide useful insights for this vulnerable group. METHODS:We analyzed the 2016-2020 National Inpatient Sample database along with the relevant ICD-10-CM codes. The focus was on PCI outcomes for ACS patients aged 65 and older who have a history of CABG. We measured primary outcomes to evaluate observed trends. RESULTS:Out of 94,610 patients, 74.5% were male, and 84.1% were white, with a median age of 75 years. A significant 94.6% underwent non-elective PCI. Common additional health issues included hyperlipidemia (83.7%), smoking (40%), complicated diabetes (34.6%), and hypertension (53.7%). We found statistically significant differences in post-catheterization-related bleeding, post-procedural respiratory failure, and Impella usage after PCI (all P<0.001). There were declining trends in PC-B (1.5% in 2016 vs. 0.7% in 2020, P<0.001) and PP-RF (0.3% in 2016 vs. 0.2% in 2020, P<0.001), with an increase in Impella usage post-PCI (1.2% in 2016 vs. 2.1% in 2020). There were declining trends in postcatheterization bleeding (1.5% [95% CI: 1.2-1.8] in 2016 vs. 0.7% [95% CI: 0.5-0.9] in 2020, P<0.001) and post-procedural respiratory failure (0.3% [95% CI: 0.2-0.4] vs. 0.2% [95% CI: 0.1-0.3], P<0.001), with an increase in Impella use (1.2% [95% CI: 1.0-1.5] vs. 2.1% [95% CI: 1.8-2.4], P<0.001). Following PCI, there were no statistically significant differences in outcomes such as All-Cause Mortality (ACM), Intracranial Bleed (IC-B), Cardiac arrest (CA), Postprocedural Stroke (PP-S), Cardiogenic Shock (CS), and intra-aortic balloon pump (IABP) and Intra-Aortic Balloon Pump (IABP) usage. DISCUSSION:Our study showed improved bleeding outcomes and postprocedural respiratory failure. We also noticed a rising trend in Impella use among older CABG patients with ACS. This trend reflects advances in coronary intervention technology and improved access techniques. However, there were no statistical differences in ACM, IC-B, CA, PP-S, CS, and IABP use. This underscores the complexity of the anatomy, the challenges of the procedure, and the high-risk nature of the population. It calls for a tailored approach to these patients to achieve better outcomes.
Abstract: Background: Cangrelor is a direct-acting intravenous P2Y12 inhibitor with a rapid onset of action and a short, predictable offset that allows platelet function to return to baseline within an hour of discontinuation. Given these advantages, cangrelor has been increasingly used to decrease the risk of perioperative and procedural complications in acute coronary syndrome (ACS) patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Objectives: To compare the ischemic and safety outcomes between IV cangrelor and oral P2Y12 inhibitors in patients of ACS undergoing revascularisation. Methods: A systematic search was conducted of PubMed/MEDLINE, Cochrane Library, ScienceDirect, and ClinicalTrials.gov was conducted from inception to 2024 for randomized clinical trials or observational cohorts comparing IV cangrelor with oral P2Y12 inhibitors among ACS patients undergoing revascularisation. Data was independently reviewed and screened by two reviewers and pooled using a random effects meta-analysis model. Results: Four studies including 25,881 participants were analyzed. Compared to oral P2Y12 inhibitors, cangrelor demonstrated significantly lower risk of stent thrombosis Across all included studies, patient demographics and baseline risk profiles were similar. Cangrelor was associated with a significantly lower incidence of stent thrombosis (OR 0.56; 95% CI 0.40–0.80; p=0.004) and higher bleeding risk (OR 1.46; 95% CI 1.22–1.74; p<0.0001). Conclusion: IV cangrelor reduces the risk of stent thrombosis without increasing the risk of other major adverse cardiovascular events, but at the cost of increased major bleeding. Its use may be most appropriate when rapid, reversible platelet inhibition is required, warranting careful clinical judgment.
BACKGROUND:Electrocardiographic artifacts can present as pseudo-arrhythmia, such as ventricular tachycardia (VT), leading to unnecessary interventions. CASE SUMMARY:A 47-year-old woman with hypertension, asthma, obstructive sleep apnea, lupus/Sjögren disease, and schizoaffective disorder was admitted for failure to thrive. Telemetry suggested polymorphic and monomorphic VT, prompting a rapid response. She was asymptomatic and hemodynamically stable, with a pulse 93/min. A baseline tremor was noted. Post-rapid-response electrocardiogram revealed an normal sinus rhythm with a QTc interval of 460 milliseconds. Preserved QRS complexes were seen to be embedded within the observed VT on telemetry review. Identification of the artifact pattern prevented further unwarranted interventions. DISCUSSION:Tremor-induced artifacts can present as compelling VT mimics. Stable hemodynamics, concealed QRS complexes, and bedside examination are crucial in distinguishing pseudo-arrhythmia from true arrhythmia. TAKE-HOME MESSAGES:Electrocardiographic artifacts should be considered in clinically stable patients with telemetry VT alarms. Careful holistic approach to such alarms can avoid unnecessary invasive procedures and antiarrhythmic use.
