Predicting PCI Outcomes

The Particulars: The risk assessment score ACEF (age, creatinine level, and ejection fraction) has previously been used to predict outcomes in cardiovascular patients. It is calculated by dividing age by ejection fraction and adding 1 to the score if creatinine levels are greater than 2 mg/dL. The ACEF score has been validated in randomized trials of cardiovascular patients but has not been evaluated in routine clinical practice for PCI recipients.

Data Breakdown: A study of patients undergoing PCI in routine clinical practice found that 21.2% of those in the high ACEF tertile had the highest 3-year death rate. Rates were 7.8% for those in the middle tertile and 3.3% in the low tertile.

Take Home Pearl: In patients undergoing PCI in routine clinical practice, the ACEF risk assessment score appears to be a good predictor of mortality.

Radiation Exposure: Comparing Radial & Femoral Routes [back to top]

The Particulars: Data on PCI- and coronary angiography-related radiation exposure when the radial and femoral routes are used are limited. The current evidence base has also been contradictory.

Data Breakdown: Between June 2004 and December 2008, 3,973 patients who had PCI or coronary angiography were assessed in a study. The average radiation exposure for those who underwent PCI via the femoral route was 112 Gy-cm², compared with 106 Gy-cm² for those who underwent the procedure via the radial route. Average exposures for patients who underwent coronary angiography were 59 Gy-cm² for the femoral route and 52 Gy-cm² for the radial route.

Take Home Pearl: Radiation exposure for patients undergoing PCI or angiography does not appear to be elevated with transradial access when compared with femoral access.

Gender Differences After MI in PCI Recipients [back to top]

The Particulars: Studies have shown that there are clear gender differences in risk profiles for patients presenting with myocardial infarction (MI). However, outcomes for men and women with STEMI who undergo PCI are not as clear.

Data Breakdown: An analysis of 3-year data from the HORIZONS-AMI trial found that women with STEMI undergoing PCI had a 77% higher risk of major bleeding after an MI than men. Women also had slightly more major adverse cardiovascular events than men (24.0% vs 21.2%), including death, reinfarction, stroke, and ischemic target vessel revascularization.

Take Home Pearls: At 3 years after an MI, women appear to have significantly more major adverse cardiovascular events than men, particularly major bleeding. However, little difference was observed in overall major adverse cardiovascular events.

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