In Hospital Outcomes for High-Risk Percutaneous Coronary Intervention (PCI) in Patients Referred From a Rural Centre to Metropolitan Sites

Rajan Rehan; Elise Kempler; Kath McMaster; Gabrielle Larnach; David Amos; Alex Elder; Ruth Arnold; Craig Juergens; Sanjay Patel; James Weaver; Martin Ng; Probal Roy; Andy Yong; David Brieger; Leonard Kritharides; Mark Adams; Harry C Lowe

doi:10.1016/j.hlc.2021.07.015

In Hospital Outcomes for High-Risk Percutaneous Coronary Intervention (PCI) in Patients Referred From a Rural Centre to Metropolitan Sites

Heart Lung Circ. 2022 Feb;31(2):224-229. doi: 10.1016/j.hlc.2021.07.015. Epub 2021 Aug 12.

Authors

Rajan Rehan¹, Elise Kempler², Kath McMaster³, Gabrielle Larnach³, David Amos³, Alex Elder³, Ruth Arnold³, Craig Juergens⁴, Sanjay Patel⁵, James Weaver¹, Martin Ng⁶, Probal Roy⁷, Andy Yong⁷, David Brieger⁸, Leonard Kritharides⁷, Mark Adams⁶, Harry C Lowe⁹

Affiliations

¹ Cardiology Departments, Orange Health Service, Orange, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
² Royal Prince Alfred Hospital, Sydney, NSW, Australia.
³ Cardiology Departments, Orange Health Service, Orange, NSW, Australia.
⁴ Cardiology Departments, Orange Health Service, Orange, NSW, Australia; The Southwest Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁵ Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
⁶ Cardiology Departments, Orange Health Service, Orange, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Strathfield Private Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
⁷ Concord Repatriation General Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
⁸ Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia; Strathfield Private Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
⁹ Cardiology Departments, Orange Health Service, Orange, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia. Electronic address: h.lowe@bigpond.net.au.

PMID: 34391688
DOI: 10.1016/j.hlc.2021.07.015

Abstract

Background: Cardiac Society of Australia and New Zealand (CSANZ) guidelines recommend elective high-risk percutaneous coronary intervention (PCI) is not performed in sites greater than 1 hour from cardiac surgery.

Methods: In hospital outcomes for all patients from Orange Health Service (OHS) from January 2017 to January 2020 who were transferred electively to tertiary centres in Sydney for high risk PCI were examined.

Results: One hundred and fourteen (114) patients were identified, with 1,259 PCIs performed at OHS over the same period without transfer. The mean age of these 114 patients was 71 years, with 74.6% male. Receiving hospitals were Royal Prince Alfred Hospital, Sydney, NSW (66.7%), Concord Repatriation General Hospital, Concord, NSW (19.3%) and Strathfield Private Hospital, Strathfield, NSW (14%). The definition of high risk and indication for transfer included at least one of: moderate or greater calcification of the target lesion or proximal segment (34%), single or multiple target lesions that in aggregate jeopardised over 50% of remaining viable myocardium (27%), degenerated saphenous vein grafts (14.8%), chronic total occlusions (7.0%) and severe left ventricular (LV) impairment (3.9%). American Heart Society/American College of Cardiology (AHA/ACC) lesion types were A (1%), B1 (4.2%), B2 (40.2%), and C (54.6%). PCI was performed via the femoral route in 96.2%. The mean procedure duration was 72 minutes, mean combined fluoroscopy time was 19 minutes and mean radiation dose as defined by Reference Air Kerma was 1,630 mGy. Complications occurred in 13 patients and were: acute vessel dissection requiring stenting (4), perforation (2), acute vessel closure (4), puncture site related (1), and life-threatening arrhythmia (2). There were no cases of emergent coronary artery bypass graft (CABG) or death.

Conclusion: This contemporary cohort of high-risk patients transferred electively from a regional PCI centre to a tertiary cardiac unit underwent lengthy PCI procedures, with high radiation doses, and a modest rate of peri-procedural complications, but had otherwise excellent procedural and clinical outcomes.

Keywords: Ischaemic heart disease; Percutaneous coronary intervention; Rural health/Medicine.

MeSH terms

Aged
Cohort Studies
Coronary Artery Bypass
Female
Hospitals
Humans
Male
Percutaneous Coronary Intervention*
Stents
Treatment Outcome
United States