Simple Tool Reduces Coronary Angioplasty Complications

A new screening tool calculates a patient's bleeding risk during percutaneous coronary intervention (PCI), based on nine clinical variables.

Researchers at Allina Health (Minneapolis, MN, USA) conducted a study to examine the efficacy of a screening tool developed from data collected from the US National Cardiovascular Data Registry (NCDR) Cath-PCI Registry. They first created a data dashboard for all Allina Health cardiac catheterization staff to use before PCI procedures, and held learning sessions about the importance and benefits of using the tool to identify high-risk patients before their procedures, so that strategies to avoid bleeding can be put in place.

They then reviewed data on all patients in the Allina Health system from July 2009 to December 2011 to retrospectively verify the NCDR's screening tool's ability to predict patients with high, intermediate, and low bleeding risks. Data collection and analysis were simplified because the hospitals have a unified electronic medical record and participate in NCDR. The results showed that within one month, more than 75% of patients were being screened before procedures, resulting in a 5.3% decrease in all post-procedure complications, including the need for blood transfusions. The study was published on November 4, 2014, in Circulation: Cardiovascular Quality Outcomes.

“Bleeding from the insertion site from blood thinners used during the procedure is a common complication of PCI, occurring two to six percent of the time. That might not sound serious, but bleeding is associated with adverse events, including death,” said lead author Craig Strauss, MD, MPH, of the Allina health Abbott Northwestern Hospital. “Achieving these improvements should lead to significant reductions including costs associated with hospital readmissions.”

During PCI, a cardiologist feeds a deflated balloon or other device on a catheter from the inguinal femoral artery or radial artery up through blood vessels until they reach the site of blockage in the heart; X-ray imaging is used to guide the catheter threading. At the blockage, the balloon is inflated to open the artery, allowing blood to flow. A stent is often placed at the site of blockage to permanently open the artery.

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