CART-CL: Clinical and Research Update

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Presentation transcript:

CART-CL: Clinical and Research Update CRT17 February 21, 2017 Anthony A Bavry, MD MPH Interventional Cardiology, North FL/South GA Veterans Health System Associate Professor of Medicine, University of Florida, Gainesville, FL

Disclosures Research Support: Consultant: Travel Support: Norvartis; modest Eli Lily; modest Regado Biosciences; significant Gilead; significant Consultant: ACC/Cardiosource; significant Boehringer Ingelheim; modest Travel Support: Edwards; modest

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

Program started data collection in 2005 Cardiovascular Assessment Reporting and Tracking system for Cath Labs (CART-CL) Part of a national quality improvement initiative to improve quality of cardiovascular care delivered to VHA Customized software application embedded within VHA electronic health records Captures standardized data for all 78 VHA laboratories that perform cardiac catheterization procedures Program started data collection in 2005 Complete participation by all VHA cath labs in 2009

Data recorded is housed in single national data repository CART-CL Automatically creates reports for inclusion in electronic patient records Pre-procedure assessment, cardiac catheterization, and PCI Data recorded is housed in single national data repository Core data elements conform to definitions and standards of the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR) Program application has continuous monitoring, maintenance, and updating by dedicated analytic and technical staff

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

Partnership with VA surgery 173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos) 23% of PCI patients underwent non-cardiac surgery w/n 2 years MACE a/w emergency surgery and advanced cardiac disease, but not stent type or timing of surgery beyond 6 month

Radial Catheterization PCI Cases by Access Site: Sites ≥ 1 rPCI FY 2008-2010 11.42 2.32

Radial Catheterization Baseline Characteristics Patient Characteristics All (N = 24,143) Transfemoral (N = 22,834) Transradial (N = 1,309) P-Value Age 63 (59.2, 70.9) (59.3, 71.0) (59.2, 68.5) 0.006 Male 98.4% 0.887 Renal Failure 14.7% 15.9% 0.213 Diabetes 41.7% 41.5% 45.0% 0.012 Dyslipidemia 79.3% 78.8% 86.5% <.001 Hypertension 80.7% 80.2% 87.9% Tobacco use 54.2% 53.4% 67.0% CVD 15.0% 14.9% 17.2% 0.021 PVD 17.9% 17.5% 23.7% COPD 14.0% 13.7% 18.6% Patients undergoing rPCI had significant more comorbidities: Diabetes, Dyslipidemia, HTN, Tobacco use, CVD, PVD, COPD

Radial Catheterization Unadjusted Procedural Success: Overall Population P = 0.18

Thank You JAMA 2014; 312: 1754

JAMA 2014; 312: 1754

173 STEMI patients; 17% with cardiogenic shock, 39% rescue angioplasty 792 STEMI patients; 92% achieved TIMI 3 flow and 48% achieved TIMI blush 3 (Sianos)

Thank You