1. 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

2. 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

3. 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)

4. 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)

5. 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)

6. 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

7. 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

8. 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)

9. 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)

10. 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)

11. 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)

12. 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)

13. 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)

14. 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)

15. 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)

16. 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)

17. 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)

18. 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)

19. 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)

20. 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)

21. 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)

22. 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. 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)

24. 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)

25. 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)

26. 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

27. Radial Catheterization
PCI Cases by Access Site: Sites ≥ 1 rPCI FY
11.42
2.32

28. 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

29. Radial Catheterization Unadjusted
Procedural Success: Overall Population
P = 0.18

30. Thank You
JAMA 2014; 312: 1754

31. JAMA 2014; 312: 1754

32. 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)

33. Thank You