Percutaneous Coronary Intervention Complications and Guide Catheter SizeBigger Is Not Better
P. Michael Grossman, MD*, ,*,
Hitinder S. Gurm, MD*,,
Richard McNamara, MD ,
Thomas LaLonde, MD||,
Hameem Changezi, MD¶,
David Share, MD, MPH ,
Dean E. Smith, PhD*,
Stanley J. Chetcuti, MD*,,
Mauro Moscucci, MD* for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
* Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Hospitals and Health Center, Ann Arbor, Michigan
Departments of Family Medicine and Pediatrics, University of Michigan Hospitals and Health Center, Ann Arbor, Michigan
Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
Spectrum Health, Grand Rapids, Michigan
|| St. John's Hospital and Medical Center, Detroit, Michigan
¶ Genesys Regional Medical Center, Grand Blanc, Michigan
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Figure 1 Proportion of Patients in the Cohort That Underwent Coronary Intervention With an 8-F Guiding Catheter at a Given Hospital
The use of 8-F guide catheters, compared with 6-F guide catheters, ranged from 0.3% to 72.3% across various hospitals in the consortium.
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Figure 2 Adjusted and Unadjusted In-Hospital Outcomes of Patients Treated With 8-F Guiding Catheters Versus 6-F Guiding Catheters
The first plot (left) shows unadjusted odds ratios; the second plot (center) shows risk-adjusted odds ratios; and the third plot (right) shows risk-adjusted and propensity-adjusted odds ratios. Contrast-induced nephropathy, drop in hemoglobin by >3 g/dl, transfusion, coronary artery bypass graft, myocardial infarction, death, and major adverse cardiac events were more common in patients treated with the 8-F guide catheter, even after risk adjustment or after adjustment for the propensity to receive an 8-F guide catheter. Nephropathy requiring dialysis, gastrointestinal bleeding, and stroke were more common in the 8-F treated patients, but these differences were not significant after risk adjustment or after adjustment for the propensity to receive an 8-F guide catheter. CABG = coronary artery bypass graft; CIN = contrast-induced nephropathy; Drop in Hgb = drop in hemoglobin by >3 g/dl; GI = gastrointestinal; Hgb = hemoglobin; MACE = major adverse cardiac event; MI = myocardial infarction; NRD = nephropathy requiring dialysis; Post Proc Trans = post-procedure transfusion; Vasc Comp = vascular complication.
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Figure 3 Standardized Mortality Rate in Patients Undergoing PCI Based Upon the Guide Catheter Size
The observed and predicted mortality of 8-F guide catheter PCI patients was higher than the observed mortality of the 6- and 7-F guide patients (p < 0.05 for both). The observed mortality in patients treated with 8-F guide catheters was higher than the predicted mortality (p < 0.05) and the observed mortality of those who underwent PCI with a 6-F guide was lower than the predicted mortality (p < 0.05). The SMR (a ratio of observed mortality and predicted mortality) of patients treated with an 8-F guide was significantly higher than the SMR of patients who underwent PCI with a 6- or 7-F catheter (p < 0.05). PCI = percutaneous coronary intervention; SMR = standardized mortality rate.
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Figure 4 Hospital Quartiles According to Guide Use and Mortality
Participating hospitals were ranked according to 8-F guide use and divided into quartiles. Within each quartile, the mortality of patients who underwent PCI with 8-F guides was significantly greater than that of the 6-F guide groups (p > 0.003). Q = quartile; other abbreviations as in Figure 3.
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Figure 5 Temporal Use of 6-, 7-, and 8-F Guide Catheters for PCI
There was a significant decline in the use of 8-F guide catheters for PCI over the study period (Cochran-Armitage trend p value < 0.0001). Abbreviation as in Figure 3.
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