The bleeding risk treatment paradox at the physician and hospital level: Implications for reducing bleeding in patients undergoing percutaneous coronary intervention.

Background: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Bleeding avoidance strategies (BAS) are used paradoxically less in patients at high-risk of bleeding: "bleeding risk-treatment paradox" (RTP). We determined whether hospitals and physicians, who do not align BAS to PCI patients' bleeding risk (ie, exhibit a RTP) have higher bleeding rates.

Incremental Cost of Acute Kidney Injury after Percutaneous Coronary Intervention in the United States.

Contrast-induced acute kidney injury (AKI) is a common and severe complication of percutaneous coronary intervention (PCI). Despite its substantial burden, contemporary data on the incremental costs of AKI are lacking. We designed this large, nationally representative study to examine: (1) the independent, incremental costs associated with AKI after PCI and (2) to identify the departmental components of cost contributing to the incremental costs associated with AKI.

Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes.

Importance: Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is associated with lower costs and preferred by patients. However, to our knowledge, contemporary patterns of SDD after elective PCI with respect to the incidence, hospital variation, trends, costs, and safety outcomes in the United States are unknown.

Objective: To examine (1) the incidence and trends in SDD; (2) hospital variation in SDD; (3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers.

Impact of Appropriate Use on the Estimated Radiation Risk to Men and Women Undergoing Radionuclide Myocardial Perfusion Imaging.

Unlabelled: The impact of appropriate use criteria (AUC) for myocardial perfusion imaging (MPI) with SPECT on the estimated lifetime attributable risk (LAR) of cancer is unknown.

Methods: A cohort of 1,511 consecutive patients who underwent clinically indicated (99m)Tc-setamibi MPI were categorized into appropriate/uncertain (n = 823) versus inappropriate (n = 688) use groups according to the 2009 AUC and were prospectively followed for 27 ± 10 mo. Logistic regression models were used to determine the annualized probability of major adverse cardiac events (MACE) of cardiac death or myocardial infarction and the probability of revascularization within 6 mo of MPI, accounting for relevant covariates.

Appropriate use criteria for SPECT myocardial perfusion imaging: Are they appropriate for women?

Background: Several studies have reported that women are more likely to receive inappropriate SPECT myocardial perfusion imaging (MPI), suggesting gender disparity in AUC determination. We investigated the impact of gender on the diagnostic and prognostic utility of AUC.

Methods And Results: We analyzed a multi-site prospective cohort of 1511 consecutive patients (43.

Impact of insurance carrier, prior authorization, and socioeconomic status on appropriate use of SPECT myocardial perfusion imaging in private community-based office practice.

Background: The impact of health insurance carrier and socioeconomic status (SES) on the adherence to appropriate use criteria (AUC) for radionuclide myocardial perfusion imaging (MPI) is unknown.

Hypothesis: Health insurance carrier's prior authorization and patient's SES impact adherence to AUC for MPI in a fee-for-service setting.

Methods: We conducted a prospective cohort study of 1511 consecutive patients who underwent outpatient MPI in a multi-site, office-based, fee-for-service setting.

Impact of appropriate use on the prognostic value of single-photon emission computed tomography myocardial perfusion imaging.

Background: Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown.

Methods And Results: A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted.

The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: a cautionary note in patients with diabetes and coronary artery disease.

Background: The prognostic implications of transient ischemic dilatation (TID) of the left ventricle with otherwise normal single-photon emission computed tomography myocardial perfusion imaging (MPI) remain controversial. Whether this finding may have prognostic implications only in high-risk populations, such as patients with diabetes or manifest coronary artery disease (CAD), is uncertain.

Methods: We conducted a prospective cohort study of 1,236 consecutive patients with normal (99m)Tc-sestamibi MPI, defined as normal perfusion (summed stress score = 0) and normal left ventricle volume and function.

The prognostic value of cardiac SPECT performed at the primary care physician's office.

Background: The prognostic value of single-photon emission computed-tomography (SPECT)-myocardial perfusion imaging (MPI) is well documented. However, the utility of SPECT-MPI when performed at a low-volume primary care physician's (PCP's) office is unknown.

Methods: We conducted a prospective cohort study of consecutive patients referred by their PCP to undergo a stress-MPI at the PCP's office using a mobile laboratory.