Understanding operator stent choice in the catheterization laboratory using a pre-procedure survey: Opportunities for quality improvement.

Journal Article

We sought to characterize how the perceived risk of early dual antiplatelet therapy (DAPT) discontinuation is incorporated into operator decision-making regarding stent choice, using a simple pre-procedure survey screening for clinical variables that may lead to early DAPT discontinuation.Understanding which factors influence operator decision-making regarding stent choice during percutaneous coronary intervention (PCI) could help identify areas for quality improvement.We retrospectively identified 1202 patients who underwent PCI from July 2008 to January 2013 at the Durham Veterans Affairs Medical Center. We excluded patients without a complete pre-procedure survey within 14days of PCI, repeat procedures on the same patient and those who received both drug-eluting stents (DES) and bare-metal stents (BMS) or no stent during PCI, leaving 864 patients. The primary outcome was the independent association of "yes" responses to survey items with the odds of DES use during PCI.Of 864 patients, 661 received DES and 203 received BMS. A "yes" response to "planned major surgery or dental work in the next year" (OR 0.20, 95% CI 0.11-0.36, p<0.001), "recent bleeding event or bleeding diathesis" (OR 0.31, 95% CI 0.14-0.68, p=0.003) or "currently taking Coumadin" (OR 0.39, 95% CI 0.19-0.78, p=0.007) was independently associated with lower odds of DES use.Responses to 3 items on a simple pre-procedure survey screening for clinical variables that may lead to early DAPT discontinuation were independently associated with stent type used during PCI, suggesting the importance of these factors in an operator's stent choice.

Full Text

Duke Authors

Cited Authors

  • Chung, MJ; Hansen, JD; Schulteis, RD; Boggan, JC; Jones, WS; Povsic, TJ; Roberts, S; Krucoff, MW; Rao, SV

Published Date

  • December 2017

Published In

Volume / Issue

  • 18 / 8

Start / End Page

  • 588 - 591

PubMed ID

  • 28529095

Electronic International Standard Serial Number (EISSN)

  • 1878-0938

International Standard Serial Number (ISSN)

  • 1553-8389

Digital Object Identifier (DOI)

  • 10.1016/j.carrev.2017.05.004

Language

  • eng