How It Applies to cPCI Adhir Shroff, MD, MPH Associate Professor of - - PowerPoint PPT Presentation

SCAI’s Transition 4 Value:

How It Applies to cPCI

Adhir Shroff, MD, MPH

Associate Professor of Medicine University of Illinois – Chicago Jesse Brown VA Medical Center arshroff@uic.edu @ARS_MD2004 #RadialFirst

www.transitionforvalue.org

Disclosures:

▪ Current financial disclosures: Medtronic, CSI, Terumo, Abiomed

Complex PCI

• More commonly performed as population ages
• New devices and techniques have made complex PCI safer and more

accessible to a wider audience

• Complex PCI belong to complex patients with higher comorbidity

burden

• It is the norm that vascular access site complications are the most

common or among the most common complications

• TAVR, CTO, Atherectomy, renal denervation, HD support/shock

cPCI: PCI in post CABG Patients in the UK

Steady trend towards more TR and less TF

TF LRA RRA

J Am Coll Cardiol Intv 2018;11:482–92

cPCI: Atherectomy Cases from National Inpatient Sample

Atherectomy associated with higher rates of adverse events Atherectomy associated with higher cost

Am J Cardiol 2016;117:555e 562

$21,224.00 $25,272.00 $19,000.00 $20,000.00 $21,000.00 $22,000.00 $23,000.00 $24,000.00 $25,000.00 $26,000.00 No Atherectomy Atherectomy No Atherectomy Atherectomy

Use of TR access as an Ancillary Access Site:

Complex structural, coronary, peripheral interventions

• Lower rates of BARC

3/5 bleeding

• 6.7 vs. 19.7%,

p<0.001

• Lower Hgb drop
• 1.13 vs 1.92 g/dL,

p=0.008

• Shorter LOS
• 5 vs 7days, p<0.001

Catheterization and Cardiovascular Interventions 91:97–102 (2018)

Complex PCI

• More commonly performed as population ages
• New devices and techniques have made complex PCI safer and more

accessible to a wider audience

• Complex PCI belong to complex patients with higher comorbidity

burden

• It is the norm that vascular access site complications are the most

common or among the most common complications

• TAVR, CTO, Atherectomy, renal denervation, HD support/shock
• Radial access can nearly eliminate vascular access site complications

for cPCI

Transition 4 Value:

www.transitionforvalue.org

• Educational program to promote

transradial access

• Focus is on clinical challenges &

creating value

• Short slide decks that can be utilized

by clinicians and administrators

• Serve as an educational resource as

well as a teaching tool

• Individualized learning

Transition 4 Value: Foundation for cPCI

Topics

Author

1

How Value-Based Healthcare affects clinical practice: Introduction

Sunil Rao

2

Clinical benefits of transradial access

Samir Pancholy

3

Rethinking care delivery in a Transradial cath lab

Chris Pyne

4

Femoral to radial 101- Where to begin for MD’s

Rajiv Gulati

5

Clinical Best Practices, Tips & Tricks for TRA technique

Jennifer Tremmel

6

Economic benefits of transradial access

Adhir Shroff

7

Cath Lab Staff’s role in TRA adoption

Bernadette Speiser

8

Your TRA support network: How to initiate change

Ian Gilchrist

9 TRA for LM PCI

Arasi Maran

10 TRA for bypass graft PCI

Alex Truesdell

11 Coronary atherectomy and TRA

Amer Ardati

www.transitionforvalue.org

(1) Clarifies clinical and reimbursement definitions of discharge strategies, (2) Reviews the technological advances and literature supporting reduced hospitalization duration and risk assessment (3) Describes changes to the consensus recommendations on length of stay following PCI

Questions?????

11

Thank you.

arshroff@uic.edu @ARS_MD2004 312-485-4511

www.transitionforvalue.org

http://www.scai.o .org/v /vascular-access-and-closure

Download Vascular Access eBook on SCAI.org