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

J Am Coll Cardiol Intv 2018;11:482 – 92 cPCI: PCI in post CABG Patients in the UK Steady trend towards more TR and less TF TF LRA RRA

Am J Cardiol 2016;117:555e 562 cPCI: Atherectomy Cases from National Inpatient Sample Atherectomy associated with higher Atherectomy associated with higher rates of adverse events cost $26,000.00 $25,272.00 $25,000.00 $24,000.00 $23,000.00 $22,000.00 $21,224.00 $21,000.00 $20,000.00 $19,000.00 No Atherectomy Atherectomy No Atherectomy Atherectomy

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

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

www.transitionforvalue.org Transition 4 Value: • 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

www.transitionforvalue.org Transition 4 Value: Foundation for cPCI Author Topics How Value-Based Healthcare affects clinical practice: Introduction Sunil Rao 1 Clinical benefits of transradial access Samir Pancholy 2 Rethinking care delivery in a Transradial cath lab Chris Pyne 3 Femoral to radial 101- Where to begin for MD’s Rajiv Gulati 4 Clinical Best Practices, Tips & Tricks for TRA technique Jennifer Tremmel 5 Economic benefits of transradial access Adhir Shroff 6 Cath Lab Staff’s role in TRA adoption Bernadette Speiser 7 Your TRA support network: How to initiate change Ian Gilchrist 8 9 TRA for LM PCI Arasi Maran 10 TRA for bypass graft PCI Alex Truesdell 11 Coronary atherectomy and TRA Amer Ardati

(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

www.transitionforvalue.org Questions????? Thank you. arshroff@uic.edu @ARS_MD2004 312-485-4511 11

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