C C Simpfendorfer

Cleveland Clinic, Cleveland, OH, United States

Are you C C Simpfendorfer?

Claim your profile

Publications (18)93.76 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To ascertain causes of death and the incidence of percutaneous coronary intervention (PCI) related mortality within 30 days. BACKGROUND: Public reporting of 30-day mortality after PCI without clearly identifying the cause may result in operator risk avoidance and impact hospital reputation and reimbursements. Death certificates, utilized by previous reports, have poor correlation with actual cause of death and may be inadequate for public reporting. METHODS: All patients who died within 30 days of a PCI from January 2009 to April 2011 at a tertiary care center were included. Causes of death were identified through detailed chart review using Academic Research Consortium consensus guidelines and compared to reported death certificates. The causes of death were divided into cardiac and non-cardiac and PCI and non PCI-related categories. RESULTS: Of the 4078 PCIs, 81 deaths (2%) occurred within 30 days. Of these, 58% died of cardiac and 42% of non-cardiac causes. However, only 42% of 30-day deaths were attributed to PCI-related complications. Compared to PCI-related, patients with non PCI-related death presented with a higher incidence of cardiogenic shock (15/47 (32%) versus 2/34 (6%); p < 0.01) and cardiac arrest (19/47 (40%) versus 1/34 (3%); p < 0.01). Death certificates had only 58% accuracy (95% CI, 45%-72%) for classifying patients as experiencing cardiac versus non-cardiac death. CONCLUSIONS: Less than half of 30-day deaths are attributed to a PCI-related complication. Death certificates are inaccurate and do not report PCI-related deaths, which may represent a better marker of PCI quality.
    Journal of the American College of Cardiology 05/2013; · 14.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD). BACKGROUND: It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment. METHODS: Using institutional diagnostic catheterization database of consecutive patients undergoing coronary angiography from 1/2004 to 1/2010, we examined records for patients with a positive stress test and >70% coronary stenosis or symptoms of angina and >80% coronary stenosis. We excluded those with acute coronary syndromes, low ejection fraction (EF), history of CABG, and CABG following index catheterization. We stratified patients by treatment and performed unadjusted and propensity matched analyses. The outcome was all-cause mortality obtained from the Social Security Death Index. RESULTS: We identified 3,375 patients using study inclusion criteria. Mean age was 65 ± 11 years and 69% (n=2332) were men. Mean EF was 55 ± 8%. In the unadjusted cohort, 1265 patients received medical management and 2110 received PCI. The unadjusted analysis revealed significantly better survival in PCI patients (p<0.0001) (HR: 0.51; 95% confidence interval (CI), 0.41-0.63). Propensity matching was performed for 1,580 patients and analysis showed better survival among patients receiving PCI (0=0.04) (HR: 0.74; 95% CI, 0.55-0.98). PCI continued to show better survival after excluding patients with malignancy (p=0.03) and unstable angina (p=0.007). CONCLUSIONS: This single center registry analysis demonstrated better survival in stable CAD patients undergoing PCI compared to medical management alone. These data suggest there may be a benefit of PCI beyond symptom relief. Future randomized trials are needed to further understand the role of PCI in broader patient populations. © 2012 Wiley-Liss, Inc.
    Catheterization and Cardiovascular Interventions 04/2012; · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We compared in-hospital femoral complications of Angio-Seal, Perclose, and manual compression in consecutive patients who underwent percutaneous coronary interventions in the era of glycoprotein IIb/IIIa platelet inhibition. Femoral closure devices have a similar overall risk profile as manual compression, even in patients treated with glycoprotein IIb/IIIa platelet inhibition, although certain rare complications such as retroperitoneal hemorrhage and severe access-site infection may be more common with the use of these devices.
    The American Journal of Cardiology 11/2000; 86(7):780-2, A9. · 3.21 Impact Factor
  • Conrad Simpfendorfer, Kandice Kottke-Marchant, Eric J. Topol
    Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/1996; 27(2):242-242.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives.This study sought to evaluate the short-term results and long-term outcome of percutaneous revascularization of ostial saphenous vein graft stenoses in a large patient series.Background.Previous studies have demonstrated that the results of balloon angioplasty for native coronary ostial stenoses are significantly worse than those for nonostial lesions. However, it is controversial whether interventions in patients with ostial saphenous vein grafts carry a similar prognosis.Methods.We identified 68 consecutive patients with ostial (group I) and 72 consecutive patients with proximal, nonostial (group II) saphenous vein graft stenoses who underwent percutaneous angioplasty or directional atherectomy for a single new stenosis at the Cleveland Clinic between 1986 and 1992.Results.Success was achieved in 61 patients (89.7%) in group I and 64 (88.9%) in group II (p = 0.88). There were no differences in major procedural complications (death, Q wave infarction and bypass surgery) between the two groups. At a mean (±SD) follow-up of 23 ± 17 months, 36 patients (64%) in group I had one or more adverse events (death, infarction, repeat coronary revascularization or cardiac-related hospital admission) compared with 34 patients (58%) in group II (p = 0.87). Twenty-eight patients (50%) were angina free in group I compared with 33 (56%) in group II (p = 0.65). During the follow-up period in group I, 7 patients died (13%), 10 had a myocardial infarction (18%), 11 had repeat bypass surgery (20%), 8 had repeat percutaneous interventions (14%), and 30 had one or more cardiac-related hospital admissions (54%). The incidence of these events was similar in group II except for a slightly higher incidence of myocardial infarction: 6 patients died (10%), 3 had a myocardial infarction (5%), 12 had repeat bypass surgery (20%), 12 had repeat percutaneous interventions (20%), and 26 had one or more cardiac-related hospital admissions (44%).Conclusions.Unlike ostial native coronary disease, the clinical, procedural and follow-up profile of ostial saphenous vein graft revascularization is not significantly worse than proximal nonostial disease. This finding may be related to the overall suboptimal results of percutaneous revascularization in saphenous vein grafts compared with native coronary arteries or to the unfavorable intrinsic properties of ostial native coronary arteries compared with ostial vein grafts.
    Journal of the American College of Cardiology 11/1995; · 14.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. To determine whether excision of complex, ulcerated plaque improves the risk of patients with unstable angina to the level of those with stable angina, the results of directional coronary atherectomy were compared in patients with these two syndromes.Background. The procedural results of angioplasty in the setting of unstable angina are not as favorable as those observed for chronic stable angina, presumably because thrombus-associated plaque augments the risk of abrupt closure.Methods. Two hundred eighty-seven consecutive patients who had undergone directional atherectomy for a single new stenosis were studied. Seventy-seven patients had stable angina (Group I); 110 patients had progressively worsening angina hi the absence of rest or postinfarction angina (Group II); and 100 patients had rest or postinfarction angina, or both (Group III).Results. Major behende complications (death, Q wave infarction, emergency bypass surgery) occurred more frequently in Group m (1.3% [Group I] vs. 0.9% [Group II] vs. 7% (Group III], p = 0.036). This difference was largely due to a higher incidence of emergency surgery in Group III (1.3% [Group I] vs. 0% [Group II] vs. 5% [Group III], p = 0.05). Clinical follow-up was obtained in 97% of successful procedures for a mean followup period of 22 months (range 9 to 52) and revealed a higher incidence of hospital admission for angina (p = 0.05) and a trend toward more bypass surgery (p = 0.09) and myocardial infarction (p = 0.16) in Group III. There was no difference in repeat percutaneous interventions among the three groups (range 19% to 24%, p = 0.75).Conclusions. These results show that the definition of unstable angina is important in determining the immediate outcome of directional atherectomy. In the absence of rest or postinfarction angina, the immediate results are not significantly different from those obtained in stable angina. Our results also suggest that both the immediate and short-term outcome in unstable angina are not greatly influenced by atherectomy but more so by the pathophysiology of unstable angina, which increases the complications of percutaneous interventions.
    Journal of the American College of Cardiology 08/1994; · 14.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The optimal level of heparin anticoagulation for elective PTCA is unknown. To determine if PTCA complications are related to the level of anticoagulation, serial ACT values were prospectively measured in 189 patients undergoing 201 elective PTCA procedures. The mean heparin dose before balloon inflation (pre-inflation) was 10,100 units, and the mean dose per procedure was 13,200 units. The mean pre-inflation ACT was 295 sec, but was < 300 sec in more than 50% of patients. Acute complications were not related to any ACT parameter and the development of new intracoronary thrombus was not observed. In elective PTCA procedures, the routine monitoring of ACT values is unnecessary when standard heparin doses are used.
    Catheterization and Cardiovascular Diagnosis 04/1993; 28(4):279-82.
  • S E Jones, R E Raymond, C C Simpfendorfer, P L Whitlow
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with significant coronary artery disease are at increased risk for myocardial infarction and death when undergoing major noncardiac surgery, particularly vascular, thoracic and upper abdominal procedures. Revascularization with coronary bypass surgery has shown to be effective in reducing perioperative coronary events in such patients. Little data is available on the role of preoperative coronary angioplasty in this setting. The objective of this study was to determine the perioperative cardiac outcome in patients undergoing coronary angioplasty within six weeks of major noncardiac surgery. We analyzed our experience with 108 consecutive patients (85 males) with a mean age of 68 years (range 41-83) who underwent coronary angioplasty within 42 days of a major operative procedure, which was defined as either a vascular, thoracic or upper abdominal procedure. Multivessel disease was present in 48% of patients. Angioplasty success rate was 97% with 33 (31%) patients having more than one lesion dilated. Angioplasty complications included 1 stroke and 4 non-Q wave myocardial infarctions. The mean time from angioplasty to operative procedure was 14.5 days (range 0-41 days). Ninety six (91%) of the patients underwent vascular surgery--including 42 abdominal aneurysm repairs, 29 carotid endarterectomies, 21 lower extremity bypass operations and four renal artery bypass procedures. Eight patients had major abdominal surgery and one patient had a thoracic procedure. Postoperative cardiac complications included three non-Q wave myocardial infarctions and one Q-wave myocardial infarction which resulted in the only cardiac death (0.9%). There were no sustained ventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)
    The Journal of invasive cardiology 01/1993; 5(6):212-8. · 1.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Repeat coronary angioplasty has become the standard approach to a first restenosis. However, the long-term outcome of such a strategy is not well defined. In the present study, 465 patients (mean age 58 years [range 27 to 79], 53% with multivessel disease) underwent a second angioplasty procedure at the same site. The procedure was successful in 96.8% with a 1.5% rate of in-hospital bypass surgery, a 0.9% incidence rate of myocardial infarction and no procedural deaths. Four hundred sixty-three patients (99.6%) were followed up for a mean of 40.5 months. Forty-nine patients (10.6%) underwent a third angioplasty procedure at the same site, 55 (11.8%) had coronary bypass surgery and 33 (7.1%) underwent angioplasty at a different site. During follow-up, 12 patients (2.6%) sustained a myocardial infarction and 21 (4.5%) died including 13 (2.8%) with cardiac death. Of the 442 surviving patients, 88% experienced sustained functional improvement and 78% were free of angina. The actuarial 5-year cardiac survival rate was 96% and the rate of freedom from cardiac death and myocardial infarction was 92%. For the subgroup of 49 patients who had a third angioplasty procedure at the same site, the success rate was 93.9% with a 2% incidence rate of myocardial infarction. There were no in-hospital deaths or coronary artery bypass operations. The mean follow-up interval for this subgroup was 30.5 months with a 22.4% cross-over rate to coronary bypass surgery, a 4.1% incidence rate of myocardial infarction and a 2% cardiac mortality rate. At last follow-up, 89% of patients had sustained functional improvement and 76% were free of angina. The combined angiographic and clinical restenosis rate was 48%. Repeat angioplasty as treatment for restenosis is an effective approach associated with a high success rate, low incidence of procedural complications, and sustained functional improvement in combination with an acceptable rate of bypass surgery. However, there is a trend toward diminished angioplasty efficacy after a second restenosis. Thus, decisions for further revascularization should be made after careful review of available options.
    Journal of the American College of Cardiology 06/1992; 19(6):1310-4. · 14.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: From 1984 to 1987, 537 consecutive patients (mean age 58 years; range 34 to 79) underwent angioplasty for proximal left anterior descending coronary artery disease. The procedure was clinically successful in 516 (96.1%). Procedural complications included myocardial infarction (2.2%; Q wave 0.9%, non-Q wave 1.3%), in-hospital bypass surgery (3%) and death (0.4%). Follow-up was obtained in 534 patients (99.8%) for a mean duration of 44 months (range 8 to 75). Follow-up cardiac catheterization, performed in 391 patients (76%), demonstrated a 39.6% angiographic restenosis rate. Ninety-eight (19%) of the patients with a clinically successful result required additional revascularization for recurrent left anterior descending artery disease by angioplasty (12.8%) or coronary artery bypass grafting (4.7%), or both (1.5%). During follow-up there was a 2.5% incidence rate of myocardial infarction (anterior myocardial infarction 1.6%), and 27 patients (5.2%) died, 14 (2.7%) of cardiac causes. The actuarial 5-year cardiac survival rate was 97%, freedom from cardiac death and myocardial infarction was 94% and freedom from cardiac death, myocardial infarction, coronary artery bypass surgery and repeat left anterior descending artery angioplasty was 77%. At last follow-up 76% of patients were free of angina and 88% reported sustained functional improvement. Angioplasty is an effective treatment for proximal left anterior descending coronary artery disease that has a high success rate, low incidence of procedural complications and provides excellent long-term cardiac survival, freedom from cardiac events and sustained functional improvement.
    Journal of the American College of Cardiology 04/1992; 19(4):745-51. · 14.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the increasing use of the internal mammary artery as the conduit of choice in coronary bypass surgery, it is anticipated that an expanding patient population will have stenosis, usually at the site of internal mammary-to-coronary artery anastomosis. In our series 31 patients underwent dilatation at either the site of anastomosis (24), the native coronary artery beyond the anastomosis (4), or both (3) with no mortality, myocardial infarction, or need for emergency coronary artery bypass surgery. Angiographic and clinical success was achieved in 28 patients (90%). There were two internal mammary artery dissections with both patients requiring elective coronary bypass surgery. Of the patients in whom dilatation was successful, 22 (79%) have been followed for longer than 6 months and 19 (86%) have had sustained functional improvement at a mean of 35 months after angioplasty. One patient is to undergo repeat coronary bypass surgery. No patient has had a myocardial infarction or died during follow-up. Although percutaneous transluminal coronary angioplasty of the internal mammary artery has inherent difficulties because of the anatomic characteristics of the vessel, it can be performed with a high degree of primary success and a low incidence of complications and can provide long-term clinical improvement.
    American Heart Journal 09/1991; 122(2):423-9. · 4.50 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/1991; 17(2).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study is to prospectively compare myocardial perfusion imaging with rubidium-82 (82Rb) by positron emission tomography (PET) with thallium-201 (201Tl) imaging by single-photon emission tomography (SPECT) by recording both studies with a single dipyridamole handgrip stress, and reading both sets of images with the same display technique. In a series of 202 patients with previous coronary arteriography, the sensitivity, specificity, and accuracy of 82Rb PET were 93%, 78%, and 90% and for 201Tl SPECT 76%, 80%, and 77%, respectively. When 70 patients with previous therapeutic interventions were excluded, the remaining 132 patients showed a sensitivity, specificity, and accuracy of 95%, 82% and 92% for 82Rb PET and 79%, 76%, and 78% for 201Tl SPECT. The improved contrast resolution of PET resulted in markedly superior images and a more confident identification of defects.
    Journal of Nuclear Medicine 01/1991; 31(12):1899-905. · 5.77 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/1991; 17(2).
  • D H Korzick, D A Underwood, C C Simpfendorfer
    [Show abstract] [Hide abstract]
    ABSTRACT: The value of early symptom-limited stress electrocardiography following percutaneous transluminal coronary angioplasty in assessing late outcome was evaluated in 218 patients. All subjects were tested using the Bruce or Sheffield Protocols, 2.5 +/- 1.3 days after percutaneous transluminal coronary angioplasty. Repeat coronary angiography was performed after percutaneous transluminal coronary angioplasty because of symptoms (58%) or as routine follow-up (42%). Stress electrocardiography results were compared to coronary angiography. The sensitivity and specificity were 35.3% and 52.6%, respectively. The positive and negative predictive values were 39.6% and 48.0%. Two acute myocardial infarctions and one coronary angiographic-proven restenosis occurred within hours of the stress electrocardiogram in three patients (1.4%). It is concluded that symptom-limited stress testing immediately following percutaneous transluminal coronary angioplasty has no prognostic value and may carry increased risk for immediate negative coronary events.
    Cleveland Clinic Journal of Medicine 01/1990; 57(1):53-6. · 3.40 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/1990; 15(2).
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/1990; 15(2).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Out of a total of 1,500 percutaneous coronary angioplasties (PTCA), 55 (3.6%) were associated with balloon rupture. Lesion calcification was noticed in 7 of these 55 patients (12.7%). Balloon rupture occurred at a mean pressure of 10.7 atmospheres. All balloons were retrieved without difficulty. Intimal tears were noted in 18 (32.7%) cases. Three patients required bypass surgery. In 29 patients restudied angiographically, the restenosis rate was 38%. Balloon rupture during PTCA does not seem to be associated with detrimental consequences.
    Angiology 12/1986; 37(11):828-31. · 2.37 Impact Factor