1425: Risk Mitigation for Percutaneous Coronary Intervention in the Cardiac Catheterization Lab

Introduction: For patients undergoing percutaneous coronary intervention (PCI), procedure-associated acute kidney injury (AKI) and bleeding are significant events that negatively impact morbidity, mortality, and healthcare costs. Methods: This nonexperimental quality improvement project aimed to reduce the incidence of AKI and bleeding events by formalizing the pre-procedure evaluation and clinical optimization processes, as well as enhancing intra- and post-procedural surveillance for high-risk patients. The rates of AKI and bleeding events before and after the intervention were assessed using data from the National Cardiovascular Data Registry (NCDR) CathPCI Registry. Results: During the 12-month intervention period, AKI events were reduced by 35.7%, and bleeding events decreased by 53.2% compared to the previous 12-month baseline. Both measures were substantially lower than the organization-wide average. Conclusions: A standardized process with objective risk stratification and consistent implementation of mitigation interventions reduces AKI and bleeding events. The SCAI PCI Risk Calculator is a valuable tool in identifying patients at high risk for PCI-associated AKI and bleeding with minimal impact on workflow. A systematic process owned by the cardiac cath lab team, supported by an advanced practice registered nurse in collaboration with procedural physicians, can enhance a culture of safety and reduce harm.