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Toomath S, Arnott C, Patel S. Radial First in Primary Percutaneous Coronary Intervention-Ensuring At-Risk Groups Aren't Left Behind. Heart Lung Circ 2022; 31:1047-1048. [PMID: 35691885 DOI: 10.1016/j.hlc.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shamus Toomath
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
| | - Sanjay Patel
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia; The Heart Research Institute, Sydney, NSW, Australia
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2
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Sattar Y, Majmundar M, Ullah W, Mamtani S, Kumar A, Robinson S, Zghouzi M, Mir T, Dhamrah U, Al-Khadra Y, Pacha HM, Darmoch F, Soud M, Hakim Z, Bagur R, Kaul P, Ijioma N, Panchal A, Shroff AR, Alraies MC. Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:433-444. [PMID: 33896335 DOI: 10.1080/14779072.2021.1915768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial. METHODS PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model. RESULTS We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year. CONCLUSION TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Monil Majmundar
- New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Sahil Mamtani
- Internal Medicine, Atlantic Care Regional Medical Center, Atlantic City, NJ, USA
| | - Ashish Kumar
- Internal Medicine, St John's Medical College Hospital, Bangalore, India
| | - Sam Robinson
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Umaima Dhamrah
- Internal Medicine , Icahn School of Medicine at Mount Sinai Elmhurst Hospital, NY, New York, USA
| | - Yasser Al-Khadra
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Homam Moussa Pacha
- McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Heart & Vascular Institute, Houston, TX, USA
| | - Fahed Darmoch
- Internal Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Mohamad Soud
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Zaher Hakim
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Rodrigo Bagur
- London Health Science Centre, Western University, London, Canada
| | - Prashant Kaul
- Department of Cardiology, Piedmont Heart Institute, Atlanta, GA, USA
| | | | - Ankur Panchal
- Department of Cardiology, University of Pittsburgh Medical Center, PA, USA
| | - Adhir R Shroff
- Department of Cardiology, University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, IL, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 311] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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Ji L, Liu C, Li P, Wang X, Liu C, Hou Y. Increased pulse wave transit time after percutaneous coronary intervention procedure in CAD patients. Sci Rep 2018; 8:115. [PMID: 29311630 PMCID: PMC5758522 DOI: 10.1038/s41598-017-18520-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
Abstract
Pulse wave transit time (PWTT) has been widely used as an index in assessing arterial stiffness. Percutaneous coronary intervention (PCI) is usually applied to the treatment of coronary artery disease (CAD). Research on the changes in PWTT caused by PCI is helpful for understanding the impact of the PCI procedure. In addition, effects of stent sites and access sites on the changes in PWTT have not been explored. Consequently, this study aimed to provide this information. The results showed that PWTT significantly increased after PCI (p < 0.01) while the standard deviation (SD) of PWTT time series had no statistically significant changes (p = 0.60) between before and after PCI. Significantly increased PWTT was found in the radial access group (p < 0.01), while there were no significant changes in the femoral access group (p > 0.4). Additionally, PWTT in the left anterior descending (LAD) group significantly increased after PCI (p < 0.01), but the increase that was found in the right coronary artery (RCA) group was not significant (p > 0.1). Our study indicates that arterial elasticity and left ventricular functions can benefit from a successful PCI procedure, and the increase of peripheral PWTT after PCI can help to better understand the effectiveness of the procedure.
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Affiliation(s)
- Lizhen Ji
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.,Institute of Environment and Ecology, College of Geography and Environment, Shandong Normal University, Jinan, 250014, China
| | - Chengyu Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Peng Li
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Xinpei Wang
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Changchun Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
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Heshmat H, haddad YE, Farouk M, Abdelmegeed M. Radial Access in Primary PCI for Acute Myocardial Infarction. Interv Cardiol 2017. [DOI: 10.5772/intechopen.69131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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6
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Elmahdy MF, ElMaghawry M, Hassan M, Kassem HH, Said K, Elfaramawy AA. Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction. Heart Lung Circ 2016; 26:35-40. [PMID: 27374862 DOI: 10.1016/j.hlc.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/12/2016] [Accepted: 04/23/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this study was conducted to compare the safety, feasibility, and outcomes of right radial access (RRA) vs. left radial access (LRA) in the setting of primary PCI. METHODS We retrospectively analysed the data of 400 consecutive patients presenting to our institution with STEMI for whom primary PCIs were performed via RRA and LRA. RESULTS Mean age of the whole studied population was 57±12.8 years, with male predominance (77.2%). There were 202 cases in the RRA group and 198 in the LRA group, with no significant difference in demographics and clinical characteristics for patients included in both groups. There was no significant difference in procedure success rate (97.5% for RRA vs. 98.4% for LRA; P=0.77). In addition, no significant difference between both approaches was observed in the contrast volume, number of catheters, fluoroscopy time (FT), needle-to-balloon time, post-procedure vascular complications, in hospital reinfarction, stroke/transient ischaemic attack (TIA) or death. CONCLUSION Right radial access and LRA are equally safe and effective in the setting of primary PCI. Both approaches have a high success rate and comparable needle-to-balloon time.
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Affiliation(s)
- Mahmoud Farouk Elmahdy
- Cardiology Department, Cairo University, Cairo, Egypt; Cardiology Department, Aswan Heart Centre, Aswan, Egypt.
| | | | | | | | - Karim Said
- Cardiology Department, Cairo University, Cairo, Egypt
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7
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Ruiz-Rodriguez E, Asfour A, Lolay G, Ziada KM, Abdel-Latif AK. Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome. South Med J 2016; 109:61-76. [PMID: 26741877 DOI: 10.14423/smj.0000000000000404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are needed. This systematic review and meta-analysis aims to compare major cardiovascular outcomes and safety endpoints in patients with ACS managed with PCI using radial versus femoral access. METHODS Randomized controlled trials and cohort studies comparing RA versus FA in patients with ACS were analyzed. Our primary outcomes were mortality, major adverse cardiac event, major bleeding, and access-related complications. A fixed-effects model was used for the primary analyses. RESULTS Fifteen randomized controlled trials and 17 cohort studies involving 44,854 patients with ACS were identified. Compared with FA, RA was associated with a reduction in major bleeding (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.33-0.61, P < 0.001), access-related complications (OR 0.27, 95% CI 0.18-0.39, P < 0.001), mortality (OR 0.64, 95% CI 0.54-0.75, P < 0.001), and major adverse cardiac event (OR 0.70, 95% CI 0.57-0.85, P < 0.001). These significant reductions were consistent across different study designs and clinical presentations. CONCLUSIONS Based on this large meta-analysis, RA for primary PCI in the setting of ACS is associated with reduction in cardiac and safety endpoints when compared with FA in both urgent and elective procedures. This should encourage a wider adoption of this technique among centers and interventional cardiologists.
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Affiliation(s)
- Ernesto Ruiz-Rodriguez
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed Asfour
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Georges Lolay
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Khaled M Ziada
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
| | - Ahmed K Abdel-Latif
- From the Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky and the Lexington VA Medical Center, Lexington, Kentucky
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8
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Fu Q, Hu H, Wang D, Chen W, Tan Z, Li Q, Chen B. Randomized comparative study of left versus right radial approach in the setting of primary percutaneous coronary intervention for ST-elevation myocardial infarction. Clin Interv Aging 2015; 10:1003-8. [PMID: 26150704 PMCID: PMC4484656 DOI: 10.2147/cia.s81568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growing evidence suggests that the left radial approach (LRA) is related to decreased coronary procedure duration and fewer cerebrovascular complications as compared to the right radial approach (RRA) in elective percutaneous coronary intervention (PCI). However, the feasibility of LRA in primary PCI has yet to be studied further. Therefore, the aim of this study was to investigate the efficacy of LRA compared with RRA for primary PCI in ST-elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS A total of 200 consecutive patients with STEMI who received primary PCI were randomized to LRA (number [n]=100) or RRA (n=100). The study endpoint was needle-to-balloon time, defined as the time from local anesthesia infiltration to the first balloon inflation. Radiation dose by measuring cumulative air kerma (CAK) and CAK dose area product, as well as fluoroscopy time and contrast volume were also investigated. RESULTS There were no significant differences in the baseline characteristics between the two groups. The coronary procedural success rate was similar between both radial approaches (98% for left versus 94% for right; P=0.28). Compared with RRA, LRA had significantly shorter needle-to-balloon time (16.0±4.8 minutes versus 18.0±6.5 minutes, respectively; P=0.02). Additionally, fluoroscopy time (7.4±3.4 minutes versus 8.8±3.5 minutes, respectively; P=0.01) and CAK dose area product (51.9±30.4 Gy cm(2) versus 65.3±49.1 Gy cm(2), respectively; P=0.04) were significantly lower with LRA than with RRA. CONCLUSION Primary PCI can be performed via LRA with earlier blood flow restoration in the infarct-related artery and lower radiation exposure when compared with RRA; therefore, the LRA may become a feasible and attractive alternative to perform primary PCI for STEMI patients.
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Affiliation(s)
- Qiang Fu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongyu Hu
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dezhao Wang
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhixu Tan
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qun Li
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Buxing Chen
- Department of Cardiology, Beijing Titantan Hospital, Capital Medical University, Beijing, People's Republic of China
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9
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He P, Yang Y, Qiao S, Xu B, Yao M, Wu Y, Yuan J, Chen J, Liu H, Dai J, Yang X, Tang X, Wang Y, Li W, Gao R. Comparison of short- and medium-term clinical outcomes between transradial approach and transfemoral approach in a high-volume PCI heart center in China. PLoS One 2015; 10:e0118491. [PMID: 25826213 PMCID: PMC4380354 DOI: 10.1371/journal.pone.0118491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background Transradial approach (TRA) outweighed transfemoral approach (TFA) in acute coronary syndrome patients because the former has better short-term outcomes in high-volume percutaneous coronary intervention (PCI) centers. Our study was one of the limited studies specifically in comparing the short- and medium-term effects of TRA and those of TFA in patients undergoing elective PCIs. Methods A total of 21,242 patients who underwent elective PCI with stent implantation were included. Using propensity score methodology, 1,634 patient pairs were matched. Major clinical outcomes and PCI-related complications between TRA and TFA were compared. Results In the propensity score-matched patients, the rates of in-hospital net adverse clinical events, which included death, myocardial infarction (MI), target vessel revascularization (TVR), stroke, and major bleeding, were much lower with TRA than with TFA (1.8% vs. 3.9%, P < 0.001). This difference was mainly due to the lower rate of major bleeding (0.6% vs. 1.8%, P < 0.001) and the decreased rate of MI (1.1% vs. 1.9%, P = 0.060). PCI-related dissection and thrombosis were similar between the TRA and TFA groups (both P > 0.05). Meanwhile, one-year incidence rates of major adverse cardiovascular events, which included death, MI, and TVR, were also similar (4.1% vs. 4.9%, P = 0.272) in TRA and TFA. Multivariable regression analyses showed that TRA was an independent predictor of the low rate of in-hospital net adverse clinical events (odds ratio, 0.53; 95% confidence interval, 0.40 to 0.71), but not of major adverse cardiovascular events at one-year follow-up (hazard ratio, 1.01; 95% confidence interval, 0.96 to 1.06). Conclusions In patients undergoing elective PCI, TRA patients had lower rates of in-hospital net adverse clinical outcomes compared with TFA patients. TRA might be recommended as a routine approach in high-volume PCI hospitals for elective PCIs.
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Affiliation(s)
- Peiyuan He
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yuejin Yang
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- * E-mail:
| | - Shubin Qiao
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Bo Xu
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Min Yao
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yongjian Wu
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jinqing Yuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jue Chen
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Haibo Liu
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jun Dai
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xiao Yang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xinran Tang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Wang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wei Li
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Runlin Gao
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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Azzalini L, Ly HQ. Letter by Azzalini and Ly regarding article, "The learning curve for transradial percutaneous coronary intervention among operators in the United States: a study from the National Cardiovascular Data Registry". Circulation 2015; 131:e357. [PMID: 25712064 DOI: 10.1161/circulationaha.114.011035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Hung Q Ly
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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11
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Pang J, Zhang Z, Yang YJ, Li N, Bai M, Peng Y, Zhang J, Li Q, Zhang B. The efficacy and safety of transradial percutaneous coronary intervention VS transfemoral percutaneous coronary intervention for ST-segment elevation myocardial infarction patients: A meta-analysis. Int J Cardiol 2014; 177:483-8. [DOI: 10.1016/j.ijcard.2014.04.209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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RUBARTELLI PAOLO, CRIMI GABRIELE, BARTOLINI DAVIDE, BELLOTTI SANDRO, IANNONE ALESSANDRO, FONTANA VINCENZO. Switching from Femoral to Routine Radial Access Site for ST-Elevation Myocardial Infarction:
A Single Center Experience. J Interv Cardiol 2014; 27:591-9. [DOI: 10.1111/joic.12157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- PAOLO RUBARTELLI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - GABRIELE CRIMI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - DAVIDE BARTOLINI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | - SANDRO BELLOTTI
- Department of Cardiology; ASL3 Ospedale Villa Scassi; Genoa Italy
| | | | - VINCENZO FONTANA
- Epidemiology, Biostatistics and Clinical Trials Unit; IRCCS AOU San Martino - IST; Genoa Italy
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13
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Abstract
The transradial route for coronary angiography is a growing trend in the United States. Nurse practitioners (NPs) are an essential part of the preprocedural assessment and management of patients. This article will outline the benefits and risks of transradial access as well as methods for NPs to assess arterial hand circulation.
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14
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Gao L, Hu X, Liu YQ, Xue Q, Feng QZ. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction. Clin Interv Aging 2014; 9:1241-6. [PMID: 25114518 PMCID: PMC4124048 DOI: 10.2147/cia.s62642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes.
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Affiliation(s)
- Lei Gao
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xin Hu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yu-Qi Liu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qiao Xue
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Quan-Zhou Feng
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
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15
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Khan R, Ly HQ. Transradial percutaneous coronary interventions in acute coronary syndrome. Am J Cardiol 2014; 114:160-8. [PMID: 24925803 DOI: 10.1016/j.amjcard.2014.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 01/26/2023]
Abstract
Transradial access (TRA) is becoming increasingly used worldwide for percutaneous coronary intervention (PCI) after acute coronary syndromes (ACS). TRA compared with transfemoral access has been noted to improve clinical outcomes in clinical trials and large registry cohort studies. However, much of the benefits of TRA PCI are noted in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI, where TRA PCI has been associated with reductions in major bleeding events and potentially lower short- and long-term mortality rates. Although much less data exist for TRA PCI in unstable angina and/or non-ST elevation myocardial infarction, similar reductions in bleeding and mortality have not been consistently described. Differences in outcome benefit with TRA PCI among various ACS subtypes may be attributable to the potentially increased inherent risk of periprocedural bleeding in STEMI compared with unstable angina and/or non-ST elevation myocardial infarction. Pre- and intra-procedural factors associated with STEMI treatment, such as use of pharmacoinvasive therapy and aggressive antithrombotic regimens likely increase bleeding risk in patients. In conclusion, this review describes the evidence for TRA PCI across the spectrum of ACS and highlights why differences in clinical benefit may exist among ACS subtypes.
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Door-to-balloon time in radial versus femoral approach for primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Chiang A, Gada H, Kodali SK, Lee MS, Jeremias A, Pinto DS, Bangalore S, Yeh RW, Henry TD, Lopez-Cruz G, Mehran R, Kirtane AJ. Procedural variation in the performance of primary percutaneous coronary intervention for ST-elevation myocardial infarction: A SCAI-based survey study of US interventional cardiologists. Catheter Cardiovasc Interv 2013; 83:721-6. [DOI: 10.1002/ccd.25276] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/28/2013] [Accepted: 10/23/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Austin Chiang
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Hemal Gada
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Susheel K. Kodali
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Michael S. Lee
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Allen Jeremias
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Duane S. Pinto
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Sripal Bangalore
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Robert W. Yeh
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Timothy D. Henry
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Georgina Lopez-Cruz
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Roxana Mehran
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
| | - Ajay J. Kirtane
- Columbia University Medical Center/New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York
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Radial artery occlusion after percutaneous coronary interventions - an underestimated issue. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:353-61. [PMID: 24570753 PMCID: PMC3927109 DOI: 10.5114/pwki.2013.38865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/15/2013] [Accepted: 10/30/2013] [Indexed: 12/18/2022] Open
Abstract
The femoral approach is the most common arterial access for percutaneous coronary artery interventions. Despite the convenience and simplicity of this approach, it is burdened with a high risk of arterial puncture bleeding, which worsens the prognosis of the patient. An alternative approach through the radial artery has been gaining more and more popularity in recent years. This is due to a significant reduction of local bleeding complications as compared with the femoral artery approach. The use of the radial approach in patients with ST-segment elevation myocardial infarction improves outcome, reducing the risk of death, subsequent myocardial infarction and stroke, and is the preferred approach according to the latest ESC guidelines. In addition to improving safety, it is beneficial for improving patient comfort, with a shorter recovery after the procedure, shorter hospitalization and lower medical costs. One of the major complications of procedures performed through the radial approach is radial artery occlusion (RAO). Although it usually has an asymptomatic course, RAO eliminates the ability to use the radial artery as an access in the future. A number of factors that contribute to the occurrence of RAO have been identified, such as the size of the sheath and the catheter, diameter ratio of the sheath to the diameter of the radial artery, insufficient anticoagulation and, above all, the way of obtaining hemostasis at the puncture site: the duration of artery compression after sheath removal and the preservation of artery patency during compression (so-called patent hemostasis). This paper presents the current state of the art about the factors that contribute to the occurrence of RAO and methods for preventing this complication.
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Rao SV, Tremmel JA, Gilchrist IC, Shah PB, Gulati R, Shroff AR, Crisco V, Woody W, Zoghbi G, Duffy PL, Sanghvi K, Krucoff MW, Pyne CT, Skelding KA, Patel T, Pancholy SB. Best practices for transradial angiography and intervention: a consensus statement from the society for cardiovascular angiography and intervention's transradial working group. Catheter Cardiovasc Interv 2013; 83:228-36. [PMID: 24123781 DOI: 10.1002/ccd.25209] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Sunil V Rao
- Duke University Medical Center, Durham, North Carolina
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De Luca G, Schaffer A, Wirianta J, Suryapranata H. Comprehensive meta-analysis of radial vs femoral approach in primary angioplasty for STEMI. Int J Cardiol 2013; 168:2070-81. [PMID: 23490083 DOI: 10.1016/j.ijcard.2013.01.161] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/04/2012] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
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Freixa X, Belle L, Joseph L, Tanguay JF, Souteyrand G, L Allier PL, Jolicœur EM. Immediate vs. delayed stenting in acute myocardial infarction: a systematic review and meta-analysis. EUROINTERVENTION 2013; 8:1207-16. [PMID: 23425545 DOI: 10.4244/eijv8i10a185] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To conduct a meta-analysis of studies comparing immediate versus delayed stenting in populations where primary percutaneous coronary intervention (PCI) or early invasive revascularisation was the initial mode of reperfusion. METHODS AND RESULTS We identified five non-randomised studies and one randomised trial for a total of 590 patients in studies comparing immediate to delayed stenting in populations where primary PCI or early invasive revascularisation was the initial mode of reperfusion. In non-randomised studies, delayed stenting was associated with a reduction of procedure-related angiographic events (OR=0.13, 95% credible interval [CrI]: 0.03- 0.36). No differences were observed in the rates of major bleeding (OR=0.81, 95% CrI: 0.01-13.42) and major adverse cardiac events (OR=0.40, 95% CrI: 0.09-1.91), between delayed and immediate stenting. In one randomised trial, delayed stenting was associated with a reduction in myocardial infarction during hospitalisation (39% vs. 60%; relative risk [RR]=0.55, 95% confidence interval [CI]: 0.39-0.80). None of the patients assigned to delayed stenting experienced a major adverse cardiac event in the interval between the initial angiogram and the stenting. CONCLUSIONS Delayed stent implantation is associated with better angiographic outcomes. Randomised trials are required to assess whether delayed stenting translates into better long-term cardiac outcomes.
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Affiliation(s)
- Xavier Freixa
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Québec, Canada
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Kajiya T, Agahari F, Wai KL, Tai BC, Lee CH, Chan KH, Teo SG, Richards AM, Tan HC, Low AF, Chan MY. A single-center experience of transitioning from a routine transfemoral to a transradial intervention approach in ST-elevation myocardial infarction: Impact on door-to-balloon time and clinical outcomes. J Cardiol 2013; 62:12-7. [DOI: 10.1016/j.jjcc.2013.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/28/2013] [Accepted: 02/18/2013] [Indexed: 11/27/2022]
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Iqbal Z, Cohen M, Pollack C, Goldstein P, Zeymer U, Huber K, Barthelemy O, Cayla G, Aout M, Vicaut E, Montalescot G. Safety and efficacy of adjuvant glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention performed from the radial approach for acute ST segment elevation myocardial infarction. Am J Cardiol 2013; 111:1727-33. [PMID: 23528027 DOI: 10.1016/j.amjcard.2013.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 11/25/2022]
Abstract
The use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) in high-risk patients with acute coronary syndromes has been associated with reductions in ischemic events but increases in bleeding complications. The role of GPIs in patients who undergo primary percutaneous coronary intervention (PCI) by the transradial approach (TRA) is not well studied. The aim of this post hoc analysis from the randomized prospective Acute Myocardial Infarction Treated With Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short- and Long-Term Follow-Up (ATOLL) trial was to assess the safety and efficacy of GPIs in primary PCI performed using the TRA. A total of 910 patients were enrolled in ATOLL; 522 patients (67%) underwent PCI using the TRA. Two comparative analyses were performed. First, patients who underwent PCI using the TRA who received GPIs were compared with those who did not receive GPIs. Second, patients who underwent PCI using the TRA who received GPIs were compared with those who underwent PCI using a nonradial route and received GPIs. Composite end points of net clinical benefit, ischemic outcomes, and safety consisting of bleeding and transfusion at 1 month were analyzed. A propensity score was constructed, and weight adjustment were made for variables, including but not limited to age, weight, gender, renal function, concomitant use of other medications, Killip class, and medical history, when analyzing the end points. There was no significant difference in net clinical benefit or ischemic outcomes between either TRA patients with versus without GPIs or TRA patients with GPIs versus non-TRA patients with GPIs. Additionally, there were significantly fewer major bleeding events and blood transfusions in TRA patients with GPIs compared with non-TRA patients with GPIs. In conclusion, the addition of GPIs in the setting of primary PCI using the TRA was not associated with bleeding liability. The use of GPIs with TRA was associated with safer outcomes than using GPIs with a nontransradial approach. This study was limited in that it was a nonrandomized retrospective analysis.
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Mamas MA, Ratib K, Routledge H, Neyses L, Fraser DG, de Belder M, Ludman PF, Nolan J. Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention: are the results of randomized trials achievable in clinical practice? JACC Cardiovasc Interv 2013; 6:698-706. [PMID: 23769648 DOI: 10.1016/j.jcin.2013.03.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/06/2013] [Accepted: 03/15/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to investigate the influence of access site utilization on mortality, major adverse cardiac and cardiovascular events (MACCE), bleeding, and vascular complications in a large number of patients treated by primary percutaneous coronary intervention (PPCI) in the United Kingdom over a 5-year period, through analysis of the British Cardiovascular Intervention Society database. BACKGROUND Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing PPCI. A significant proportion of such bleeding complications are related to the access site, and adoption of radial access may reduce these complications. These benefits have not previously been studied in a large unselected national population of PPCI patients. METHODS Mortality (30-day), MACCE (a composite of 30-day mortality and in-hospital myocardial re-infarction, target vessel revascularization, and cerebrovascular events), and bleeding and access site complications were studied based on transfemoral access (TFA) and transradial access (TRA) site utilization in PPCI STEMI patients. The influence of access site selection was studied in 46,128 PPCI patients; TFA was used in 28,091 patients and TRA in 18,037. Data were adjusted for potential confounders using Cox regression that accounted for the propensity to undergo radial or femoral approach. RESULTS TRA was independently associated with a lower 30-day mortality (hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.52 to 0.97; p < 0.05), in-hospital MACCE (HR: 0.73, 95% CI: 0.57 to 0.93; p < 0.05), major bleeding (HR: 0.37, 95% CI: 0.18 to 0.74; p < 0.01), and access site complications (HR: 0.38, 95% CI: 0.19 to 0.75; p < 0.01). CONCLUSIONS This analysis of a large number of PPCI procedures demonstrates that utilization of TRA is independently associated with major reductions in mortality, MACCE, major bleeding, and vascular complication rates.
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Affiliation(s)
- Mamas A Mamas
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
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De Servi S, Mariani G, Mariani M, D'Urbano M. How to reduce mortality in ST-elevation myocardial infarction patients treated with primary percutaneous coronary interventions: cut the bleeding. Curr Med Res Opin 2013; 29:189-94. [PMID: 23350949 DOI: 10.1185/03007995.2013.770389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-hospital mortality for ST-elevation myocardial infarction (STEMI) has declined thanks to a greater use of primary percutaneous coronary interventions (PCI) associated with more effective antiplatelet and anticoagulant drugs. In this regard, bivalirudin has been shown to decrease total and cardiac mortality as compared to unfractionated heparin (UFH). OBJECTIVE The primary purpose of this analysis is to evaluate the hypothesis that the reduction of in-hospital bleeding is the most plausible explanation for the improved survival of STEMI patients treated with bivalirudin during primary PCI. The secondary objective is to reconsider the prognostic significance of the radial access alone or in association with bivalirudin on the basis of the published data. METHODS We have done a comprehensive evaluation of the main and related publications of the HORIZONS-AMI trial in addition to an extensive research by Medline of randomized trials evaluating the prognostic impact of radial access as compared with the femoral one in primary PCI. RESULTS In the HORIZONS-AMI trial bivalirudin resulted in significantly lower rates of the 30 day primary endpoint (defined as major adverse ischemic outcomes plus major bleeding) over UFH plus GPI, largely due to the significantly lower rate of the protocol-defined major bleeding. All-cause and cardiac mortality were also reduced in the bivalirudin arm at 3 year follow-up. Recent studies have also shown that the use of the radial instead of the femoral approach for primary PCI is associated with reduced bleeding as well as reduced mortality. CONCLUSIONS Our research suggests that decreasing bleeding by either a pharmacologic strategy (use of bivalirudin) or a technical approach (the transradial access) improves survival in STEMI patients undergoing primary PCI. The validity of this hypothesis should be confirmed by specific randomized trials.
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Affiliation(s)
- Stefano De Servi
- Department of Cardiovascular Diseases, Ospedale Civile di Legnano, Milan, Italy.
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Byrne RA, Cassese S, Linhardt M, Kastrati A. Vascular access and closure in coronary angiography and percutaneous intervention. Nat Rev Cardiol 2012. [DOI: 10.1038/nrcardio.2012.160] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hofma SH, Brouwer J, Velders MA, van't Hof AWJ, Smits PC, Queré M, de Vries CJ, van Boven AJ. Second-generation everolimus-eluting stents versus first-generation sirolimus-eluting stents in acute myocardial infarction. 1-year results of the randomized XAMI (XienceV Stent vs. Cypher Stent in Primary PCI for Acute Myocardial Infarction) trial. J Am Coll Cardiol 2012; 60:381-7. [PMID: 22835668 DOI: 10.1016/j.jacc.2012.01.073] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The goal of this study was to compare the efficacy and safety of second-generation everolimus-eluting stents (EES) with first-generation sirolimus-eluting stents (SES) in primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). BACKGROUND Drug-eluting stents (DES) in AMI are still feared for possible late and very late stent thrombosis (ST). Newer-generation DES, with more hemocompatible polymers and improved healing, may show promise regarding increased efficacy of DES with improved safety. However, no randomized trials in AMI are available. METHODS A total of 625 patients with AMI were randomized (2:1) to receive EES or SES in the XAMI (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction) trial. Primary endpoint was major adverse cardiac events (MACE) at 1 year consisting of cardiac death, nonfatal AMI, or any target vessel revascularization. The study was powered for noninferiority of EES. Secondary endpoints comprised ST rates and MACE rate up to 3 years. RESULTS The MACE rate was 4.0% for EES and 7.7% for SES; the absolute difference was -3.7% (95% confidence interval: -8.28 to -0.03; p = 0.048) and relative risk was 0.52 (95% confidence interval: 0.27 to 1.00). One-year cardiac mortality was low at 1.5% for EES versus 2.7% for SES (p = 0.36), and 1-year incidence of definite and/or probable ST was 1.2% for EES versus 2.7% for SES (p = 0.21). CONCLUSIONS In this all-comer, randomized, multicenter AMI trial, second-generation EES was noninferior to SES, and superiority for MACE was suggested. ST rate in EES at 1-year was low, but long-term follow-up and larger studies will have to show whether very late ST rates will also be improved in newer DES. (XienceV Stent vs Cypher Stent in Primary PCI for Acute Myocardial Infarction [XAMI]; NTR1123).
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Affiliation(s)
- Sjoerd H Hofma
- Medical Center Leeuwarden,Henri Dunantweg 2, Leeuwarden, the Netherlands.
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Tayeb HM, Nelson AJ, Willoughby SR, Worthley MI. Antiplatelet therapy in acute coronary syndromes: current agents and impact on patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2012; 2:7-19. [PMID: 22915965 PMCID: PMC3417919 DOI: 10.2147/prom.s9834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Indexed: 02/02/2023]
Abstract
Platelets play a central role in atherothrombosis and subsequent development of acute coronary syndromes (ACS). The understanding of this process has driven a large body of evidence demonstrating the mortality and morbidity benefits of antiplatelet agents in the ACS population. As expected, however, these agents come with an intrinsically increased risk of bleeding which underlies the vast majority of their complications and adverse effects. In today’s setting of compounding comorbidities and broadening indications, finding the balance between thrombosis prevention and bleeding risk remains the challenge for all clinicians considering these medications. This article reviews the current main antiplatelet agents that are available for clinical use and outlines their impact on ACS outcome. We also outline factors which affect the response to these agents and discuss strategies to optimize clinical outcomes.
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Affiliation(s)
- Hussam M Tayeb
- Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DK, Kim DI, Cho KI, Kim BH, Park YH, Je HG, Kim DS. The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. EUROINTERVENTION 2012; 8:501-10. [PMID: 22581470 DOI: 10.4244/eijv8i4a78] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jae-Sik Jang
- Department of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea.
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Segev A, Matetzky S, Danenberg H, Fefer P, Bubyr L, Zahger D, Roguin A, Gottlieb S, Kornowski R. Contemporary use and outcome of percutaneous coronary interventions in patients with acute coronary syndromes: insights from the 2010 ACSIS and ACSIS-PCI surveys. EUROINTERVENTION 2012; 8:465-9. [DOI: 10.4244/eijv8i4a73] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, Meerkin D, Joseph L. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 2012; 163:632-48. [PMID: 22520530 DOI: 10.1016/j.ahj.2012.01.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI. RESULTS We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials. CONCLUSION Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
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Comparison of 3-year clinical outcomes after transradial versus transfemoral percutaneous coronary intervention. Cardiovasc Interv Ther 2012; 27:84-92. [DOI: 10.1007/s12928-012-0098-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
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DOMINICI MARCELLO, DILETTI ROBERTO, MILICI CATERINA, BOCK CARLO, GARG SCOT, DE PAOLIS MARCELLA, AMBROSIO GIUSEPPE, BOSCHETTI ENRICO. Left Radial versus Right Radial Approach for Coronary Artery Catheterization: A Prospective Comparison. J Interv Cardiol 2012; 25:203-9. [DOI: 10.1111/j.1540-8183.2011.00689.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Généreux P, Mehran R, Palmerini T, Caixeta A, Kirtane AJ, Lansky AJ, Brodie BR, Witzenbichler B, Mockel M, Guagliumi G, Peruga JZ, Dudek D, Fahy MP, Dangas G, Stone GW. Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction: the HORIZONS-AMI trial. EUROINTERVENTION 2011; 7:905-16. [DOI: 10.4244/eijv7i8a144] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sengottuvelu G. Current Status of Radial Interventions. APOLLO MEDICINE 2011. [DOI: 10.1016/s0976-0016(11)60069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nadarasa K, Robertson MC, Wong CK, Green BK, Chen VH, Wilkins GT, Williams MJ. Rapid cycle change to predominantly radial access coronary angiography and percutaneous coronary intervention. Catheter Cardiovasc Interv 2011; 79:589-94. [DOI: 10.1002/ccd.23120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/07/2011] [Indexed: 11/10/2022]
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Prada-Delgado Ó, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, Castro-Beiras A. Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2011; 161:1207-13. [PMID: 21641370 DOI: 10.1016/j.ahj.2011.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI. METHODS A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion. RESULTS Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91). CONCLUSIONS The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.
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Affiliation(s)
- Óscar Prada-Delgado
- Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, Frasier D, Gulati R, Skelding K, Bertrand O, Patel T. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78:823-39. [PMID: 21544927 DOI: 10.1002/ccd.23052] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/13/2011] [Indexed: 01/21/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/standards
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/methods
- Cardiac Catheterization/standards
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/therapy
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/methods
- Catheterization, Peripheral/standards
- Clinical Competence
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/standards
- Credentialing
- Endovascular Procedures/adverse effects
- Endovascular Procedures/methods
- Endovascular Procedures/standards
- Humans
- Patient Selection
- Radial Artery
- Risk Assessment
- Risk Factors
- Societies, Medical
- Treatment Outcome
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Affiliation(s)
- Ronald P Caputo
- St. Joseph's Hospital, S.U.N.Y. Upstate Medical School, Syracuse, New York 13203, USA.
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Gilchrist IC. Transradial Catheterization's Grass Roots Epidemic⁎⁎Editorials published in JACC: Cardiovascular Interventions reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Interventions or the American College of Cardiology. JACC Cardiovasc Interv 2010; 3:1032-4. [DOI: 10.1016/j.jcin.2010.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/04/2010] [Indexed: 11/25/2022]
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