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Balfe C, Jacob B, Morad S, Elsayed A, Tan LYJ, Nelson E, AlBaghdadi A, Power A, Twomey D, McDermott B, Ahern C, Abbas SF, Hennessy T, Ullah I, Arnous S, Kiernan T. Clinical Outcomes and Associations With Radial to Femoral Crossover in ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 200:103-111. [PMID: 37307779 DOI: 10.1016/j.amjcard.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/13/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
Radial access during primary percutaneous coronary intervention is associated with reduced mortality and major bleeding compared with femoral access and is the recommended access site. Nevertheless, failure to secure radial access may necessitate crossover to femoral access. This study aimed to identify the associations with crossover from radial to femoral access in all comers with ST-elevation myocardial infarction and to compare the clinical outcomes with those patients who did not require crossover. From 2016 to 2021, a total of 1,202 patients presented to our institute with ST-elevation myocardial infarction. Associations, clinical outcomes, and independent predictors of crossover from radial to femoral access were identified. From 1,202 patients, radial access was used in 1,138 patients (94.7%) and crossover to femoral access occurred in 64 patients (5.3%). Patients who required crossover to femoral access had higher rates of access site complications and longer length of stay in the hospital. Inpatient mortality was higher in the group requiring a crossover. This study identified 3 independent predictors of crossover from radial to femoral access in primary percutaneous coronary intervention: cardiogenic shock, cardiac arrest before arrival at the catheterization laboratory, and previous coronary artery bypass grafting. Biochemical infarct size and peak creatinine was also found to be higher in those requiring crossover. In conclusion, crossover in this study portended an increased rate of access site complications, greatly prolonged length of stay, and a significantly higher risk of death.
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Affiliation(s)
- Christopher Balfe
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland.
| | - Benjamin Jacob
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Samir Morad
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Amged Elsayed
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Lok Yi Joyce Tan
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Edel Nelson
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Ali AlBaghdadi
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Aoife Power
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - David Twomey
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Breda McDermott
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Catriona Ahern
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Syed Farhat Abbas
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Terence Hennessy
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Ihsan Ullah
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Samer Arnous
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland
| | - Thomas Kiernan
- Cardiology Department, University Hospital Limerick, Co. Limerick, Ireland; School of Medicine, University of Limerick, Co. Limerick, Ireland
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Shanahan W, Bagwe I, Brassill MJ, O'Regan P. Reduced and more appropriate referrals of patients with type 2 diabetes using liver stiffness measurement compared to FIB-4. Ir J Med Sci 2022; 192:649-654. [PMID: 35486350 DOI: 10.1007/s11845-022-03019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatty liver disease and fibrosis are common in patients with type 2 diabetes mellitus (T2DM). Recently published European Association for the Study of the Liver guidelines have suggested screening such patients using liver stiffness measurement (LSM) or fibrosis-4 index (FIB-4) to exclude advanced fibrosis. AIMS We initiated a screening programme at the diabetes out-patient clinic to assess the reliability of the suggested approaches and resulting referrals. METHODS In this prospective study, consecutive patients attending for T2DM review at an Irish level 3 (district general) hospital between September and November 2021 were screened for liver fibrosis using LSM and had their FIB-4 calculated. The first 100 patients with valid LSM measurements were included in the analysis. RESULTS Referral rates to the hepatology clinic varied by modality used. If FIB-4 ≥ 1.3 criterion was used, the referral rate to the hepatology clinic was 45%; using LSM < 8 kPa to rule out advanced fibrosis resulted in 34% referral rate; using LSM ≥ 10 kPa to suggest probable compensated advanced chronic liver disease reduced referral rates to 15%. Combining FIB-4 with LSM in a two-step algorithm led to missed potentially significant liver disease in large numbers. 47% patients with LSM ≥ 8 kPa and 33% with LSM ≥ 10 kPa had FIB-4 < 1.3. CONCLUSIONS Screening of patients with T2DM using LSM alone rather than FIB-4 leads to reduced numbers of, and more appropriate, referrals to the hepatology clinic. Shifting from an exclusion (LSM < 8 kPa) to an inclusion based (LSM ≥ 10 kPa) approach may lessen the potential of screening to overwhelm hepatology services.
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Affiliation(s)
- William Shanahan
- Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland.
| | - Isha Bagwe
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
| | - Mary Jane Brassill
- Department of Endocrinology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
| | - Paud O'Regan
- Department of Gastroenterology, Tipperary University Hospital, Clonmel, Co Tipperary, Ireland
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