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Ocsan RJ, Doost A, Marley P, Farshid A. The Rise of Transradial Artery Access for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndromes in Australia. J Interv Cardiol 2020; 2020:4397697. [PMID: 33312077 PMCID: PMC7719530 DOI: 10.1155/2020/4397697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) via transradial artery access (TRA) or transfemoral artery access (TFA). BACKGROUND Over the last decade, evidence for the benefit of TRA for PCI has grown, leading to a steady uptake of TRA around the world. Despite this, the topic remains controversial with contrary evidence to suggest no significant benefit over TFA. METHODS A retrospective study of consecutive ACS patients from 2011 to 2017 who underwent PCI via TRA or TFA. The primary outcome was Major Adverse Cardiovascular Events (MACE), a composite of death, myocardial infarction (MI), target lesion revascularisation (TLR), or coronary artery bypass graft surgery (CABG) at 12 months. Secondary outcomes included Bleeding Academic Research Consortium (BARC) bleeding events scored 2 or higher, haematoma formation, and stent thrombosis, in addition to all individual components of MACE. RESULTS We treated 3624 patients (77% male), with PCI via TFA (n = 2391) or TRA (n = 1233). Transradial artery access was associated with a reduction in mortality (3% vs 6.3%; p < 0.0001), MI (1.8% vs 3.9%; p=0.0004), CABG (0.6% vs 1.5%; p=0.0205), TLR (1% vs 2.9%; p < 0.0001), large haematoma (0.4% vs 1.8%; p=0.0003), BARC 2 (0.2% vs 1.1%; p=0.0029), and BARC 3 events (0.4% vs 1.0%; p=0.0426). On multivariate Cox regression analysis, TFA, age ≥ 75, prior PCI, use of bare metal stents, cardiogenic shock, cardiac arrest, and multivessel coronary artery disease were associated with an increased risk of MACE. CONCLUSION Despite the limitations secondary to the observational nature of our study and multiple confounders, our results are in line with results of major trials and, as such, we feel that our results support the use of TRA as the preferred access site in patients undergoing PCI for ACS to improve patient outcomes.
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Affiliation(s)
- Ryan James Ocsan
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Ata Doost
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Paul Marley
- Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia
| | - Ahmad Farshid
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
- Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia
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Sultan EZM, Rabea HM, Abdelmeguid KR, Mahmoud HB. Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach. Egypt Heart J 2018; 70:1-7. [PMID: 29622990 PMCID: PMC5883500 DOI: 10.1016/j.ehj.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/21/2017] [Indexed: 11/30/2022] Open
Abstract
There was a non-significant difference regarding LVEF and TIMI flow between both PPCI and PI. Myocardium wall preservation was significant in early PI (P = 0.023) Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. No reported entry site complications also no difference in primary end point (P = 0.326). It is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI.
The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3 h from symptoms onset) or late (>3 h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12 h from symptoms onset or 12–24 h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm. Patients who were taken to a non-PCI capable hospital received streptokinase and were then transferred to our Hospital for CA. TRA was used in the catheterization laboratory for all patients. Each arm was divided according to reperfusion time into early and late subgroups. A primary endpoint was death, shock, congestive heart failure, or reinfarction up to 30 days. There was a non-significant difference regarding LVEF in both arms. Myocardium wall preservation was significant in the early PI arm (P = 0.023). TIMI flow had no discrepancy between both arms (P = 0.569). Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. There were no reported entry site complications. There was no difference in primary endpoint complications (P = 0.326) considering the different times of patients’ reperfusion (early; P = 0.696 vs. late; P = 0.424). In conclusion, it is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI. We recommend PI for STEMI patients with delay presentation if PPCI is not available.
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Affiliation(s)
- El-Zahraa M Sultan
- Clinical Pharmacist, Cardiovascular Department, Beni-Suef Hospital University, Egypt
| | - Hoda M Rabea
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | - Hesham B Mahmoud
- Prof. of Cardiology, Beni-Suef Hospital University, Beni-Suef, Egypt
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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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Rehmani A, Judkins C, Whelan A, Nguyen M, Schultz C. Comparison of Safety and Efficacy of Unfractionated Heparin Versus Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1277-1281. [PMID: 28377232 DOI: 10.1016/j.hlc.2016.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anti-platelet and anti-coagulant adjunctive therapies are associated with a clinically significant increased risk of major bleeding. We retrospectively assessed in-hospital major adverse clinical events (MACE) and major bleeding in patients undergoing percutaneous coronary intervention (PCI) who received either unfractionated heparin (UFH) or bivalirudin. METHOD Consecutive patients undergoing PCI for acute coronary syndrome (ACS) at Fremantle Hospital from August 2008 to December 2013 were identified. Patients received dual antiplatelet therapy (DAPT), with either UFH (50-100IU/kg) or bivalirudin (bolus 0.75mg/kg and infusion 1.75mg/kg/hr). Adjunctive glycoprotein IIb/IIIa (GPIIbIIIa) antagonist use was at the operator's discretion. In-hospital events were identified from case notes and PCI database review. RESULTS Of 3371 patients identified, 1740 received UFH and 1631 received bivalirudin. The two groups were similar with respect to age, 62.5 SD 12.1 yrs vs. 62.8 SD 12.2 yrs, (p=0.575) female gender, 24% vs. 26% (p=0.10), current smokers, 66% vs. 70% (p=0.53), diabetes, 25% vs. 26% (p=0.62) and the use of DAPT (p=ns). Presentation with ST-segment-elevation myocardial infarction (STEMI) was significantly higher in the UFH group (28% vs. 19%, p<0.001). The use of transfemoral arterial access was similar (93% UFH vs. 92% bivalirudin) (p=0.41). More patients received GPIIb/IIIa antagonist in the UFH group (30% vs. 3%; p <0.001). There was no difference in pre-discharge acute stent thrombosis (<24hours) occurring in 1.0% with UFH vs. 0.5% with bivalirudin (p=0.20). The equipoise on the outcomes of stent thrombosis persisted after multivariate adjustment for difference in rates of STEMI. In-hospital BARC Type 1-3 major bleeding occurred in 3.7% in the UFH group vs. 2.9% in the bivalirudin group (p=0.20). CONCLUSION Unfractionated heparin compared with bivalirudin was not associated with a higher incidence of in-hospital MACE or major bleeding in a cohort with overall high rates of transfemoral access, despite significantly higher use of GPIIb/IIIa antagonists in the UFH group.
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Affiliation(s)
- Ahmed Rehmani
- Department of Cardiology, Fremantle Hospital, Perth, WA, Australia.
| | - Chris Judkins
- Department of Cardiology, Fremantle Hospital, Perth, WA, Australia
| | - Alan Whelan
- Department of Cardiology, Fremantle Hospital, Perth, WA, Australia
| | - Michael Nguyen
- Department of Cardiology, Fremantle Hospital, Perth, WA, Australia
| | - Carl Schultz
- Department of Cardiology, Fremantle Hospital, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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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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Abdul Jabbar A, Mufti O, Sabol A, Markert R, White B, Broderick G. Arterial Access in Patients With De Novo Acute Coronary Syndrome Undergoing Coronary Angiography. Angiology 2016; 68:360-365. [PMID: 27252244 DOI: 10.1177/0003319716652277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding is a major limitation of antithrombotic therapy among invasively managed patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs). Randomized clinical trials have generally failed to favor either the femoral or the radial arterial approach for coronary angiography or intervention in NSTE-ACS. In 561 hospitalized patients with a new diagnosis of NSTE-ACS referred for coronary angiography, 364 and 197 patients underwent the femoral and the radial approach, respectively. Femoral and radial access did not differ in bleeding complications in the first 72 hours (8 of 364 or 2.2% vs 8 of 197 or 4.1%, P = .21), duration of hospitalization (4.67 ± 5.02 vs 4.51 ± 4.81, P = .28) nor in-hospital mortality (0.8% vs 0.5%, P = .67). Contrast volume was higher for femoral versus radial cases (204 ± 119 vs 168 ± 104, P < .001). In patients with de novo NSTE-ACS without prior cardiac bypass, radial and femoral arterial access did not differ in instances of bleeding within the first 72 hours postoperatively, length of hospital stay, or in-hospital mortality. Less contrast was used in radial cases, which may represent an advantage for patients with renal insufficiency.
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Affiliation(s)
- Ali Abdul Jabbar
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA.,2 Division of Cardiovascular Medicine, Department of Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Omar Mufti
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Angeline Sabol
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Ronald Markert
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - Bryan White
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
| | - George Broderick
- 1 Cardiology Division, Department of Internal Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH, USA
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Choe JC, Cha KS, Choi JH, Kim BW, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Youn YJ, Lee SH, Cho BR, Kim DI, Han KR, Jeong MH, Yoon J. Comparison of Frequency of Bleeding and Major Adverse Cardiac Events After Transradial Versus Transfemoral Intervention in the Recent Antiplatelet Era. Am J Cardiol 2016; 117:1588-1595. [PMID: 27026640 DOI: 10.1016/j.amjcard.2016.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
The transradial approach is increasingly used for percutaneous coronary intervention (PCI), and we therefore aimed to compare the clinical outcomes after transradial intervention (TRI) and transfemoral intervention (TFI) in all patients undergoing PCI. Among 6,973 patients enrolled in a nationwide, prospective, multicenter registry (February 2013 to September 2013), 1,860 underwent TRI (n = 1,445, 77.7%) and TFI (n = 415, 22.3%). Bleeding and major adverse cardiac events (MACE; death, myocardial infarction, revascularization, or stent thrombosis) were compared. Bleeding occurred in 42 patients (2.3%) and was significantly less likely in the TRI versus TFI group (overall cohort: 1.5% vs 4.8%, p = 0.001; propensity score-matched: n = 728, 2.7% vs 5.2%, p = 0.048). Multivariate regression revealed that TRI was negatively associated with bleeding (odds ratio 0.42, 95% CI 0.21 to 0.83, p = 0.013). MACE occurred in 152 patients (8.2%). Kaplan-Meier estimates showed higher MACE-free survival rates in the TRI versus TFI group (overall cohort: 93.3% vs 86.7%, log-rank p = 0.026; propensity score-matched: 91.8% vs 86.5%, log-rank p = 0.04). Cox proportional analysis demonstrated that TRI independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p = 0.024). In conclusion, TRI is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI.
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Kadakia MB, Rao SV, McCoy L, Choudhuri PS, Sherwood MW, Lilly S, Kobayashi T, Kolansky DM, Wilensky RL, Yeh RW, Giri J. Transradial Versus Transfemoral Access in Patients Undergoing Rescue Percutaneous Coronary Intervention After Fibrinolytic Therapy. JACC Cardiovasc Interv 2015; 8:1868-76. [DOI: 10.1016/j.jcin.2015.07.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 11/25/2022]
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