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Bi X, Guo Q, Jia H, Song T, Feng J, Li M, Wang Q. Effect of transradial catheterization and nifedipine on flow- and nitroglycerin-mediated dilations of distal and proximal radial artery. Coron Artery Dis 2022; 33:648-654. [PMID: 36238973 PMCID: PMC9622370 DOI: 10.1097/mca.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/21/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Radial artery (RA) dysfunction after transradial access intervention is not limited to the distal portion but can also occur in the proximal portion of RA. The aim of the present study was to assess the effect of sublingual nifedipine administrated prior to puncture on the endothelial function of distal and proximal RA. METHODS Eighty-nine patients who underwent coronary angiography (CAG) were randomly assigned to the nifedipine group ( n = 45) or control group ( n = 44). The flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of distal and proximal RA were measured at baseline, 24 h, and 48 h after transradial angiography. RESULTS Compared with the control group, the nifedipine group only limited the reduction of FMD in the distal RA at 24 and 48 h [6.52 ± 1.40% (24 h) vs. 5.85 ± 1.38% (24 h), P = 0.03; 7.41 ± 1.30% (48 h) vs. 6.65 ± 1.25% (48 h), P = 0.006], whereas FMD alterations in the proximal RA were not restored by nifedipine. Both groups were still lower than baseline values (11.66 ± 2.35% and 11.24 ± 2.22%). We observed similar effects of nifedipine on the NMD of the distal RA. CONCLUSION Although transradial angiography-induced dysfunction was reported in both distal and proximal RA, nifedipine could help restore the distal endothelial function of the cannulated RA.
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Affiliation(s)
- Xile Bi
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qianghua Guo
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Hongdan Jia
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Tingting Song
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Jianshuang Feng
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Min Li
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qingsheng Wang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, China
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Association between the Angle of the Left Subclavian Artery and Procedural Time for Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. J Interv Cardiol 2022; 2022:3249745. [PMID: 36474644 PMCID: PMC9691329 DOI: 10.1155/2022/3249745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background The effect of left subclavian artery tortuosity during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear. Methods Of 245 ACS patients (from November 2019 and May 2021), 79 who underwent PCI via a left radial approach (LRA) were included. We measured the angle of the left subclavian artery in the coronal view on CT imaging as an indicator of the tortuosity and investigated the association between that angle and the clinical variables and procedural time. Results Patients with a left subclavian artery angle of a median of <70 degrees (severe tortuosity) were older (75.4 ± 11.7 vs. 62.9 ± 12.3 years, P < 0.001) and had a higher prevalence of female sex (42.1% vs. 14.6%, P=0.007), hypertension (94.7% vs. 75.6%, P=0.02), and subclavian artery calcification (73.7% vs. 34.2%, P < 0.001) than those with that ≥70 degrees. The left subclavian artery angle correlated negatively with the sheath cannulation to the first balloon time (ρ = -0.51, P < 0.001) and total procedural time (ρ = -0.32, P=0.004). A multiple linear regression analysis revealed that the natural log transformation of the sheath insertion to first balloon time was associated with a subclavian artery angle of <70 degrees (β = 0.45, P < 0.001). Conclusion Our study showed that lower left subclavian artery angles as a marker of the tortuosity via the LRA were strongly associated with a longer sheath insertion to balloon time and subsequent entire procedure time during the PCI.
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The association of transradial access and transfemoral access with procedural outcomes in acute ischemic stroke patients receiving endovascular thrombectomy: A meta-analysis. Clin Neurol Neurosurg 2022; 215:107209. [DOI: 10.1016/j.clineuro.2022.107209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
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Jones J, Rathod KS, Beirne AM, Hamshere SM, Choudry FA, O'Mahony C, Guttmann OP, Knight CJ, Amersey R, Wragg A, Baumbach A, Mathur A, Jones DA. An observational study assessing the predictors of procedural failure from the radial approach. Is right radial access always the best? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:86-91. [DOI: 10.1016/j.carrev.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
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Badescu MC, Ciocoiu M, Rezus E, Badulescu OV, Tanase DM, Ouatu A, Dima N, Ganceanu-Rusu AR, Popescu D, Seritean Isac PN, Genes TM, Rezus C. Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia. Life (Basel) 2021; 11:1072. [PMID: 34685443 PMCID: PMC8537181 DOI: 10.3390/life11101072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/22/2022] Open
Abstract
Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient's thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y12 receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Anca Ouatu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Roxana Ganceanu-Rusu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Tudor-Marcel Genes
- Department of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Neurological Rehabilitation Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Hirshfeld JW, Faxon DP, Williams DO. Impact of Crossover: A Consideration for Initial Access Site Selection. JACC Cardiovasc Interv 2021; 14:374-377. [PMID: 33602432 DOI: 10.1016/j.jcin.2020.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- John W Hirshfeld
- Cardiovascular Medicine Division at the Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - David P Faxon
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David O Williams
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Changal K, Syed MA, Atari E, Nazir S, Saleem S, Gul S, Salman FNU, Inayat A, Eltahawy E. Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States. BMC Cardiovasc Disord 2021; 21:250. [PMID: 34020605 PMCID: PMC8139069 DOI: 10.1186/s12872-021-02068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach. METHODS A detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers. RESULTS A total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004). CONCLUSION The shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.
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Affiliation(s)
- Khalid Changal
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA.
| | | | - Ealla Atari
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Sameer Saleem
- Department of Cardiovascular Medicine, University of Kentucky, Bowling Green, USA
| | - Sajjad Gul
- Internal Medicine, St. Francis Medical Center, University of Illinois at Peoria, Peoria, USA
| | - F N U Salman
- Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Asad Inayat
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Ehab Eltahawy
- Professor and Program Director of Cardiovascular Medicine and Interventional Cardiology, University of Toledo, 3000 Arlington Ave., MS 1118, Toledo, 43614, OH, USA.
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Dworeck C, Redfors B, Völz S, Haraldsson I, Angerås O, Råmunddal T, Ioanes D, Myredal A, Odenstedt J, Hirlekar G, Koul S, Fröbert O, Linder R, Venetsanos D, Hofmann R, Ulvenstam A, Petursson P, Sarno G, James S, Erlinge D, Omerovic E. Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 9:323-332. [PMID: 33025815 PMCID: PMC7756052 DOI: 10.1177/2048872620908032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. RESULTS During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55-0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25-0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24-0.73, P = 0.002). CONCLUSIONS In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.
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Affiliation(s)
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Dan Ioanes
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Anna Myredal
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Geir Hirlekar
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | | | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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Campo G, Fortuna D, Berti E, De Palma R, Pasquale GD, Galvani M, Navazio A, Piovaccari G, Rubboli A, Guardigli G, Galiè N, Boriani G, Tondi S, Ardissino D, Piepoli M, Banchelli F, Santarelli A, Casella G. In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study. LANCET REGIONAL HEALTH-EUROPE 2021; 3:100055. [PMID: 34557800 PMCID: PMC8454529 DOI: 10.1016/j.lanepe.2021.100055] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has put several healthcare systems under severe pressure. The present analysis investigates how the first wave of the COVID-19 pandemic affected the myocardial infarction (MI) network of Emilia-Romagna (Italy). Methods Based on Emilia-Romagna mortality registry and administrative data from all the hospitals from January 2017 to June 2020, we analysed: i) temporal trend in MI hospital admissions; ii) characteristics, management, and 30-day mortality of MI patients; iii) out-of-hospital mortality for cardiac cause. Findings Admissions for MI declined on February 22, 2020 (IRR -19.5%, 95%CI from -8.4% to -29.3%, p = 0.001), and further on March 5, 2020 (IRR -21.6%, 95%CI from -9.0% to -32.5%, p = 0.001). The return to pre-COVID-19 MI-related admission levels was observed from May 13, 2020 (IRR 34.3%, 95%CI 20.0%-50.2%, p<0.001). As compared to those before the pandemic, MI patients admitted during and after the first wave were younger and with fewer risk factors. The 30-day mortality remained in line with that expected based on previous years (ratio observed/expected was 0.96, 95%CI 0.84-1.08). MI patients positive for SARS-CoV-2 were few (1.5%) but showed poor prognosis (around 5-fold increase in 30-day mortality). In 2020, the number of out-of-hospital cardiac deaths was significantly higher (ratio observed/expected 1.17, 95%CI 1.08-1.27). The peak was reached in April. Interpretation In Emilia-Romagna, MI hospitalizations significantly decreased during the first wave of the COVID-19 pandemic. Management and outcomes of hospitalized MI patients remained unchanged, except for those with SARS-CoV-2 infection. A concomitant increase in the out-of-hospital cardiac mortality was observed. Funding None.
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Affiliation(s)
- Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara S. Anna, Via Aldo Moro 8, 44124 Cona, FE, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Daniela Fortuna
- Regional Agency for Health and Social Care, Emilia-Romagna region, Bologna, Italy
| | - Elena Berti
- Regional Agency for Health and Social Care, Emilia-Romagna region, Bologna, Italy
| | - Rossana De Palma
- Regional Authority for Health and Welfare, Emilia-Romagna region, Bologna, Italy
| | - Giuseppe Di Pasquale
- Regional Authority for Health and Welfare, Emilia-Romagna region, Bologna, Italy
| | - Marcello Galvani
- Cardiovascular Department, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Alessandro Navazio
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Andrea Rubboli
- Cardiovascular Department, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Gabriele Guardigli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara S. Anna, Via Aldo Moro 8, 44124 Cona, FE, Italy
| | - Nazzareno Galiè
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | | | - Stefano Tondi
- UO Cardiologia, Ospedale di Baggiovara, Modena, Italy
| | - Diego Ardissino
- Cardiology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Massimo Piepoli
- UO Cardiologia, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Federico Banchelli
- Regional Agency for Health and Social Care, Emilia-Romagna region, Bologna, Italy
| | | | - Gianni Casella
- Cardiology Unit, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
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Jiménez Díaz VA, Hovasse T, Íñiguez A, Copt S, Byrne J, Brunel P, Morice MC, Abizaid A, Tespilli M, Walters D, Ortiz Sáez A, Bastos Fernández G, Stoll HP, Urban P. Impacto del acceso vascular en el pronóstico tras la angioplastia coronaria en pacientes con alto riesgo hemorrágico: subanálisis predefinido del estudio LEADERS FREE. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yokoi K, Mizote I, Shiraki T, Ide S, Mukai T, Nakamura D, Oeun B, Ohtani T, Hikoso S, Ikari Y, Sakata Y. Differences in routes of guiding catheters for left coronary artery according to access sites assessed by the combined angiography-computed tomography system. Cardiovasc Interv Ther 2020; 36:298-306. [PMID: 32537725 DOI: 10.1007/s12928-020-00681-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
Differences in guiding catheters (GCs) manipulations and selections among different access sites are currently unclear. We examined the differences in the routes of GCs for the left coronary artery (LCA) among the right radial, left radial, and femoral approaches. We used a combined angiography-computed tomography (CT) system that enabled to perform CT scans during percutaneous coronary intervention (PCI). We enrolled 88 patients who underwent CT scans during LCA PCI or percutaneous transluminal septal myocardial ablation. To evaluate the route of GCs, we analyzed the positions of the catheter's contact point on the contralateral aortic wall to the LCA ostium, which were expressed by the angle formed by the vertical line and the diagonal line from the GC shaft to the center of the aorta. The procedures were performed via the right radial in 47 cases, left radial in 20, and femoral approach in 21. The positions of the catheter's contact point were significantly different depending on the approaches (interquartile range - 3.7 [- 14.3 to 7.8], - 46.5 [- 76.9 to - 9.3], and - 30.7 [- 39.4 to - 22.4] degrees, respectively; p < 0.001). Multivariate analysis demonstrated that access sites and LCA ostium locations had significant impacts on the positions of the catheter's contact point. The routes of LCA GCs were different among the right radial, left radial, and femoral approaches.
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Affiliation(s)
- Kensuke Yokoi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tatsuya Shiraki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiko Ide
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Mukai
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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12
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Huded CP, Kapadia SR, Ballout JA, Krishnaswamy A, Ellis SG, Raymond R, Cho L, Simpfendorfer C, Bajzer C, Martin J, Nair R, Lincoff AM, Kravitz K, Menon V, Hantz S, Khot UN. Association of adoption of transradial access for percutaneous coronary intervention in ST elevation myocardial infarction with door-to-balloon time. Catheter Cardiovasc Interv 2020; 96:E165-E173. [PMID: 32105411 PMCID: PMC7496393 DOI: 10.1002/ccd.28785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/14/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022]
Abstract
Objectives We aimed to study adoption of transradial primary percutaneous coronary intervention (TR‐PPCI) for ST elevation myocardial infarction (STEMI) (“radial first” approach) and its association with door‐to‐balloon time (D2BT). Background TR‐PPCI for STEMI is underutilized in the United States due to concerns about prolonging D2BT. Whether operators and hospitals adopting a radial first approach in STEMI incur prolonged D2BT is unknown. Methods In 1,272 consecutive cases of STEMI with PPCI at our hospital from January 1, 2011, to December 31, 2016, we studied TR‐PPCI adoption and its association with D2BT including a propensity matched analysis of similar risk TR‐PPCI and trans‐femoral primary PCI (TF‐PPCI) patients. Results With major increases in hospital‐level TR‐PPCI (hospital TR‐PPCI rate: 2.6% in 2011 to 79.4% in 2016, p‐trend<.001) and operator‐level TR‐PPCI (mean operator TR‐PPCI rate: 2.9% in 2011 to 81.1% in 2016, p‐trend = .005), median hospital level D2BT decreased from 102 min [81, 142] in 2011 to 84 min [60, 105] in 2016 (p‐trend<.001). TF crossover (10.3%; n = 57) was not associated with unadjusted D2BT (TR‐PPCI success 91 min [72, 112] vs. TF crossover 99 min [70, 115], p = .432) or D2BT adjusted for study year and presenting location (7.2% longer D2BT with TF crossover, 95% CI: −4.0% to +18.5%, p = .208). Among 273 propensity‐matched pairs, unadjusted D2BT (TR‐PPCI 98 [78, 117] min vs. TF‐PPCI 101 [76, 132] min, p = .304), and D2BT adjusted for study year and presenting location (5.0% shorter D2BT with TR‐PPCI, 95% CI: −12.4% to +2.4%, p = .188) were similar. Conclusions TR‐PPCI can be successfully implemented without compromising D2BT performance.
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Affiliation(s)
- Chetan P Huded
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland Clinic, Cleveland, Ohio.,Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jad A Ballout
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Stephen G Ellis
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Russell Raymond
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Chris Bajzer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Martin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ravi Nair
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott Hantz
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Umesh N Khot
- Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland Clinic, Cleveland, Ohio.,Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Mansour MJ, Chammas E, Hamoui O, Honeine W, AlJaroudi W. Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification. Echocardiography 2020; 37:253-259. [PMID: 31903656 DOI: 10.1111/echo.14580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Mohamad Jihad Mansour
- Division of Cardiology Faculty of Medical Sciences Lebanese University Hadath Lebanon
- Division of Cardiovascular Medicine Clemenceau Medical Center Affiliated with Johns Hopkins International Beirut Lebanon
| | - Elie Chammas
- Division of Cardiology Faculty of Medical Sciences Lebanese University Hadath Lebanon
- Division of Cardiovascular Medicine Clemenceau Medical Center Affiliated with Johns Hopkins International Beirut Lebanon
| | - Omar Hamoui
- Division of Cardiovascular Medicine Clemenceau Medical Center Affiliated with Johns Hopkins International Beirut Lebanon
| | - Walid Honeine
- Division of Cardiovascular Medicine Clemenceau Medical Center Affiliated with Johns Hopkins International Beirut Lebanon
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine Clemenceau Medical Center Affiliated with Johns Hopkins International Beirut Lebanon
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14
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Jiménez Díaz VA, Hovasse T, Íñiguez A, Copt S, Byrne J, Brunel P, Morice MC, Abizaid A, Tespilli M, Walters D, Ortiz Sáez A, Bastos Fernández G, Stoll HP, Urban P. Impact of vascular access on outcome after PCI in patients at high bleeding risk: a pre-specified sub-analysis of the LEADERS FREE trial. ACTA ACUST UNITED AC 2019; 73:536-545. [PMID: 31563471 DOI: 10.1016/j.rec.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prognostic impact of bleeding in high bleeding risk (HBR) patients depending on the location of bleeding and prognosis in nonaccess site bleeding is unknown. We aimed to assess the impact of vascular access site on bleeding complications after percutaneous coronary interventions for HBR patients at 30-day and 2-year follow-up. METHODS The LEADERS FREE trial included 2432 HBR PCI patients. A Biolimus A9 drug-coated stent was superior to a bare-metal stent for safety and efficacy. This is a predefined sub-analysis of the LEADERS FREE trial. RESULTS Transradial access (TRA) was used in 1454 patients (59.8%) and transfemoral access (TFA) in 978 (40.2%), according to operator preference. The safety and benefits of drug-coated stents over bare-metal stents were independent of vascular access. At 30 days and 2 years, major bleeding had occurred in 2.4% and 7.5% of TRA patients and 4.6% and 10.9% of TFA patients (P=.003), respectively. Most of these events in both groups (2.1% and 7.0% for TRA; 3.2% and 9.4% for TFA, respectively) were nonaccess site-related. TRA was associated with a significant reduction in adjusted rates of major bleeding both at 30 days (HR, 1.98; 95%CI, 1.25-3.11; P=.003) and at 2 years of follow-up (HR, 1.51; 95%CI, 1.14-2.01; P=.003). This difference was driven by both access and nonaccess bleeding. CONCLUSIONS Operators preferred TRA for most HBR patients, which was associated with a significant reduction in major bleeding events. However, most of these events in this population are unrelated to vascular access.
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Affiliation(s)
- Víctor Alfonso Jiménez Díaz
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Thomas Hovasse
- Cardiology Department, Hôpital Privé Jacques Cartier, Massy, France
| | - Andrés Íñiguez
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Jonathan Byrne
- Cardiology Department, King's College, London, United Kingdom
| | | | | | - Alex Abizaid
- Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Darren Walters
- Cardiology Department, Prince Charles Hospital, Queensland, Australia
| | - Alberto Ortiz Sáez
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Guillermo Bastos Fernández
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Philip Urban
- Cardiology Department, Hôpital de la Tour, Geneva, Switzerland.
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15
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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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16
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Wang W, Wan Z, Wu B, Lu L, Tang Y. Finite element analysis for mechanics of guiding catheters in transfemoral intervention. J Card Surg 2019; 34:690-699. [PMID: 31233248 DOI: 10.1111/jocs.14132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the percutaneous coronary intervention (PCI), the strong backup support of a guiding catheters is essential in reaching a target coronary lesion successfully. Nevertheless, it is difficult to explore the mechanics of a guiding catheter by analytical and experimental methods due to its complex deformation and interactions among guiding catheter, guide wire, and artery. In this study, the finite element method was used to analyze the backup support of a guiding catheter in transfemoral intervention (TFI). METHODS A finite element model was established in the light of geometric, mechanical properties of the guiding catheter and boundary con ditions. To validate the finite element model, an arterial tree model was constructed to measure the backup force of the guiding catheters in TFI. Then, the process of the guiding catheter disengaged from the ostium was analyzed. RESULTS The influencing rules of the geometric parameters of the guiding catheter on its backup support in TFI were obtained with the help of the finite element model. The result shows that the larger the outer diameter and wall thickness, the greater the backup support, 2.0 to 2.3 mm of the outer diameter was suggested. When designing a guiding catheter, it is wise to avoid α, the angle between the line and wall of the artery, being within 60° and 75° and it is a better choice if the contact length is between 5 and 12 mm. CONCLUSIONS This study sought to investigate the influencing rules of the geometric parameters of the guiding catheter on its backup support in transfemoral intervention. A finite element model for analyzing the backup support of a guiding catheter was validated by experiments. It indicated that the finite element method can analyze the varied laws of the guiding catheter with different geometric parameters.
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Affiliation(s)
- Wei Wang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Zhenping Wan
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Boxi Wu
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Longsheng Lu
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
| | - Yong Tang
- School of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, China
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17
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Hirzallah H, Amro A, Kusmic D, Curtis Z, Leigh EC, Numan Y, Parsons J, Amro M, Akpanudo S, Sayyed R, Elhamdani M. Comparison of Transradial and Transfemoral Approaches for Coronary Angiography and Percutaneous Intervention in Patients with Coronary Bypass Grafts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:2-5. [PMID: 30885499 DOI: 10.1016/j.carrev.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/15/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to compare the transradial and transfemoral approaches for coronary angiography and percutaneous intervention in patients with coronary artery bypass grafts in terms of volume of radiographic contrast administered during cardiac catheterization, fluoroscopy time, and total procedure time. BACKGROUND The transradial access has been increasingly used as an alternative to transfemoral. Several studies demonstrated that such access is associated with lower rates of vascular and bleeding complications. Although coronary artery bypass graft patients comprise a significant portion of the coronary artery disease population, this subpopulation was often excluded or underrepresented in transradial access studies. METHODS Single center, retrospective cohort study. In the study period, all patients who had previously undergone coronary artery bypass graft surgery and had received cardiac catheterization at our institution were included in the study population. RESULTS A total of 2153 patients were included in the study. From these, 1937 were performed by femoral artery and 216 by transradial approach. Compared to the transfemoral approach, transradial access was associated with lower contrast use (136.3 ± 74.4 ml vs. 122.8 ± 59.1 ml, p = 0.035) and longer fluoroscopy time (13.9 ± 25.6 min vs. 15.9 ± 14.3 min, p < 0.001). CONCLUSION Diagnostic and interventional catheterization through the transradial approach in patients with previous coronary artery bypass graft surgery was associated with less contrast amount used and longer fluoroscopy time compared to the transfemoral approach. The transradial approach was also associated with lower crossover rates and less vascular complications.
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Affiliation(s)
- Hisham Hirzallah
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America.
| | - Ahmed Amro
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Damir Kusmic
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Zachary Curtis
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Emilia C Leigh
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Yazan Numan
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Julia Parsons
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | | | - Sutoidem Akpanudo
- Marshall University Joan C. Edwards School of Medicine, Department of Internal Medicine, United States of America
| | - Rameez Sayyed
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
| | - Mehiar Elhamdani
- Marshall University Joan C. Edwards School of Medicine, Department of Cardiovascular Disease, United States of America
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18
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Anderson GL, Osborn JL, Nei SD, Bell MR, Barsness GW, Mara KC, Ou NN. Comparison of In-Hospital Bleeding and Cardiovascular Events with High-Dose Bolus Tirofiban and Shortened Infusion to Short-Duration Eptifibatide as Adjunctive Therapy for Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:44-49. [PMID: 30539747 DOI: 10.1016/j.amjcard.2018.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022]
Abstract
Potent platelet inhibition is one of the most important medical interventions to prevent ischemic complications during and after percutaneous coronary intervention (PCI). Practice has evolved with the introduction of potent oral P2Y12 inhibitors that provide quick, effective platelet inhibition, and the need for routine glycoprotein IIb/IIIa inhibitors (GPIs) has decreased. Additionally, a shorter duration of GPI infusion has been shown to be safe with adequate oral antiplatelet loading, but clinical outcome data are limited to eptifibatide. This single-center, retrospective cohort study analyzed in-hospital outcomes for patients who received adjunctive GPI therapy for PCI before and after an institution-wide switch to high-dose bolus tirofiban with shortened infusion from short-duration eptifibatide. The primary end point was a composite in-hospital outcome of major and minor bleeding and cardiovascular events (death, myocardial infarction, coronary artery bypass grafting, ischemic stroke, and target vessel revascularization). Secondary end points included bleeding and cardiovascular event types. A total of 357 and 446 patients received eptifibatide and tirofiban, respectively, from February 1, 2014 through September 30, 2017. Thirty five eptifibatide and 46 tirofiban patients experienced an in-hospital composite event (9.8% vs 10.3%, p = 0.81). There was no difference found between in-hospital bleeding (6.4% vs 5.4%, p = 0.52) or cardiovascular events (5.6% vs 6.5%, p = 0.60) with the use of eptifibatide or tirofiban, respectively. Multivariable analysis showed that patients with transradial access or an indication of unstable angina were less likely to experience an in-hospital composite event (OR 0.30 and 0.19, respectively, p <0.001 for both). In conclusion, the use of high-dose bolus tirofiban with shortened infusion versus short-duration eptifibatide was not associated with an increase of in-hospital bleeding or cardiovascular events.
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19
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Ohya M, Shimada T, Osakada K, Kuwayama A, Miura K, Murai R, Amano H, Kubo S, Otsuru S, Habara S, Tada T, Tanaka H, Fuku Y, Katoh H, Goto T, Kadota K. In-Hospital Bleeding and Utility of a Maintenance Dose of Prasugrel 2.5 mg in High Bleeding Risk Patients With Acute Coronary Syndrome. Circ J 2018; 82:1874-1883. [DOI: 10.1253/circj.cj-18-0114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Katsuya Miura
- Department of Cardiology, Kurashiki Central Hospital
| | - Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital
| | - Suguru Otsuru
- Department of Cardiology, Kurashiki Central Hospital
| | - Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
| | - Harumi Katoh
- Department of Cardiology, Kurashiki Central Hospital
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital
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20
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Mentias A, Raza MQ, Barakat AF, Youssef D, Raymond R, Menon V, Simpfendorfer C, Franco I, Ellis S, Tuzcu EM, Kapadia SR. Effect of Shorter Door-to-Balloon Times Over 20 Years on Outcomes of Patients With Anterior ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:1254-1259. [PMID: 28838603 DOI: 10.1016/j.amjcard.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST-elevation myocardial infarction (STEMI) between 1995 and 2014. Over the past 20 years, 1,658 patients presenting to our center with anterior STEMI underwent primary percutaneous coronary intervention within 12 hours of presentation. We divided these into 4 quartiles, 1995 to 1999 (n = 312), 2000 to 2004 (n = 408), 2005 to 2009 (n = 428), and 2010 to 2014 (n = 510). Across the 4 quartiles, mean age decreased (64.4, 62, 60.3, and 60 years, p <0.01). In all groups, there was a significant rise in prevalence of smoking, hypertension, and obesity. The median length of hospital stay decreased (6, 4.4, 4.2, and 3.6 days, p <0.01), as did the median door-to-balloon time (DBT) (217, 194, 135, and 38 minutes, p <0.01). Thirty-day and 1-year mortality improved over time (14.4%, 11.8%, 8.4%, and 7.8%; and 20.5%, 16.4%, 15.9%, and 13.9%) (p = 0.01 both). Also, 3-year mortality improved (25.3%, 21.6%, 21.3%, and 16.5%, p = 0.02). After adjusting for age, gender, co-morbidities, ejection fraction, clinical shock, and mitral regurgitation, shorter DBT was associated with lower long-term mortality (compared with DBT <60 minutes; 60 to 90 minutes hazard ratio [HR] 1.67, 95% confidence interval [CI] 0.93 to 3.00, p = 0.084; 90 to 120 minutes, HR 1.74, 95% CI 1.02 to 2.95, p = 0.04; >120 minutes, HR 1.91, 95% CI 1.23 to 2.96, p = 0.004). In conclusion, over the past 2 decades, long-term outcomes improved in patients presenting with anterior STEMI associated with shortening of DBT.
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21
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Schernthaner C, Hammerer M, Harb S, Heigert M, Hoellinger K, Lassnig E, Maurer E, Schuler J, Siostrzonek P, Ulmer H, Winter A, Altenberger J. Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction. Wien Klin Wochenschr 2017; 130:182-189. [DOI: 10.1007/s00508-017-1260-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/18/2017] [Indexed: 11/24/2022]
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22
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Yamashita Y, Shiomi H, Morimoto T, Yaku H, Kaji S, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Abe M, Akao M, Nagao K, Shizuta S, Ono K, Kimura T. Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry. Heart Vessels 2017; 32:1448-1457. [DOI: 10.1007/s00380-017-1021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
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23
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Dai Y, Li C, Zhang F, Yang J, Chang S, Lu H, Yang H, Huang Z, Qian J, Ge L, Ge J. Safety and Efficacy of Percutaneous Coronary Intervention via Transradial Versus Transfemoral Approach in Bypass Grafts. Angiology 2017; 69:136-142. [PMID: 28602142 DOI: 10.1177/0003319717711765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the efficacy and safety of the transradial approach percutaneous coronary intervention (TRA-PCI) and transfemoral approach percutaneous coronary intervention (TFA-PCI) for bypass grafts lesions. Patients (n = 184) were retrospectively enrolled. Less contrast was used during the procedure in the TRA group than in the TFA group, 201.5 (45.5) mL versus 221.5 (49.1) mL, P = .004, although fluoroscopy time was longer in the TRA group, 22.5 (6.3) minutes versus 20.3 (6.1) minutes; P = .017. The incidence of net adverse clinical events (NACEs) was lower in the TRA group than in the TFA group (3.1% vs 8.8%, respectively, P = .111). The incidence of Bleeding Academic Research Consortium type 3 and 5 bleeding (0% vs 5.5%, respectively, P = .022) was significantly lower in the TRA group than in the TFA group. For 1-year outcomes, there was no difference in the incidence of major adverse cardiovascular events (7.5% vs 9.9%, respectively, P = .569). In conclusion, TRA-PCI was associated with a lower rate of in-hospital NACEs mainly attributed to lower rates of major bleeding. The TRA-PCI showed comparable feasibility and efficacy in bypass grafts as compared with TFA-PCI when carried out by experienced operators.
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Affiliation(s)
- Yuxiang Dai
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Chenguang Li
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Feng Zhang
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Ji'e Yang
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Shufu Chang
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Hao Lu
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Hongbo Yang
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Zheyong Huang
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Juying Qian
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Lei Ge
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Junbo Ge
- 1 Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
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24
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Bagai J, Little B, Banerjee S. Association between arterial access site and anticoagulation strategy on major bleeding and mortality: A historical cohort analysis in the Veteran population. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017. [PMID: 28624360 DOI: 10.1016/j.carrev.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies have shown reduction in major bleeding with trans-radial intervention (TRI) compared with trans-femoral intervention (TFI), and with use of bivalirudin compared with heparin+glycoprotein IIb/IIIa inhibitors (GPI). We compared major bleeding, mortality and the interaction between arterial access site and the anticoagulant used for PCI in Veterans. METHODS A retrospective cohort of 1192 consecutive patients who underwent PCI at a VA hospital between 2006 and 2012 was divided into TFI-heparin (n=192), TFI-bivalirudin (n=272), TRI-heparin (n=274) and TRI-bivalirudin (n=454) groups. Primary outcomes were in-hospital major bleeding, in-hospital and 1-year all-cause mortality. Secondary outcomes were in-hospital MI, in-hospital and 1-year MACE and net adverse cardiovascular events (NACE - composite of major bleeding+MACE). RESULTS Femoral access was associated with a significantly increased risk of major bleeding compared with radial access (OR 11.87, p<0.001). Correspondingly, radial access was protective against major bleeding compared with femoral access (OR 0.128, p<0.01), but did not lower mortality or MACE by itself. Severe anemia was the only predictor of in-hospital all-cause mortality (OR=27.62, p<0.008). Presence of anemia and age>70 predicted 1-year mortality, whereas major bleeding and anemia predicted 1-year MACE. An interaction was noted between anticoagulant and access site, such that heparin showed significantly greater major bleeding in the femoral group compared with the radial group. Bivalirudin resulted in similar risk of bleeding, regardless of access site. There was a synergistic interaction between radial access and heparin (HR 0.38, p<0.05), but not radial access and bivalirudin, on reduction in 1-year NACE. CONCLUSION Radial access for PCI is associated with reduction in major bleeding, but does not have an effect on in-patient or 1-year MACE and mortality. Major bleeding is associated with poor short and intermediate term outcomes. In addition, anemia is strongly associated with increased in-patient and 1-year mortality. There is a differential effect of heparin but not bivalirudin on major bleeding, depending on the access site. There is no synergism between radial access and bivalirudin in lowering the composite outcome of MACE and major bleeding at 1year.
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Affiliation(s)
- Jayant Bagai
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, United States, University of Louisville, Louisville, KY, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, TX.
| | - Bert Little
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, United States, University of Louisville, Louisville, KY, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, TX
| | - Subhash Banerjee
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, United States, University of Louisville, Louisville, KY, VA North Texas Health Care System and UT Southwestern Medical Center, Dallas, TX
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Bi XL, Fu XH, Gu XS, Wang YB, Li W, Wei LY, Fan YM, Bai SR. Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention. Chin Med J (Engl) 2017; 129:898-902. [PMID: 27064032 PMCID: PMC4831522 DOI: 10.4103/0366-6999.179795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI. Methods: We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis. Results: Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2–5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004). Conclusion: Distal puncture sites (0–1 cm away from the radius styloid process) can lead to a higher rate of RAO. Trial Registration: ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.
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Affiliation(s)
| | - Xiang-Hua Fu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Dai Y, Yang J, Gao Z, Xu H, Sun Y, Wu Y, Gao X, Li W, Wang Y, Gao R, Yang Y. Atrial fibrillation in patients hospitalized with acute myocardial infarction: analysis of the china acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord 2017; 17:2. [PMID: 28052755 PMCID: PMC5210261 DOI: 10.1186/s12872-016-0442-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background The incidence, clinical outcomes and antithrombotic treatment spectrum of atrial fibrillation (AF) in patients hospitalized with acute myocardial infarction (AMI) have not been well studied in Chinese population. Methods Twenty-six thousand five hundred ninety-two consecutive patients diagnosed with AMI were enrolled in CAMI registry from January 2013 to September 2014. After excluding 343 patients with uncertain AF status and 1,591 patients transferred out during hospitalization, 24,658 patients were finally included in this study and involved in analysis. Results In the CAMI registry, 740 (3.0%) patients were recorded with AF prevalence during hospitalization. Higher-risk baseline clinical profile was observed in patients with AF. These patients were less likely to receive reperfusion/revascularization than those without AF. The in-hospital mortality (including death and treatment withdrawal) was significantly higher in patients with AF than that of without AF (25.2% vs. 7.2%, respectively; p < 0.01). The case of composite of adverse events was similar, which included death, treatment withdrawal, re-infarction, heart failure or stroke (42.1% vs. 16.0%, p <0.01). In multivariate logistic regression analysis, AF was an independent predictor for in-hospital mortality (odds ratio, 1.88; 95% confidence interval: 1.27–2.78) and the composite of adverse events (odds ratio, 2.11; 95% CI: 1.63–2.72). Only 5.1% of patients with AF were treated with warfarin, and 1.7% were treated with both warfarin and dual antiplatelet therapy. Conclusions The analysis was based on the CAMI registry in China. The patients hospitalized for AMI who developed AF were at significantly higher risk for in-hospital mortality and other adverse events. However, the anticoagulants including warfarin have been largely underused post hospital discharge. Trial registration Clinical Trial Registration: Identifier: NCT01874691.
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Affiliation(s)
- Yan Dai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Jingang Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Yi Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Yuan Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Xiaojin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Wei Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Yang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China.
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Bazemore TC, Rao SV. Controversies in the Management of ST-Segment Elevation Myocardial Infarction: Transradial Versus Transfemoral Approach. Interv Cardiol Clin 2016; 5:513-522. [PMID: 28581999 DOI: 10.1016/j.iccl.2016.06.006] [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] [Indexed: 06/07/2023]
Abstract
This article discusses the controversies surrounding the use of transradial versus transfemoral approaches in the management of patients with ST-segment elevation myocardial infarction, beginning with a review of the benefits of transradial percutaneous coronary intervention (PCI) in this population. The unanswered questions about the mechanism underlying the mortality benefit of transradial PCI are discussed, concluding with recommendations for safe and effective strategies for adoption of the transradial approach to optimize outcomes in these high-risk patients.
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Affiliation(s)
- Taylor C Bazemore
- Department of Internal Medicine, Duke University Medical Center, Box 3182, Durham, NC 27710, USA.
| | - Sunil V Rao
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, 2100 Erwin Road, Durham, NC 27705, USA; Department of Cardiology, Durham VA Medical Center, 508 Fulton Street, 111A, Durham, NC 27705, USA
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Asrar ul Haq M, Tsay IM, Dinh DT, Brennan A, Clark D, Cox N, Harper R, Nadurata V, Andrianopoulos N, Reid C, Duffy SJ, Lefkovits J, van Gaal WJ. Prevalence and outcomes of trans-radial access for percutaneous coronary intervention in contemporary practise. Int J Cardiol 2016; 221:264-8. [DOI: 10.1016/j.ijcard.2016.06.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/08/2016] [Accepted: 06/21/2016] [Indexed: 11/26/2022]
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Kilic S, Hermanides RS, Ottervanger JP, Kolkman E, Dambrink JHE, Roolvink V, Gosselink ATM, Kedhi E, van 't Hof AWJ. Effects of radial versus femoral artery access in patients with acute myocardial infarction: A large centre prospective registry. Neth Heart J 2016; 25:33-39. [PMID: 27561283 PMCID: PMC5179360 DOI: 10.1007/s12471-016-0887-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim This study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access. Methods This is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison. Results Retrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77 % of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7 % vs. 6.7 %, p < 0.001), and Killip class (Killip 1: 10.8 % vs. 17.3 %, p < 0.001). 30-day mortality rates were 1.7 % in the transradial group and 4.6 % in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95 % CI: 0.29–1.07, p = 0.08). Conclusion This registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.
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Affiliation(s)
- S Kilic
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - R S Hermanides
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - E Kolkman
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - J H E Dambrink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - V Roolvink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - A T M Gosselink
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - E Kedhi
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands.
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Ko RC, Liao MT, Lin L, Hsieh MY, Lin PS, Tsai KC, Chao CL, Wu CC. Feasibility and Safety of Coronary Procedures via an Arteriovenous Graft Approach in Patients on Maintenance Hemodialysis. ACTA CARDIOLOGICA SINICA 2016; 31:550-6. [PMID: 27122921 DOI: 10.6515/acs20150520a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traditionally, a radial or brachial arterial approach is unadvisable in hemodialysis patients. Consequently, coronary angiography or angioplasty is usually performed via a femoral artery approach in these patients, who carry a higher risk of vascular access complications. In hemodialysis patients, arteriovenous grafts (AVG) are created for repeated punctures; however, the feasibility and safety of a trans-AVG approach for coronary angiography or angioplasty remains unclear. METHODS In our institution, cardiac catheterizations were attempted via AV grafts in hemodialysis patients with a U-shaped forearm AVG. We retrospectively identified coronary angiography or angioplasty procedures in hemodialysis patients from a computer-based database in our hospital. The procedure details and outcomes were obtained from review of the clinical, angiographic and hemodialysis records. RESULTS From 2008 to 2013, 167 procedures in hemodialysis patients were identified from 2866 diagnostic or interventional coronary procedures in our institution. Out of these, 24 procedures in 17 patients were performed via a trans-AVG approach. In all AVG procedures, a 6F 16-cm or 7F 10-cm sheath was placed from the AVG into the brachial artery. All diagnostic procedures were successfully performed. In 14 procedures, the patients also underwent angioplasty and all of the angioplasty procedures were successful. There was no arterial spasm, arterial dissection, puncture site hematoma, or acute thrombosis of the AVG during or after the procedures. CONCLUSIONS A trans-AVG approach appears to be a feasible and safe route for coronary angiography or angioplasty in hemodialysis patients with a U-shaped forearm AVG. However, further studies with a larger patient number are necessary. KEY WORDS Arteriovenous graft; Hemodialysis; Percutaneous coronary intervention.
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Affiliation(s)
- Rye-Cheng Ko
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Min-Tsun Liao
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Lin Lin
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Mu-Yang Hsieh
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Pei-Shan Lin
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Kuei-Chin Tsai
- Division of Cardiology, Department of Medicine, Miao-Li General Hospital, Miao-Li
| | - Chia-Lun Chao
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu; ; College of Medicine, National Taiwan University
| | - Chih-Cheng Wu
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu; ; College of Medicine, National Taiwan University; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Shah RM, Patel D, Abbate A, Cowley MJ, Jovin IS. Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis. Catheter Cardiovasc Interv 2016; 88:1027-1033. [PMID: 27037544 DOI: 10.1002/ccd.26519] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 01/24/2016] [Accepted: 02/27/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Coronary angiography and angioplasty via transradial approach is shown to be associated with significant reduction in access site complications. Due to a lack of sufficient data, the use of the right or left radial approach is still operator-dependent. We performed a meta-analysis of prospective randomized studies to compare right versus left radial artery approach for coronary procedures. METHODS We found 12 randomized studies meeting the predetermined inclusion criteria. A total of 6,450 patients were included in the meta-analysis of which 3,217 patients underwent coronary procedures via right radial approach and 3,233 patients via left radial approach. The primary endpoint was the comparison of fluoroscopy time, procedure time, contrast use and cross-over rates between two radial approaches. RESULTS Pooled analysis of the included studies showed a similar rate of cross-over events (4.2% for right radial approach vs. 4.1% for left radial approach, odds ratio (OR)=1.08, P = 0.68), and similar total procedure times (18.8 ± 10.3 min vs. 18.1 ± 10.0 min, standard difference (SD) of the mean = 0.09, P = 0.162) between the two radial approaches. However, the right radial approach was found to be associated with minimally longer fluoroscopy times (5.8 ± 4.4 min vs. 5.3 ± 4.2 min, SD of the mean = 0.157, P < 0.001) and greater contrast use (84 ± 35 mL vs. 82 ± 34 mL, SD of the mean = 0.082, P = 0.003). Access site complications and the incidence of stroke were similar between two radial approaches. CONCLUSION Our meta-analysis suggests a small but statistically significant difference in terms of contrast use and fluoroscopy time in favor of coronary procedures performed via left radial approach in comparison to right radial approach without any significant difference in access site or other procedural complications between the two radial approaches. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rachit M Shah
- Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Dhavalkumar Patel
- Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Antonio Abbate
- Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Michael J Cowley
- Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia
| | - Ion S Jovin
- Department of Cardiology, Virginia Commonwealth University Hospital, Richmond, Virginia.,Department of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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Iqbal MB, Nadra IJ, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Robinson SD, Siega AD. Long-term outcomes following drug-eluting stents versus bare metal stents for primary percutaneous coronary intervention: A real-world analysis of 11,181 patients from the british columbia cardiac registry. Catheter Cardiovasc Interv 2016; 88:24-35. [DOI: 10.1002/ccd.26479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/29/2015] [Accepted: 01/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- M. Bilal Iqbal
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Imad J. Nadra
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Lillian Ding
- Provincial Health Services Authority; Vancouver British Columbia Canada
| | - Anthony Fung
- Vancouver General Hospital; Vancouver British Columbia Canada
| | - Eve Aymong
- St. Paul's Hospital; Vancouver British Columbia Canada
| | - Albert W. Chan
- Royal Columbian Hospital; Vancouver British Columbia Canada
| | - Steven Hodge
- Kelowna General Hospital; Kelowna British Columbia Canada
| | - Simon D. Robinson
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
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Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Registry. PLoS One 2016; 11:e0148931. [PMID: 26870950 PMCID: PMC4752444 DOI: 10.1371/journal.pone.0148931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/18/2016] [Indexed: 12/05/2022] Open
Abstract
Background Cardiogenic shock complicating ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. In the primary percutaneous coronary intervention (PPCI) era, randomized trials have not shown a survival benefit with intra-aortic balloon pump (IABP) therapy. This differs to observational data which show a detrimental effect, potentially reflecting bias and confounding. Without robust and valid risk adjustment, findings from non-randomized studies may remain biased. Methods We compared long-term mortality following IABP therapy in patients with cardiogenic shock undergoing PPCI during 2008–2013 from the British Columbia Cardiac Registry. We addressed measured and unmeasured confounding using propensity score and instrumental variable methods. Results A total of 12,105 patients with STEMI were treated with PPCI during the study period. Of these, 700 patients (5.8%) had cardiogenic shock. Of the patients with cardiogenic shock, 255 patients (36%) received IABP therapy. Multivariable analyses identified IABP therapy to be associated with increased mortality up to 3 years (HR = 1.67, 95% CI:1.20–2.67, p<0.001). This association was lost in propensity-matched analyses (HR = 1.23, 95% CI: 0.84–1.80, p = 0.288). When addressing measured and unmeasured confounders, instrumental variable analyses demonstrated that IABP therapy was not associated with mortality at 3 years (Δ = 16.7%, 95% CI: -12.7%, 46.1%, p = 0.281). Subgroup analyses demonstrated IABP was associated with increased mortality in non-diabetics; patients not undergoing multivessel intervention; patients without renal disease and patients not having received prior thrombolysis. Conclusions In this observational analysis of patients with STEMI and cardiogenic shock, when adjusting for confounding, IABP therapy had a neutral effect with no association with long-term mortality. These findings differ to previously reported observational studies, but are in keeping with randomized trial data.
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Yilmaz A, Ozkul A, Shin DS, Im SB, Yoon SM, Kim BT. Morphological Assessment of Cadaveric Radial, Brachial and Subclavian Arteries: A Neurointerventional Approach. J Korean Neurosurg Soc 2015; 58:499-503. [PMID: 26819682 PMCID: PMC4728085 DOI: 10.3340/jkns.2015.58.6.499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. METHODS Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. RESULTS The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was 13.41±2.19 mm, and the RSP was 26.85±2.47 mm from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as 44.23±5.47 mm, whereas the distance between the ME and the MN was 42.23±4.77 mm. The average VAO-ScA angle was 70.94±6.12°, and the length between the ScA junction (SCJ) and the VAO was 60.30±8.48 mm. CONCLUSION This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients.
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Affiliation(s)
- Ali Yilmaz
- Department Neurosurgery, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Ayca Ozkul
- Department Neurology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Dong Seong Shin
- Department Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo-Bin Im
- Department Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seok-Mann Yoon
- Department Neurosurgery, Soonchunhyang University Chonan Hospital, Cheonan, Korea
| | - Bum-Tae Kim
- Department Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Huang FY, Huang BT, Wang PJ, Zhang C, Zuo ZL, Liao YB, Xia TL, Gui YY, Peng Y, Liu W, Chen M, Zhu Y. Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2015; 67:810-9. [PMID: 26668187 DOI: 10.1177/0003319715621164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our aim was to investigate the gender disparity in the safety and efficacy of transradial percutaneous coronary intervention (PCI; TRI) and transfemoral PCI (TFI) by a meta-analysis. MEDLINE, Embase, and CENTRAL were searched to identify studies on vascular access with sex-specific events available or studies on sex difference with the events reported by vascular access. Fifteen studies involving 3 921 848 participants were included. Transradial PCI significantly reduced the risk of bleeding complications in both sexes (TRI-versus-TFI odds ratio [OR]: 0.37 in females vs 0.47 in males) and major adverse cardiac events (MACE) in females (OR: 0.70, P < .001) but not in males (OR: 0.83, P = .15) compared to TFI. Transradial PCI diminished the sex difference in the incidence of bleeding complications (female-versus-male OR: 1.82 with TRI vs 2.39 with TFI; interaction P = .01) and MACE (female-versus-male OR: 1.21 with TRI vs 1.41 with TFI; interaction P = .003) compared to TFI. Females were associated with higher crossover rate in the TRI subgroup but not in the TFI subgroup (interaction P = .05). In conclusion, TRI may improve the safety and efficacy of outcomes in both sexes and be an effective means to cut down the gender difference in prognosis.
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Affiliation(s)
- Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bao-Tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Peng-Ju Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Yue Gui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
| | | | - Peter Jüni
- Clinical Trials Unit, Institute of Primary Health Care and Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
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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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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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Iqbal MB, Nadra IJ, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Della Siega A, Robinson SD. Embolic protection device use and its association with procedural safety and long-term outcomes following saphenous vein graft intervention: An analysis from the British Columbia Cardiac registry. Catheter Cardiovasc Interv 2015; 88:73-83. [DOI: 10.1002/ccd.26237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022]
Affiliation(s)
- M. Bilal Iqbal
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Imad J. Nadra
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Lillian Ding
- Provincial Health Services Authority; Vancouver British Columbia Canada
| | - Anthony Fung
- Vancouver General Hospital; Vancouver British Columbia Canada
| | - Eve Aymong
- St. Paul's Hospital; Vancouver British Columbia Canada
| | - Albert W. Chan
- Royal Columbian Hospital; Vancouver British Columbia Canada
| | - Steven Hodge
- Kelowna General Hospital; Kelowna British Columbia Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Simon D. Robinson
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
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Ratib K, Mamas MA, Anderson SG, Bhatia G, Routledge H, De Belder M, Ludman PF, Fraser D, Nolan J. Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous coronary intervention in the United kingdom. JACC Cardiovasc Interv 2015; 8:20-9. [PMID: 25616814 DOI: 10.1016/j.jcin.2014.06.026] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/19/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population. BACKGROUND Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice. METHODS Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice. Patients were categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 30-day mortality, major adverse cardiac events, bleeding, and arterial access site complications was studied. RESULTS Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed. Following multivariate analysis, TRA was independently associated with a reduction in bleeding in all presenting syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared with a transfemoral access (TFA) with a vascular closure device in a propensity matched cohort. CONCLUSIONS In this large study, TRA is associated with reduced percutaneous coronary intervention-related complications in all patient groups and may reduce major adverse cardiac events and mortality in ACS patients. TRA is superior to transfemoral access with closure devices. Use of TRA may lead to important patient benefits in routine practice. TRA should be considered the preferred access site for percutaneous coronary intervention.
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Affiliation(s)
- Karim Ratib
- Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - Mamas A Mamas
- Manchester Heart Centre, United Kingdom; University of Manchester, Manchester, United Kingdom
| | | | - Gurbir Bhatia
- Heart of England National Health Service Trust, west Midlands, United Kingdom
| | - Helen Routledge
- Worcestershire Royal Hospital, Worcestershire, United Kingdom
| | - Mark De Belder
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Peter F Ludman
- University Hospital Birmingham, Birmingham, United Kingdom
| | | | - James Nolan
- Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper. ACTA ACUST UNITED AC 2015; 68:976-995.e10. [PMID: 26315766 DOI: 10.1016/j.rec.2015.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.
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Affiliation(s)
- José López-Sendón
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - José Ramón González-Juanatey
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Fausto Pinto
- European Society of Cardiology; Department of Cardiology, University Hospital Santa Maria, Lisbon, Portugal
| | - José Cuenca Castillo
- Sociedad Española de Cirugía Torácica-Cardiovascular; Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lina Badimón
- Centro de Investigación Cardiovascular (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Regina Dalmau
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Esteban González Torrecilla
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Ramón López-Mínguez
- Unidad de Cardiología intervencionista, Servicio de Cardiología, Hospital Infanta Crsitina, Badajoz, Spain
| | - Alicia M Maceira
- Unidad de Imagen Cardiaca, Servicio de Cardiología, ERESA Medical Center, Valencia, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Le J, Bangalore S, Guo Y, Iqbal SN, Xu J, Miller LH, Coppola J, Shah B. Predictors of Access Site Crossover in Patients Who Underwent Transradial Coronary Angiography. Am J Cardiol 2015; 116:379-83. [PMID: 26026865 PMCID: PMC4499487 DOI: 10.1016/j.amjcard.2015.04.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 01/01/2023]
Abstract
Despite increasing use of the transradial approach (TRA) for coronary angiography, TRA failure and subsequent access site crossover remain a barrier to TRA adoption. The aim of this study was to elucidate patient and procedural characteristics associated with TRA to transfemoral approach (TFA) crossover and examine TRA to TFA crossover by operator experience over time. This retrospective analysis identified 1,600 patients who underwent coronary angiography with possible percutaneous coronary intervention through TRA by operators with varied TRA experience in an urban tertiary care center from October 2010 to August 2013. Univariate and multivariable logistic regression were used to identify independent predictors of access site crossover, from TRA to TFA, and strength of association is presented as odds ratio (OR, 95% confidence interval [CI]). Access site crossover was noted in 166 patients (10.4%). Multivariable predictors of access site crossover included age >75 years (OR 1.90, 95% CI 1.23 to 2.91, p = 0.004) and operator experience (OR 2.98, 95% CI 1.96 to 4.52, p <0.0001). Less experienced operators (≤5 years TRA experience) had a decrease in access site crossover over time (quartile 1: 8.9%, quartile 2: 18.8%, quartile 3: 16.4%, and quartile 4: 8.6%, p <0.001), which paralleled an increase in the proportion of procedures using initial TRA over time (quartile 1: 38.0%, quartile 2: 53.7%, quartile 3: 54.8%, and quartile 4: 70.3%, p <0.001). Experienced operators (>5 years TRA experience) had no significant change in proportion of access site crossover over time (quartile 1: 2.8%, quartile 2: 6.4%, quartile 3: 5.6%, quartile 4: 5.8%, p = 0.54). In conclusion, rate of access site crossover in the contemporary era is relatively low and can be mitigated with operator experience.
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Affiliation(s)
- Jeffrey Le
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Sohah N Iqbal
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Jinfeng Xu
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Louis H Miller
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - John Coppola
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Binita Shah
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
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The choice of arterial access for percutaneous coronary intervention and its impact on outcome: An expert opinion perspective. Am Heart J 2015; 170:13-22. [PMID: 26093860 DOI: 10.1016/j.ahj.2015.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
Abstract
The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or lower major bleeding and vascular complications with varying levels of strength. Herein, we review the current literature on arterial access as a bleeding avoidance strategy during percutaneous coronary intervention and its impact on outcome and provide a consensus opinion based on the strength of the evidence supporting various techniques.
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Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, Rubartelli P, Briguori C, Andò G, Repetto A, Limbruno U, Cortese B, Sganzerla P, Lupi A, Galli M, Colangelo S, Ierna S, Ausiello A, Presbitero P, Sardella G, Varbella F, Esposito G, Santarelli A, Tresoldi S, Nazzaro M, Zingarelli A, de Cesare N, Rigattieri S, Tosi P, Palmieri C, Brugaletta S, Rao SV, Heg D, Rothenbühler M, Vranckx P, Jüni P. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 2015; 385:2465-76. [PMID: 25791214 DOI: 10.1016/s0140-6736(15)60292-6] [Citation(s) in RCA: 899] [Impact Index Per Article: 99.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management. METHODS We did a randomised, multicentre, superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segment elevation myocardial infarction who were about to undergo coronary angiography and percutaneous coronary intervention. Patients were randomly allocated (1:1) to radial or femoral access with a web-based system. The randomisation sequence was computer generated, blocked, and stratified by use of ticagrelor or prasugrel, type of acute coronary syndrome (ST-segment elevation myocardial infarction, troponin positive or negative, non-ST-segment elevation acute coronary syndrome), and anticipated use of immediate percutaneous coronary intervention. Outcome assessors were masked to treatment allocation. The 30-day coprimary outcomes were major adverse cardiovascular events, defined as death, myocardial infarction, or stroke, and net adverse clinical events, defined as major adverse cardiovascular events or Bleeding Academic Research Consortium (BARC) major bleeding unrelated to coronary artery bypass graft surgery. The analysis was by intention to treat. The two-sided α was prespecified at 0·025. The trial is registered at ClinicalTrials.gov, number NCT01433627. FINDINGS We randomly assigned 8404 patients with acute coronary syndrome, with or without ST-segment elevation, to radial (4197) or femoral (4207) access for coronary angiography and percutaneous coronary intervention. 369 (8·8%) patients with radial access had major adverse cardiovascular events, compared with 429 (10·3%) patients with femoral access (rate ratio [RR] 0·85, 95% CI 0·74-0·99; p=0·0307), non-significant at α of 0·025. 410 (9·8%) patients with radial access had net adverse clinical events compared with 486 (11·7%) patients with femoral access (0·83, 95% CI 0·73-0·96; p=0·0092). The difference was driven by BARC major bleeding unrelated to coronary artery bypass graft surgery (1·6% vs 2·3%, RR 0·67, 95% CI 0·49-0·92; p=0·013) and all-cause mortality (1·6% vs 2·2%, RR 0·72, 95% CI 0·53-0·99; p=0·045). INTERPRETATION In patients with acute coronary syndrome undergoing invasive management, radial as compared with femoral access reduces net adverse clinical events, through a reduction in major bleeding and all-cause mortality. FUNDING The Medicines Company and Terumo.
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Affiliation(s)
| | - Andrea Gagnor
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy
| | - Paolo Calabró
- Division of Cardiology, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Enrico Frigoli
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy; EUSTRATEGY Association, Forli', Italy
| | - Sergio Leonardi
- UOC Cardiologia, Dipartimento CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Tiziana Zaro
- A.O. Ospedale Civile di Vimercate (MB), Vimercate, Italy
| | - Paolo Rubartelli
- Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy
| | | | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Messina, Italy
| | - Alessandra Repetto
- UOC Cardiologia, Dipartimento CardioToracoVascolare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Giovanni Esposito
- Division of Cardiology-Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | | | | | | | - Paolo Tosi
- Mater Salutis Hospital-Legnago, Verona, Italy
| | | | - Salvatore Brugaletta
- Hospital Clinic, University of Barcelona, Thorax Institute, Department of Cardiology, Barcelona, Spain
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Peter Jüni
- Clinical Trials Unit, University of Bern, Bern, Switzerland; Institute of Primary Health Care, University of Bern, Bern, Switzerland
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Iqbal MB, Khamis R, Ilsley C, Mikhail G, Crake T, Firoozi S, Kalra S, Knight C, Archbold A, Lim P, Mathur A, Meier P, Rakhit RD, Redwood S, Whitbread M, Bromage D, Rathod K, Jones DA, Wragg A, Dalby M, MacCarthy P, Malik IS. Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients. Circ Cardiovasc Interv 2015; 8:e002206. [PMID: 26038482 DOI: 10.1161/circinterventions.114.002206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction. Resources are limited during out of working hours (OWH). Whether PPCI outside working hours is associated with worse outcomes and whether outcomes have improved over time are unknown. METHODS AND RESULTS We analyzed 11 466 patients undergoing PPCI between 2004 and 2011 at all 8 tertiary cardiac centers in London, United Kingdom. We defined working hours as 9 am to 5 pm (Monday to Friday). We analyzed in-hospital bleeding and all-cause mortality ≤3 years, comparing OWH versus in-working hours. A total of 7494 patients (65.3%) were treated during OWH. Multivariable analyses demonstrated that PPCI during OWH was not a predictor for bleeding (odds ratio, 1.47; 95% confidence interval [CI], 0.97-2.24; P=0.071) or 3-year mortality (hazard ratio, 1.11; 95% CI, 0.94-1.32; P=0.20). This was confirmed in propensity-matched analyses. Time-stratified analyses demonstrated that PPCI during OWH was a predictor for bleeding (odds ratio, 2.00; 95% CI, 1.06-3.80; P=0.034) and 3-year mortality during 2005 to 2008 (hazard ratio, 1.23; 95% CI, 1.00-1.50; P=0.050), but this association was lost during 2009 to 2011. During 2005 to 2008, transradial access was predominantly used during in-working hours and PPCI during OWH was predictive of reduced transradial access use (odds ratio, 0.83; 95% CI, 0.71-0.98; P=0.033), but this association was lost during 2009 to 2011. CONCLUSIONS In this study of unselected patients with ST-segment-elevation myocardial infarction, PPCI during OWH versus in-working hours had comparable bleeding and mortality. Time-stratified analyses demonstrated a reduction in adjusted bleeding and mortality during OWH over time. This may reflect the improved service provision, but the increased adoption of transradial access during OWH may also be contributory.
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Affiliation(s)
- M Bilal Iqbal
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.).
| | - Ramzi Khamis
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Ilsley
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Ghada Mikhail
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Tom Crake
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sam Firoozi
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sundeep Kalra
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Knight
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Archbold
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pitt Lim
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Anthony Mathur
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pascal Meier
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Roby D Rakhit
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Simon Redwood
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Mark Whitbread
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Dan Bromage
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Krishna Rathod
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Daniel A Jones
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Wragg
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Miles Dalby
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Phil MacCarthy
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Iqbal S Malik
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
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Bauer T, Hochadel M, Brachmann J, Schächinger V, Boekstegers P, Zrenner B, Zahn R, Zeymer U. Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry. Catheter Cardiovasc Interv 2015; 86 Suppl 1:S8-14. [PMID: 25945803 DOI: 10.1002/ccd.25987] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice. BACKGROUND The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use. METHODS Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%). RESULTS Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P < 0.001) and vascular access complications (0.3 vs. 1.8%, P < 0.001%) were lower in the TR group. In the multivariate analysis radial access was associated with an improved in-hospital survival rate (OR 0.47, 95% CI 0.35-0.65). CONCLUSIONS The radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality.
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Affiliation(s)
- Timm Bauer
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany.,Universitätsklinik Gießen, Germany
| | - Matthias Hochadel
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
| | | | | | | | | | - Ralf Zahn
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
| | - Uwe Zeymer
- Herzzentrum Ludwigshafen, Institut Für Herzinfarktforschung Ludwigshafen, Germany
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Andò G, Cortese B, Frigoli E, Gagnor A, Garducci S, Briguori C, Rubartelli P, Calabrò P, Valgimigli M. Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI-MATRIX (acute kidney injury-minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub-study. Catheter Cardiovasc Interv 2015; 86:950-7. [DOI: 10.1002/ccd.25932] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/14/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine and Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”; University of Messina; Messina Italy
| | | | | | - Andrea Gagnor
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3; Turin Italy
| | | | | | - Paolo Rubartelli
- Department of Cardiology; ASL3 Ospedale Villa Scassii; Genova Italy
| | - Paolo Calabrò
- Division of Cardiology; Department of Cardiothoracic Sciences; Second University of Naples; Naples Italy
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50
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Choi JH, Seo JM, Lee DH, Park K, Kim YD. Clinical utility of new bleeding criteria: A prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention. J Cardiol 2015; 65:324-9. [DOI: 10.1016/j.jjcc.2014.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/29/2014] [Accepted: 06/20/2014] [Indexed: 11/16/2022]
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