Is the Complication Rate of Ulnar and Radial Approaches for Coronary Artery Intervention the Same?

Angiology ◽  
2017 ◽  
Vol 68 (10) ◽  
pp. 919-925 ◽  
Author(s):  
Xile Bi ◽  
Qingsheng Wang ◽  
Defeng Liu ◽  
Quan Gan ◽  
Li Liu
Keyword(s):  
Coronary Artery ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Arterial Occlusion ◽  
Ulnar Artery ◽  
Diameter Ratio ◽  
Transradial Approach ◽  
Single Procedure ◽  
Single Center Study ◽  
Coronary Procedures

We compared the clinical outcomes of patients who underwent coronary artery intervention by the transulnar and transradial artery approaches. In this 1 year, single-center study, patients were randomized to either a radial artery (RA) or ulnar artery (UA) group. Of 538 patients, the primary outcome, arterial occlusion of a forearm artery, occurred in 21 of 225 patients in the RA group compared to 6 of 220 patients in the UA group (9.3% vs 2.7%, P = .007). The rate of arterial occlusion was significantly lower following ulnar access compared to radial (odds ratio [OR] = 3.85, P = .006). A higher risk of occlusion was associated with repeated procedures rather than a single procedure (OR = 5.14, P = .003), smoking (OR = 2.39, P = .04), and arterial to sheath diameter ratio of ≤1 (OR = 2.62, P = .03). However, the disadvantage of UA was an increase of incidence of hematomas (13.2% vs 5.8%, P = .01) and symptoms of discomfort (15.5% vs 5.8%, P = .002). In conclusion, the transulnar strategy proved to be noninferior to the transradial approach for coronary procedures ( ClinicalTrials.gov Identifier: NCT01979627).

scholarly journals Expert Opinion: Transradial Coronary Artery Procedures: Tips for Success

2017 ◽  
Vol 12 (01) ◽  
pp. 18 ◽  
Author(s):  
Kully Sandhu ◽  
Robert Butler ◽  
James Nolan ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Radiation Exposure ◽  
Femoral Artery ◽  
Patient Preference ◽  
Vascular Complications ◽  
Technological Advancement ◽  
Access Site ◽  
Early Ambulation ◽  
Transradial Approach ◽  
Coronary Procedures

Historically, the majority of coronary procedures have been performed via the femoral artery. However, since the inception of the transradial approach, a number of studies have confirmed that this technique is associated with a significant reduction in vascular complications, equivalent procedure times and radiation exposure to femoral procedures, the ability to perform complex coronary interventions, early ambulation and patient preference. Over the last decade, this has led to an exponential rise in the use of the transradial access site, with several potential technical challenges becoming increasingly recognised. However, with greater experience and technological advancement these potential obstacles may be overcome. The following review highlights the potential challenges and suggests several tips to assist transradial operators with recognising and overcoming these challenges.

scholarly journals Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG)

Circulation ◽  
2020 ◽  
Vol 142 (19) ◽  
pp. 1799-1807 ◽  
Author(s):  
Laura M. Willemsen ◽  
Paul W.A. Janssen ◽  
Joyce Peper ◽  
Mohamed A. Soliman-Hamad ◽  
Albert H.M. van Straten ◽  
...  
Keyword(s):  
Placebo Group ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Graft Patency ◽  
Bypass Grafting

Background: Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. Methods: In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with ≥1 SVGs were randomly assigned (1:1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death. Results: Among 499 randomly assigned patients, the mean age was 67.9±8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73–2.30]; P =0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72–2.05]). Conclusions: In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02352402.

Downsizing – the Future of Interventional Cardiology

2012 ◽  
Vol 7 (1) ◽  
pp. 28
Author(s):  
Giovanni Amoroso ◽  
Keyword(s):  
Contrast Agent ◽  
Vascular Complications ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Transradial Approach ◽  
Technical Developments ◽  
Coronary Procedures ◽  
Angiographic Image

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

scholarly journals Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

2020 ◽  
Author(s):  
Elaine C Khoong ◽  
Valy Fontil ◽  
Natalie A Rivadeneira ◽  
Mekhala Hoskote ◽  
Shantanu Nundy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Mixed Effects ◽  
Regression Analyses ◽  
Diagnostic Confidence ◽  
Diagnostic Uncertainty ◽  
Intervention Impact ◽  
High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

Relationship between Whole Blood Viscosity and Lesion Severity in Coronary Artery Disease

2021 ◽  
Author(s):  
Gökhan Ceyhun ◽  
Oğuzhan Birdal
Keyword(s):  
Coronary Artery ◽  
Shear Rate ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Significant Stenosis ◽  
Whole Blood Viscosity ◽  
Significant Coronary Artery Stenosis ◽  
Coronary Syndrome

Abstract Objective This article investigates the relationship of fractional flow reserve (FFR) with whole blood viscosity (WBV) in patients who were diagnosed with chronic coronary syndrome and significant stenosis in the major coronary arteries and underwent the measurement of FFR. Material and Method In the FFR measurements performed to evaluate the severity of coronary artery stenosis, 160 patients were included in the study and divided into two groups as follows: 80 with significant stenosis and 80 with nonsignificant stenosis. WBVs at low shear rate (LSR) and high shear rate (HSR) were compared between the patients in the significant and nonsignificant coronary artery stenosis groups. Results In the group with FFR < 0.80 and significant coronary artery stenosis, WBV was significantly higher compared with the group with nonsignificant coronary artery stenosis in terms of both HSR (19.33 ± 0.84) and LSR (81.19 ± 14.20) (p < 0.001). In the multivariate logistic regression analysis, HSR and LSR were independent predictors of significant coronary artery stenosis (HSR: odds ratio: 1.67, 95% confidence interval: 1.17–2.64; LSR: odds ratio: 2.46, 95% confidence interval: 2.19–2.78). In the receiver operating characteristic (ROC) curve analysis, when the cutoff value of WBV at LSR was taken as 79.23, it had 58.42% sensitivity and 62.13% specificity for the prediction of significant coronary artery stenosis (area under the ROC curve: 0.628, p < 0.001). Conclusion WBV, an inexpensive biomarker that can be easily calculated prior to coronary angiography, was higher in patients with functionally severe coronary artery stenosis, and thus could be a useful marker in predicting the hemodynamic severity of coronary artery stenosis in patients with chronic coronary syndrome.

scholarly journals Convalescent Plasma Efficacy in Life-Threatening COVID-19 Patients Admitted to the ICU: A Retrospective Cohort Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2113
Author(s):  
Mohamed Abuzakouk ◽  
Khaled Saleh ◽  
Manuel Algora ◽  
Ahmad Nusair ◽  
Jawahir Alameri ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Improvement ◽  
Primary Outcome ◽  
Neutralizing Antibody ◽  
Limited Data ◽  
Inverse Probability Weights ◽  
Single Center Study ◽  
Life Threatening ◽  
Antibody Titers ◽  
Disease Severity Scale

(1) Background: There are limited data regarding the efficacy of convalescent plasma (CP) in critically ill patients admitted to the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). We aimed to determine whether CP is associated with better clinical outcome among these patients. (2) Methods: A retrospective single-center study including adult patients with laboratory-confirmed SARS-CoV-2 infection admitted to the ICU for acute respiratory failure. The primary outcome was time to clinical improvement, within 28 days, defined as patient discharged alive or reduction of 2 points on a 6-point disease severity scale. (3) Results: Overall, 110 COVID-19 patients were admitted. Thirty-two patients (29%) received CP; among them, 62.5% received at least one CP with high neutralizing antibody titers (≥1:160). Clinical improvement occurred within 28 days in 14 patients (43.7%) of the CP group vs. 48 patients (61.5%) in the non-CP group (hazard ratio (HR): 0.75 (95% CI: 0.41–1.37), p = 0.35). After adjusting for potential confounding factors, CP was not independently associated with time to clinical improvement (HR: 0.53 (95% CI: 0.23–1.22), p = 0.14). Additionally, the average treatment effects of CP, calculated using the inverse probability weights (IPW), was not associated with the primary outcome (−0.14 days (95% CI: −3.19–2.91 days), p = 0.93). Hospital mortality did not differ between CP and non-CP groups (31.2% vs. 19.2%, p = 0.17, respectively). Comparing CP with high neutralizing antibody titers to the other group yielded the same findings. (4) Conclusions: In this study of life-threatening COVID-19 patients, CP was not associated with time to clinical improvement within 28 days, or hospital mortality.

scholarly journals Incremental prognostic value of visually estimated coronary artery calcium in patients undergoing positron emission tomography imaging

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001648
Author(s):  
Senthil Selvaraj ◽  
Muhammad Shoaib Khan ◽  
Mahesh K Vidula ◽  
Philip C Wiener ◽  
Alejandro E de Feria ◽  
...  
Keyword(s):  
Risk Factors ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Pet Imaging ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Chest Ct ◽  
Emission Tomography ◽  
Positron Emission ◽  
Traditional Risk Factors

ObjectiveVisually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)–myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and PET imaging parameters, including coronary flow reserve (CFR).MethodsWe analysed 608 patients without known coronary artery disease who underwent PET–MPI between 2012 and 2016 and had AC/CT and/or chest CT images. We used Cox regression to estimate the association of VECAC categories (≤10, 11–400, >400 Agatston units (AU)) with the primary outcome of all-cause death, acute coronary syndrome or stroke (mean follow-up 4.3±1.8 years). C-statistics assessed the relationship between PET parameters and VECAC with the primary outcome.ResultsMean age was 58±11 years, 65% were women and 67% were black. VECAC ≤10, 11–400 and >400 AU was observed in 68%, 12% and 20% of subjects, respectively. Compared with VECAC ≤10, VECAC categories 11–400 (HR 2.25, 95% CI 1.24 to 4.08) and >400 AU (HR 3.05, 95% CI 1.87 to 4.98) were associated with the primary outcome after adjusting for traditional risk factors, MPI findings and CFR. Adding VECAC to a model that included PET–MPI, CFR and clinical risk factors improved the prognostic value for the primary outcomes (c-statistic 0.71 to 0.75 with VECAC, p=0.01).ConclusionsVECAC is a potent predictor of events beyond traditional risk factors and PET imaging markers, including CFR. These data further support the importance for routine VECAC implementation.

scholarly journals Anosmia as a Screening Tool for COVID-19 Infection: A Prospective Cohort Study

2021 ◽  
pp. 1-6
Author(s):  
Esra AlHamadani ◽  
Sania Zia ◽  
Ali AlRahma ◽  
Firas AlNajjar
Keyword(s):  
Odds Ratio ◽  
Screening Tool ◽  
Index Finger ◽  
Upper Respiratory Tract ◽  
Chain Reaction ◽  
The Public ◽  
Single Center Study ◽  
Upper Respiratory ◽  
Polymerase Chain ◽  
Low Sensitivity

<b><i>Objectives:</i></b> Several studies promoted anosmia as a possible isolated symptom for coronavirus disease 2019 (COVID-19). No studies used feasible methods of smell testing that the public would use to address the accuracy of these claims. <b><i>Methods:</i></b> This is a single-center study conducted between April 2020 and June 2020. The sense of smell was tested in vitally stable suspected COVID-19 patients with no/mild upper respiratory tract infection symptoms prior to nasopharyngeal swabbing for reverse-transcriptase polymerase chain reaction. Patients were instructed to close their eyes. Each nostril was tested separately while the other was blocked with the patient’s index finger. Patients inhaled from 2 concealed vials (coffee and strawberry essence) consecutively, kept within 30 cm of the nostril for 60 s. Patients who could not identify both odors with both nostrils were recorded as “anosmia.” <b><i>Results:</i></b> Out of 346 eligible subjects, 43 had anosmia of which 26 (60%) tested COVID-19 positive. χ<sup>2</sup> test showed a <i>p</i> value &#x3c;0.001. The test showed a sensitivity of 30% (95% confidence interval [CI] 21%, 41%) and specificity 94% (95% CI 90%, 96%). Logistic regression revealed an odds ratio of 5.9 (95% CI 3.0, 12) <i>p</i> value &#x3c;0.001. <b><i>Conclusion:</i></b> Given the low sensitivity (30%) of this method in detecting COVID-19 infection, we conclude that this method is not a useful screening tool for COVID-19 infection. The moderate negative predictive value (80%) is nongeneralizable.

Prospective Analysis after Coronary-artery Bypass Grafting: Platelet GP IIIa Polymorphism (HPA-1b /PlA2) Is a Risk Factor for Bypass Occlusion, Myocardial Infarction, and Death

2000 ◽  
Vol 83 (03) ◽  
pp. 404-407 ◽  
Author(s):  
Michael Klein ◽  
Hans Dauben ◽  
Christiane Moser ◽  
Emmeran Gams ◽  
Rüdiger Scharf ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Odds Ratio ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Hereditary Risk ◽  
Artery Disease

SummaryRecently, we have demonstrated that human platelet antigen 1b (HPA-1b or PlA2) is a hereditary risk factor for platelet thrombogenicity leading to premature myocardial infarction in preexisting coronary artery disease. However, HPA-1b does not represent a risk factor for coronary artery disease itself. The aim of our present study was to evaluate the role of HPA-1b on the outcome in patients after coronaryartery bypass surgery. We prospectively determined the HPA-1 genotype in 261 consecutive patients prior to saphenous-vein coronaryartery bypass grafting. The patients were followed for one year. Among patients with bypass occlusion, myocardial infarction, or death more than 30 days after surgery, the prevalence of HPA-1b was significantly higher than among patients without postoperative complications (60 percent, 6/10, vs. 24 percent, 58/241, p <0.05, odds ratio 4.7). Using a stepwise logistic regression analysis with the variables HPA1b, age, sex, body mass index, smoking (pack-years), hypertension, diabetes, cholesterol and triglyceride concentration, only HPA-1b had a significant association with bypass occlusion, myocardial infarction, or death after bypass surgery (p = 0.019, odds ratio 4.7). This study shows that HPA-1b is a hereditary risk factor for bypass occlusion, myocardial infarction, or death in patients after coronary-artery bypass surgery.

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