scholarly journals IS Trans-Radial Approach Related to an Increased RisK of RAdiation Exposure In Patients Who Underwent Diagnostic CoronaRY Angiography or Percutaneous Coronary Intervention? (The SAKARYA Study)

2019 ◽  
Author(s):  
Çağın Mustafa Üreyen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Coronary Intervention ◽  
Radial Approach ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Diagnostic Coronary Angiography

scholarly journals Impact of trainee involvement on patient radiation exposure and contrast volumes during invasive cardiac procedures

2020 ◽  
Vol 43 (1) ◽  
pp. E18-E21
Author(s):  
Vinay Kansal ◽  
Trevor Simard ◽  
Pietro Di Santo ◽  
Aun Yeong Chong ◽  
Derek So ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Coronary Intervention ◽  
Contrast Administration ◽  
Cardiac Procedures ◽  
Primary Operator ◽  
Percutaneous Coronary ◽  
Patient Radiation Exposure ◽  
Diagnostic Coronary Angiography

Purpose: The impact of cardiology fellows (CFs) and interventional cardiology fellows (ICFs) on patient radiation and contrast exposure during diagnostic coronary angiography and percutaneous coronary intervention is unknown. Methods: Between 2011 and 2014, 16,175 cases were retrospectively assessed involving 27 CFs, 22 ICFs and 24 staff as primary operators. Results: During diagnostic coronary angiography, ICFs administered the lowest radiation dose (5,648±5,523 cGy*cm2; 1.30 ± 1.27 mSv)—achieving 22% less radiation than the staff (6,889±4,294 cGy*cm2; 1.58 ± 0.99 mSv) and 36% less than CFs (7,700±6,751 cGy*cm2; 1.77 ± 1.55 mSv) (p<0.01). When adjusted for access site, CFs administered more radiation than either the ICFs or staff. However, differences between ICFs and staff were exclusively observed during transradial procedures (p<0.01). With regards to contrast administration, ICFs administered less contrast (126.3 ± 57.6 mL) than either CFs (130±52.4 mL) or staff (132.7±47.6 mL) (p<0.01)—again, a finding isolated to the transradial cohort. Of the 6,751 percutaneous coronary intervention cases, no significant differences existed between the ICFs or staff cardiologists in patient radiation exposure—but a CF as the primary operator resulted in an 18% increase in radiation exposure. Notably, contrast use was not different amongst the types of operators (p<0.05). Conclusion: In conclusion, having a cardiology fellow as primary operator during invasive cardiac procedures increases patient radiation exposure and minimally increases contrast administration. Strategies to minimize patient radiation exposure while maintaining trainee involvement should be evaluated.

scholarly journals P0118ANEMIA AS A RISK FACTOR FOR CONTRAST-INDUCED NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emna Chaabouni ◽  
Hela Jbali ◽  
Najjar Mariem ◽  
Mzoughi Khadija ◽  
Zouaghi Karim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Strong Predictor ◽  
Coronary Intervention ◽  
Severe Anemia ◽  
Contrast Induced Nephropathy ◽  
Female Patients ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Male Patients

Abstract Background and Aims Contrast-induced nephropathy is a potentially serious complication following coronary angiography and percutaneous coronary intervention . The association between severity of anemia and Contrast-induced nephropathy following coronary angiography is not well-established. In this prospective study, we aimed at assessing the association of anemia of various severity with the risk of Contrast-induced nephropathy in patients who underwent coronary angiography Method We prospectively enrolled 158 patients who underwent coronary angiography with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &gt;25% or 0.5 mg/dL after 48 hours and anemia was defined as a value of Hb level ≤ 13 g/dl in male patients or ≤ 12 g/dl in female patients. Patients were stratified into three subgroups—mild (11.1 to 13.0 g/dL) in male patients and (11.1 to 12.0 g/dL) in female patients, moderate (9.1 to 11.0 g/dL) and severe anemia (7.0 to 9.0 g/dL). we used a multivariable logistic-regression model. Results 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent coronary angiography, 15 (9,5%) developed Contrast-induced nephropathy . Presence of anemia was associated with increased risk of developing Contrast-induced nephropathy (OR = 3.04, 95% confidence interval [CI] = 1.03 to 8.96, p= 0,043). Risk of Contrast-induced nephropathy was increasingly higher with increasing severity of the anemia; mild (OR = 1.67, 95% CI = 1.38 to 2.17, p=0,036), moderate (OR = 3.3, 95% CI = 0.61 to 10.6, p=0,028) .There was no patient with severe anemia. Conclusion In conclusion, severity of anemia is a strong predictor of CIN following coronary angiography.

Haematoma after Coronary Angiography and Percutaneous Coronary Intervention via the Femoral Artery Frequency and Risk Factors

2005 ◽  
Vol 4 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Kirsten Andersen ◽  
Marianne Bregendahl ◽  
Helen Kaestel ◽  
Mette Skriver ◽  
Jan Ravkilde
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Femoral Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Low Molecular Weight ◽  
Multivariate Logistic Regression ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Made In

Background: The most common complication after coronary angiography (CA) and percutaneous coronary intervention (PCI) is the development of haematoma. Several changes in procedures regarding CA and PCI have been made in our department in recent years. The aim of this audit is to establish how many patients develop haematoma after CA/PCI via the femoral artery and subsequently to find predictors that increase the risk of developing haematoma. Methods: We initially included 474 consecutive patients-322 patients undergoing CA and 141 patients undergoing PCI. Eleven patients were later excluded due to the absence of complete data. Thirty-three variables were registered in order to find predictors, which might increase the haematoma frequency. A univariate as well as a multivariate logistic regression analysis was performed. Results: Of the 463 patients, 6 patients developed a haematoma > 10 cm (1.3%) and 41 patients developed a haematoma > 5 cm (8.9%). The following factors were found to be associated with the generation of haematoma: Women, systolic blood pressure > 160 mm Hg, artery puncture > 1, sheath time > 16 min, ACT ≥ 175 s, Glycoprotein (GP) IIB/IIIa inhibitors, Low Molecular Weight Heparin before procedure, personnel change during compression, and anti-coagulant-treatment before procedure. Conclusions: The frequency of haematoma was 1.3% (> 10 cm) and 8.9% (> 5 cm), which corresponds with reports from similar studies and departments. The factors found to increase the risk of haematoma development can provide background for procedural changes and increase the focus on patients at increased risk in order to minimize the development of haematomas.

Abstract 188: Implementation of Choosing Wisely Recommendations for Stress-First Nuclear Myocardial Perfusion Imaging

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
David E Winchester ◽  
Randy Jeffrey ◽  
Carsten Schmalfuss ◽  
David C Wymer ◽  
Vicente Taasan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion Imaging ◽  
Radiation Dose ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Radiation Exposure ◽  
Perfusion Imaging ◽  
Coronary Intervention ◽  
Imaging Protocol ◽  
Percutaneous Coronary

Introduction: Current guidelines for myocardial perfusion imaging (MPI) encourage facilities to adopt patient-centered risk mitigation strategies such as individualized radiotracer dosing and stress-first imaging. Reducing radiation exposure is also a key recommendation of multiple societies participating in the Choosing Wisely campaign. The stated goal is for over 50% of studies to be performed with <9 millisieverts (mSv) of radiation exposure. We hypothesized that adoption of a stress-first/stress-only imaging protocol would substantially reduce the median radiation dose administered in our nuclear lab. Methods: We switched the standard imaging protocol at the Malcom Randall VA Medical Center nuclear cardiology laboratory from rest-stress to stress-rest. To achieve this, a physician was required to review the stress images at the time they were obtained to determine if further imaging was indicated. Estimated effective radiation doses (in mSv) were calculated based on the radiotracer activity administered (in millicuries) used industry standards techniques. We compared 2 cohorts of patients: rest-stress studies consecutively done between 7/17/17 and 11/12/17 and stress-first studies consecutively done between 11/13/17 and 5/17/17. As a balancing measure, we compared the rate of normal studies between the cohorts. A normal MPI was defined as no evidence of ischemia or infarction with a preserved ejection fraction. Results: In the stress-first cohort, the median dose was 2.8 millisieverts (mSv) compared with 14.1 mSv in the rest-stress cohort (80.1% reduction, p<0.0001). During the observed period, we estimate that 4,780 mSv of effective dose were avoided. In the rest-stress cohort, 424 studies were performed. In the stress-first cohort, 716 tests were performed, 423 stress only studies (59.1%) and 293 stress-rest studies (40.1%). The rate of normal studies in the stress-first cohort was not different from the rest-stress cohort (stress-first: 73.5%, (526/716) versus rest-stress: 71.7%, p=0.54, odds ratio 0.92, 95% CI 0.69-1.21) In the rest-stress cohort, 3 patients (1.0%) underwent coronary angiography and 2 patients (0.7%) underwent percutaneous coronary intervention (PCI). In the stress-first cohort 8 patients (1.1%) underwent coronary angiography and 2 patient (0.3%) underwent percutaneous coronary intervention (PCI). Conclusion: By switching from a rest-stress to a stress-first imaging protocol, we reduced the median radiation dose in our lab by 80%. We observed no change in the proportion of normal tests, suggesting no potential for harm with this strategy.

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