scholarly journals PREDILECTION & SAFETY OF TRANSRADIAL CORONARY INTERVENTION IN THE ELDERLY POPULATION

2019 ◽  
pp. 1-2
Author(s):  
Mahadevan V ◽  
Jaisankar P
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Elderly Population ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
The Elderly ◽  
Elderly Group ◽  
Access Site ◽  
Coronary Syndrome ◽  
Procedural Time

BACKGROUND: Transradial artery access for coronary intervention procedures is a safe and beneficial technique1. The safety aspects are well established in young individuals2. Elderly patients have been considered as a higher risk due to increased vascular tortuosity,calcifications and other access site related complications in comparison to younger individuals3. This study was done to assess the feasibility, efficacy and safety of transradial coronary angiography or intervention in the elderly. MATERIALS & METHODS:This study was conducted in the department of Cardiology,Chengalpattu Medical College Hospital in patients admitted coronary angiogram either for acute coronary syndrome or chronic stable angina during the period from November 2018 to April 2019. A total of 149 patients who underwent coronary angiography/ intervention through radial artery access were studied. Patients were divided into elderly population with age at or above 65 years (n = 24) & non elderly with age less than (n=125).Most of the patients who underwent procedure in both the groups are for acute coronary syndrome (ACS) than chronic stable angina (CSA) ,elderly arm (ACS vs.CSA – 91.6% vs.8.3%) & non elderly arm (ACS vs.CSA – 90.4% vs 9.6%).The two groups of population were analyzed with respect to complications such as vascular site bleeding,stroke,procedural time & access site cross over. RESULTS: The mean age was 72 ± 3.3 years in the elderly group and 49 ± 5.3 years in the non-elderly group. Baseline serum creatinine values were slightly elevated in elderly arm.The procedural time was higher in elderly arm than non elderly arm both in diagnostic (16 min 20 secs vs.2 min 45secs) as well as in interventional (41min 32 secs vs.19 min 18 secs)procedures. But the volume of contrast utilized is same in both arms with average of 40ml vs 42ml in elderly vs.non elderly arm respectively. Occurrence of puncture site bleeding or occlusion of radial artery showed no difference between two arms. The procedure completion was equally safe in both elderly and non elderly group (85 % vs.86% ). Access site cross over rate due to vessel tortuosity was higher in elderly arm (8% vs.1.5%) where as vasospasm was less in elderly compared to non elderly group (2.4% vs 7%). No case of thrombotic or bleeding risk or stroke were seen in both the arm. CONCLUSION: Transradial coronary angiography or intervention is safe and complication rates are comparable with those in non elderly patients.Procedural time for the completion of procedure is high in elderly than in non elderly due to tortuous vessel anatomy,difficulty in engaging the coronary artery & operator efficacy etc.

Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI

2021 ◽  
Vol 41 (4) ◽  
pp. 18-28
Author(s):  
Kevin White ◽  
Judy Currey ◽  
Julie Considine
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Signs And Symptoms ◽  
Coronary Artery Occlusion ◽  
Coronary Intervention ◽  
Clinical Deterioration ◽  
Access Site ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Topic Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.

scholarly journals Cardiac rehabilitation program after an acute coronary syndrome in the elderly population: benefits and safety

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P5806-P5806
Author(s):  
D. Gemma ◽  
S. O. Rosillo Rodriguez ◽  
F. De Torres Alba ◽  
S. Del Prado Diaz ◽  
A. M. Iniesta Manjavacas ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Elderly Population ◽  
The Elderly ◽  
Rehabilitation Program ◽  
Cardiac Rehabilitation Program ◽  
Coronary Syndrome

scholarly journals Clinical outcomes of patients with acute coronary syndrome and moderate or severe chronic anaemia undergoing coronary angiography or intervention

2017 ◽  
Vol 7 (7) ◽  
pp. 646-651 ◽  
Author(s):  
Lea Ohana-Sarna-Cahan ◽  
Shaul Atar
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Haemoglobin Level ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Severe Anaemia ◽  
Control Group ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: There are limited data on the impact of chronic moderate or severe anaemia on the clinical outcomes of patients with acute coronary syndrome undergoing coronary angiography or percutaneous coronary intervention. Methods: We retrospectively compared two groups of consecutive patients with acute coronary syndrome according to their haemoglobin level on admission. The research group ( n=89) had a haemoglobin level of 10.9 g/dl or less and a control group ( n=79) of age-matched patients had a haemoglobin level greater than 10.9 g/dl. We studied drug therapy before, during and after intervention, and performed 1-year follow-up of bleeding complications according to the Bleeding Academic Research Consortium criteria, all-cause mortality and re-infarction, as well as haemoglobin level on discharge, 6 and 12 months after admission. Results: Compared to controls, a haemoglobin level less than 10.9 g\dl on admission is associated with a higher rate of major bleeding: 26 patients (32%) versus none in the control group ( P<0.001); and the use of packed red blood cell (RBC) transfusion: nine patients (11.7%) versus none in the control group ( P=0.003) within the first 6 months post-catheterisation. However, the re-infarction rate and mortality were similar in the study and control groups: 9.2% versus 9.7% ( P=0.915) and 12.6% versus 8.9% ( P=0.434), accordingly. Conclusions: Chronic moderate or severe anaemia in patients with acute coronary syndrome undergoing coronary angiography or percutaneous coronary intervention is associated with a substantially increased risk of bleeding in the first 6 months. However, rates of mortality and re-infarction were similar.

scholarly journals Changes in serum serotonin levels in patients with acute coronary syndrome and stable angina undergoing percutaneous coronary intervention

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097010
Author(s):  
Donghoon Han ◽  
Jae Hyuk Choi ◽  
Sehun Kim ◽  
Sang Min Park ◽  
Dong Geum Shin ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Antiplatelet Agents ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Serum Serotonin

Objective Activated platelets release serotonin, causing platelet aggregation and vasoconstriction. Serotonin levels were investigated in patients with acute coronary syndrome (ACS) and chronic stable angina (CSA) treated with percutaneous coronary intervention (PCI). Methods Consecutive patients undergoing PCI for either ACS or CSA were enrolled between July 2009 and April 2010. Patients were pre-treated with dual antiplatelet agents (aspirin and clopidogrel) before PCI. Serum serotonin levels, measured at baseline, pre- and post-PCI, and at 90 min, and 6, 12, 24 and 48 h following PCI, were compared between ACS and CSA groups. Results Sixty-three patients with ACS and 60 with CSA were included. Overall baseline characteristics were similar between the two groups. Serotonin levels at post-PCI (55.2 ± 120.0 versus 20.1 ± 24.0) and at peak (regardless of timepoint; 94.0 ± 170.9 versus 38.8 ± 72.3) were significantly higher in the ACS versus CSA group. At 90 min and 6, 24 and 48 h post-PCI, serum serotonin was numerically, but not significantly, higher in patients with ACS. Serotonin levels fluctuated in both groups, showing an initial rise and fall, rebound at 24 h and drop at 48 h post-PCI. Conclusions In patients undergoing PCI, serum serotonin was more elevated in patients with ACS than those with CSA, suggesting the need for more potent and sustained platelet inhibition, particularly in patients with ACS.

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