scholarly journals The Systemic Inflammation on Transradial vs Transfemoral Approach for Coronary Angiography in Patients with Chronic Coronary Syndrome <br/>—Does Transradial Coronary Angiography Trigger More Inflammation?

2021 ◽  
Vol 11 (02) ◽  
pp. 99-105
Author(s):  
Ozge Cetinarslan ◽  
Aysem Kaya ◽  
Alev Arat Ozkan
Keyword(s):  
Coronary Angiography ◽  
Systemic Inflammation ◽  
Transfemoral Approach ◽  
Coronary Syndrome

scholarly journals Radial versus femoral access for coronary angiography and interventions: a systematic review and meta-analysis of randomized trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Chiarito ◽  
D Cao ◽  
J Nicolas ◽  
A Roumeliotis ◽  
D Power ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Significant Risk ◽  
Number Needed To Treat ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
All Cause Mortality

Abstract Background The presence of any benefits associated with radial or femoral access among patients undergoing coronary angiography and percutaneous coronary interventions (PCI) is still debated. Purpose Our aim is to provide a comprehensive quantitative appraisal of the effects of access site on the risks of stroke, myocardial infarction, and major bleeding in patients undergoing coronary angiography with or without PCI. Methods In January 2020, we searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access for coronary angiography with or without subsequent PCI. Odds ratios (OR) were used as metric of choice for treatment effects with random-effects models. Co-primary efficacy endpoints were stroke and myocardial infarction. Primary safety endpoint was major bleeding. Secondary endpoints were all cause mortality and vascular complications. Heterogeneity was assessed with the I-squared index. This study is registered with PROSPERO. Results We identified 31 trials, including 30,414 patients. Risks of stroke (OR 1.11, 95% CI 0.76–1.64, I2=0%) and myocardial infarction (OR 0.90, 95% CI 0.79–1.03, I2=0%) were comparable between radial and femoral access. Radial access was associated with a reduction for the risk of major bleeding as compared to femoral access (OR 0.53, 95% CI 0.42–0.67, I2=3.3%) with a number needed to treat of 92. Findings were consistent regardless clinical features and procedure performed, with the only exception of an increased benefit of the radial access in patients with chronic coronary syndrome (p forinteraction=0.005). The risk for all-cause mortality (OR 0.73, 95% CI 0.61–0.89, I2=0%) and vascular complication (OR 0.32, 95% CI 0.23–0.44, I2=16.7%) was significantly lower in the radial compared to femoral access group. Conclusions In patients undergoing coronary angiography with or without PCI, radial compared to femoral access did not reduce the risk of stroke and myocardial infarction, with no impact on the effect estimates of clinical presentation, age, gender, or subsequent PCI. Whereas, radial access is associated with a significant risk reduction of major bleeding as compared to femoral access. The benefit favoring radial access is of important clinical relevance in view of the relatively low number needed to treat to prevent a major bleeding and the significant impact on mortality. Funding Acknowledgement Type of funding source: None

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Conventional Coronary Angiography ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

Impact of Age, Gender and Indigenous Status on Access to Diagnostic Coronary Angiography for Acute Coronary Syndrome

2011 ◽  
Vol 20 ◽  
pp. S13
Author(s):  
Yvette Roe ◽  
Robyn McDermott ◽  
Murthy Mittinty ◽  
Christopher Zeitz ◽  
Derek Chew
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Indigenous Status ◽  
Coronary Syndrome ◽  
Diagnostic Coronary Angiography

scholarly journals THE RESULTS OF URGENT CORONARY ANGIOGRAPHY AND STENTING IN THE ACUTE CORONARY SYNDROME

2016 ◽  
Vol 26 (1) ◽  
pp. 098-121
Author(s):  
VI Davydkin ◽  
◽  
MD Romanov ◽  
MF Yerzin ◽  
AA Kovalev ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Coronary Syndrome

scholarly journals Renal Allograft-Related Inflammation and Accelerated Coronary-Artery Disease: A Case Report

2021 ◽  
Author(s):  
Rainer Ullrich Pliquett ◽  
Andrea Tannapfel ◽  
Sait Sebastian Daneschnejad
Keyword(s):  
Kidney Transplant ◽  
Systemic Inflammation ◽  
Renal Allograft ◽  
Active Role ◽  
Coronary Plaque ◽  
Plaque Instability ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease

Background: Although persistent systemic inflammation is considered to be predictive for future cardiovascular events, it remains unclear whether or not C-reactive protein (CrP) plays an active role in coronary-plaque instability. Here, we report a case of a patient with failed and super-infected renal allograft as a source for systemic inflammation presenting with repeat acute coronary syndromes. Case presentation: A 52-years-old male type-2 diabetic with a failed kidney transplant who was hospitalized for acute urinary-tract infection. In the presence of other, classic cardiovascular risk factors, peak values of CrP coincided with episodes of unstable angina treated by cardiologic interventions. Besides pyelonephritis, the histological examination of the kidney transplant revealed signs of chronic rejection and the presence of a renal cell carcinoma in situ. Once the renal allograft has been removed, systemic inflammation was attenuated, the patient was not rehospitalized for acute-coronary syndrome within the next 12 months. Conclusion: In this case, systemic inflammation was paralleled by instability of coronary plaques as documented by repeat coronary angiograms.

Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome

Angiology ◽  
2018 ◽  
Vol 70 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Burak Açar ◽  
Ozcan Ozeke ◽  
Mustafa Karakurt ◽  
Yasin Ozen ◽  
Mustafa Bilal Özbay ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Coronary Atherosclerosis ◽  
Scoring Systems ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Atherosclerotic Burden ◽  
First Occurrence ◽  
And Control ◽  
The Impact

Diabetes mellitus (DM) is associated with more extensive coronary atherosclerosis and more vulnerable plaque phenotypes. However, DM should not be considered a homogeneous and purely binary entity in terms of risk assessment. We evaluated the impact of prediabetic status on coronary atherosclerosis burden in patients with first-time acute coronary syndrome (ACS) who underwent urgent coronary angiography. The patients were divided into DM, prediabetes, and control groups. The 3-vessel disease (TVD) rates and SYNTAX and Gensini scoring systems for defining atherosclerotic burden were compared. The study was conducted in 469 consecutive patients admitted with a diagnosis of ACS. Of these, 250 patients were admitted at the first occurrence of ACS undergoing diagnostic coronary angiography. SYNTAX and Gensini scores and TVD rates were higher in prediabetic patients than in nondiabetic patients ( P = .004, P = .008, and P = .014, respectively), but similar in prediabetic and diabetic patients ( P = .912, P = .773, and P = 1.000, respectively). Coronary atherosclerosis burden is more advanced in prediabetic patients than in nondiabetic patients and is comparable between prediabetic and diabetic patients at first presentation of ACS. Cardiologists should not miss the opportunity to diagnose prediabetes and DM when patients present with an ACS.

scholarly journals Associations of Serum Cortisol with Cardiovascular Risk and Mortality in Patients Referred to Coronary Angiography

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Stefan Pilz ◽  
Verena Theiler-Schwetz ◽  
Christian Trummer ◽  
Martin H Keppel ◽  
Martin R Grübler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Natural Killer Cells ◽  
Coronary Angiography ◽  
Cardiovascular Risk Factors ◽  
Natural Killer ◽  
Cardiovascular Mortality ◽  
Serum Cortisol ◽  
Killer Cells ◽  
Coronary Syndrome

Abstract Context Serum cortisol may be associated with cardiovascular risk factors and mortality in patients undergoing coronary angiography, but previous data on this topic are limited and controversial. Objective We evaluated whether morning serum cortisol is associated with cardiovascular risk factors, lymphocyte subtypes, and mortality. Methods This is a prospective cohort study performed at a tertiary care centre in south-west Germany between 1997 and 2000. We included 3052 study participants who underwent coronary angiography. The primary outcome measures were cardiovascular risk factors, lymphocyte subtypes, and all-cause and cardiovascular mortality. Results Serum cortisol was associated with an adverse cardiovascular risk profile, but there was no significant association with coronary artery disease or acute coronary syndrome. In a subsample of 2107 participants, serum cortisol was positively associated with certain lymphocyte subsets, including CD16+CD56+ (natural killer) cells (P &lt; 0.001). Comparing the fourth versus the first serum cortisol quartile, the crude Cox proportional hazard ratios (with 95% CIs) were 1.22 (1.00-1.47) for all-cause and 1.32 (1.04-1.67) for cardiovascular mortality, respectively. After adjustments for various cardiovascular risk factors, these associations were attenuated to 0.93 (0.76-1.14) for all-cause, and 0.97 (0.76-1.25) for cardiovascular mortality, respectively. Conclusions Despite significant associations with classic cardiovascular risk factors and natural killer cells, serum cortisol was not a significant and independent predictor of mortality in patients referred to coronary angiography. These findings might reflect that adverse cardiovascular effects of cortisol could be counterbalanced by some cardiovascular protective actions.

Abstract 374: Trans-radial Access Angiography Learning Curve

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Julian Chan ◽  
Rosanna Tavella ◽  
John F Beltrame ◽  
Matthew Worthley ◽  
Sivabaskari Pasupathy ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Learning Curve ◽  
Radial Artery ◽  
Vascular Access ◽  
Best Practice ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Increased Risk ◽  
Radial Operators

Introduction: Radial artery access has been adopted widely around the world as standard best practice for coronary angiography with or without percutaneous coronary intervention. Radial artery access offers benefits in regard to reduced major bleeding, reduced hospital stay, fewer vascular complications, similar procedural times, patient preference and a mortality benefit in acute coronary syndrome/STEMI management. Despite transradial access being best practice, there has been a slow uptake of this technique amongst some cardiologists/interventionalists, particularly in the USA. This may partially be attributed to uncertainties regarding the learning curve and concerns regarding delaying treatment in STEMI if radial access fails. Methods: Using the data from the Coronary Angiography Database Of South Australia registry (CADOSA), we sought to determine the radial access failure rates for acute cases during transition from routine femoral access to routine radial access from 2012 to 2016, a period when the greatest transition in practice occurred. Data regarding initial vascular access, success or failure, and subsequent vascular access was prospectively recorded for all cases. Operators with at least a 70% rate of initial radial access were deemed to be established radial operators and acted as controls for operators transitioning from femoral access (at least 70% of cases) to radial access during the study period. Cases were further classified as elective, urgent (eg inpatient ACS) or emergency (eg STEMI). Results: There were 23 operators with sufficient volumes, responsible for 20,073 cath lab visits during the 5 year period studied. The overall radial access rate increased from 57% in 2012 to 78% in 2016. For operators transitioning from a default femoral access (76% of case) to a default radial access (75% of cases), the radial access failure rate for urgent and emergency cases was 3.7%, compared to 3.5% for experienced radial operators over the same period. Conclusion: Despite strong evidence of benefit for radial access angiography and intervention, compared to femoral access, some operators remain reluctant to transition. Utilising the CADOSA database, we observed a safe transition from femoral to radial access without an increased risk of access site failure for acute cases. Transition from femoral to radial access can be made safely by a range of clinicians managing acute cases.

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