Never again. Once used for cardiac catherization the Radial Artery cannot be used for CABG.

The use of the Radial Artery (RA) as a conduit in coronary artery bypass grafting (CABG) has been steadily increasing since the early 1990’s and based on the most recent data may well become the standard of care for patients with multi-vessel coronary artery disease (CAD) requiring multiple arterial grafts. The TRA approach for cardiac catherization has also increased steadily in use by interventional cardiologists owing to its reduction in bleeding and vascular complications when compared with the femoral approach and is now considered the preferred arterial access. However, prior use of transradial access (TRA) for cardiac catherization is a contra-indication for the use of the RA for CABG because of high rates of structural damage to the vascular wall and potential for graft failure. In this issue of the Journal of Cardiac Surgery Clarke et al. examine the RA of two patients who had TRA for coronary angiography 8 and 12 years prior and note that both patients had chronic injury with dissection and obstruction of the lumen secondary to fibrosis suggesting that TRA causes long-term and irreversible damage rendering them unsuitable as conduits for CABG.

Electric Toy Car to Reduce Anxiety Before a Cardiac Catherization: Randomized Controlled Trial

Anxiety before an invasive intervention is associated in children with persistent psychological disorders. We studied the effect of the transfer to the catheterization room by an electric toy-car on the anxiety of children and their parents before a cardiac catheterization. Forty-eight children with a median age of 5.6 years [4.2-7.0] were randomized to either riding on an electric car to go to the catheterization laboratory or being transported lying supine on a gurney. Anxiety assessments were performed by a physician blinded to allocation group on the day before the procedure (T0) and at anesthesia induction (T1). The modified Yale score (mYPAS-SF) and visual analog scale for anxiety (VAS-A) were used in the children, and the VAS-A in the parents. The mYPAS-SF, VAS-A-child and the VAS-A-parent scores were significantly higher at T1 than at T0 (P < 0.001, P < 0.001, and P = 0.005, respectively). The primary outcome (the median mYPAS-SF score at T1) was not significantly different in the two groups when males and females were combined. At T1, the VAS-A-child score, however, was significantly lower in the intervention than the control group (22 versus 55, P < 0.001). In the boys, the median mYPAS-SF score at T1 was significantly lower in the intervention group (25.0 versus 51.0, P = 0.024). No difference was observed in girls. The VAS-A parent score was lower at T1 in the intervention group (60 versus 87, P = 0.05). Conclusion: Riding to the catheterization laboratory on an electric toy car decreased anxiety at anesthesia induction in boys and also decreased parental anxiety.Clinical trial Registration: Registration number: ID-RCB: 2019-A00459-48. Date of registration: March 27th 2019.

Early Detection of Checkpoint Inhibitor-Associated Myocarditis Using 68Ga-FAPI PET/CT

Objective: Checkpoint inhibitors (ICIs) have gained importance in recent years regarding the treatment of a variety of oncologic diseases. The possibilities of diagnosing cardiac adverse autoimmune effects of ICIs are still limited. We aimed to implement FAPI PET/CT imaging in detecting ICI-associated myocarditis.Methods: In a retrospective study, FAPI PET/CT scans of 26 patients who received ICIs from 01/2017 to 10/2019 were analyzed. We compared tracer enrichment in the heart of patients without any signs of a cardiac disease (n = 23) to three patients with suspected ICI-associated myocarditis. To exclude any significant coronary heart disease, cardiac catherization was performed. All three patients' myocardial biopsies were examined for inflammatory cells.Results: Three patients showed clinical manifestations of an ICI syndrome including myocarditis with elevated levels of hsTnT (175 pg/ml, 1,771 pg/ml, 157 pg/ml). Further cardiological assessments revealed ECG abnormalities, lymphocyte infiltration of the myocardium in the biopsies or wall motion abnormalities in echocardiography. These patients' FAPI PET/CTs showed cardiac enrichment of the marker which was less distinct or absent in patients receiving ICIs without any signs of immunological adverse effects or cardiac impairment (n = 23) [Median SUV myocarditis patients: 1.79 (IQR: 1.65, 1.85), median SUV non-myocarditis patients: 1.15 (IQR: 0.955, 1.52)].Conclusions: Apart from the successful implementation of ICIs in oncological treatments, ICI-associated myocarditis is still a challenging adverse effect. FAPI PET/CT may be used in order to identify affected patients at an early stage. Moreover, when integrated into cancer stage diagnostics, it contributes to cardiac risk stratification besides biomarker, ECG and echocardiography.

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract

Abstract 15809: 68 Gallium Fibroblast Activating Protein Inhibitor Positron Emission Tomography is Able to Diagnose Checkpoint Inhibitor-induced Myocarditis

Introduction: Checkpoint inhibitors (ICIs) have gained importance in recent years regarding the treatment of a variety of oncologic diseases. The possibilities of diagnosing cardiac adverse autoimmune effects of ICIs are still limited. We aimed to implement FAPI PET/CT imaging in detecting ICI-induced myocarditis. Methods: In a retrospective study, FAPI PET/CT scans of 26 patients who received ICIs from 01/2017 to 10/2019 were analyzed. We compared tracer enrichment in the heart of patients without any signs of a cardiac disease (n=23) to three patients with suspected ICI-induced myocarditis. To exclude any significant coronary heart disease, cardiac catherization was performed. Myocardial biopsies were examined, especially in regard to the infiltration of immune cells. Results: Three patients showed clinical manifestations of an ICI syndrome including myocarditis with elevated levels of hsTnT (175 pg/ml, 1771 pg/ml, 157 pg/ml). Further cardiological assessments revealed ECG abnormalities, lymphocyte infiltration of the myocardium in the biopsies or wall motion abnormalities in echocardiography. These patients’ FAPI PET/CTs showed a locally defined cardiac enrichment of the marker which was absent in patients receiving ICIs without any signs of immunological adverse effects and cardiac impairment (n=23) (Median SUV myocarditis patients: 1.79 (IQR: 1.65, 1.85), median SUV non-myocarditis patients: 1.15 (IQR: 0.955, 1.52)). Conclusions: Myocardial biopsy, the current gold standard of the diagnosis of ICI-induced myocarditis, is susceptible to sampling errors and results arrive within a few days. We provide first evidence that FAPI PET/CT is able to diagnose ICI-induced myocarditis and can demonstrate locally enhanced manifestation of ICI-induced myocarditis on time.

Abstract 15466: Trajectory of Acute Coronary Syndrome Cases During the COVID-19 Pandemic

Background: The COVID-19 pandemic was associated with a worrisome decrease in acute coronary syndrome (ACS) cases. We sought to investigate the trajectory of ACS following the relaxation of isolation orders and public service education. Hypothesis: We hypothesized that during the COVID-19 pandemic, ACS cases would decrease during the period of strict isolation and thereafter increase, illustrating a “rebound effect”, during the period of relaxed isolation. Methods: All adults with concern for ACS requiring cardiac catheterization at one academic center from 22 December 2019 to 13 June 2020 were included. Cases were designated as ST-elevation myocardial infarction (STEMI), STEMI activation, out-of-hospital cardiac arrest (OHCA), Non-STEMI/unstable angina (NSTEMI/UA), and/or total ACS. 18 December - 14 March, 15 March - 9 May, and 10 May - 13 June were designated as pre-isolation COVID-19 (piC), strict isolation COVID-19 (siC), and relaxed isolation COVID-19 (riC), respectively. Fisher’s exact test was used to compare average cases per week in piC vs. siC and siC vs. riC. One-way ANOVA was used to compare cases across piC, siC, and riC together. Analysis was completed with STATA/MP 16.1. Results: 315 cases concerning for ACS requiring cardiac catherization lab activation were included. When comparing piC with siC and siC with riC, there were no significant differences in STEMI, STEMI activation, OHCA, NSTEMI/UA, or total ACS. When compared across piC, siC, and riC simultaneously there were no significant differences in STEMI (p=0.426), STEMI activation (p=0.172), OHCA (p=0.167), NSTEMI/UA (p=0.362), and total ACS (p=0.219). Total ACS, STEMI activation, NSTEMI/UA, and OHCA exhibited a trend towards a rebound effect (Graph). Conclusions: There were no significant changes in the incidence of total ACS, OHCA, STEMI, STEMI activation, or NSTEMI/UA between pre-isolation, strict isolation, and relaxed isolation periods of the COVID-19 pandemic.

Abstract 359: Unit-Specific Influences on Conscious Sedation Nursing Practices: Comparing Medication Utilization and Patient Outcomes

Background: Unit-Specific influences may determine the amount of sedation given to patients and lead to deviations in patient satisfaction and clinical outcomes due to vague guidelines (4). This study aims to compare medication utilization, clinical outcomes and patient satisfaction in order to determine safety and efficacy of nurse administrated conscious sedation. Methods: Data from outpatient procedures in Cardiac Catherization Lab (Cath Lab) and Interventional Radiology (IR) departments were collected including comorbidities, labs, procedural characteristics, clinical outcomes, and post-sedation questionnaires. Results: Mean age was 63 ± 14 years and 124 (54.9%) were males. Cath Lab n=132 and IR n=94. Procedure duration(min) was found to be longer in the Cath Lab 55 (37,81), than in IR 24 (16,45), p-value of <0.001. The American Society of Anesthesiologist (ASA) scores of Cath Lab 26(21%), IR 29(30.9%), p-value (0.1). Total amount of versed (mg) given in the Cath Lab 2 (1,2), significantly less than IR 3 (1,4.5) with a p-value of <0.01. Total amount of fentanyl (mcg) for Cath Lab 50(50,100), and IR 100 (50,100) with a p-value of <0.01. Median time between 1 st and 2 nd dose of versed in Cath Lab 0 (0,1), IR 9 (5, 16). Median time between 2 nd and 3 rd dose of versed for Cath Lab 0 (0,0), IR 6 (0,13.5) with a p-value <0.001. Median time between 1 st and 2 nd dose of fentanyl in Cath Lab 1 (0,14.8), IR 12.5 (6.8, 24) with a p-value <0.001. Median time between 2 nd and 3 rd dose of fentanyl for Cath Lab 0 (0,0), IR 0,(0,15), p-value <0.001. Median second dose of versed in Cath Lab 0 (0,1), IR 1 (1,1). Median second dose of fentanyl in Cath Lab 25 0 (0,25), IR 25 (25,50), p-value <0.001. Post-Sedation Questionnaire completed by 57 patients, Cath Lab n=30, IR n=27. Patients that felt uncomfortable during their procedure in Cath Lab 11(36.7%), compared to IR 1 (3.7%). The choice of sedation that patient would choose if undergoing a similar procedure again if under general anesthesia Cath Lab 6(20%), IR 0(0%), p-value 0.03. Patients stated that they would recommend conscious sedation to others based on their previous experience, Cath Lab 24 (80%), IR 27(100%). Conclusion: Patients receiving conscious sedation while undergoing procedures in both the Cath Lab and IR were found to have no adverse outcomes and were considered safe. The procedural duration of catheterization procedures was significantly longer than IR with no adverse outcomes, but patients in the Cath lab received less sedation medication and were found to be less satisfied with their procedure. Patients from Cath Lab received less initial sedation medication and rarely received an additional dose. Cath Lab patients were more likely to not recommended conscious sedation to others (20%), and 6 (20%) stated they would rather undergo a similar procedure under general anesthesia; 36.7% of Cath Lab patients stated that they were uncomfortable during the procedure.