Coronary catheterization via distal transradial access in patient with superficial radial artery: a case report

Background The routine radial artery (RA) puncture may fail when anatomical variation of the RA is encountered. Superficial radial artery (SRA) is one of the anatomic variants of the RA, with the incidence of about 1 to 1.5%. Recently, distal transradial access (dTRA) has emerged as a novel approach for coronary catheterization (CC), but performing CC through dTRA in patient with SRA has never been reported. Case presentation A 57-year-old male was admitted to hospital due to intermittent chest pain for 4 days. He was diagnosed with unstable angina pectoris and planned to receive coronary angiography (CAG). Before the operation, the existence and course of SRA were confirmed by palpation and ultrasonography with color Doppler. We marked the puncture site under the guidance of ultrasonography and successfully performed CC through the dTRA during patient’s hospitalization. Conclusions As far as we know, this is the first report that presents a case of SRA and percutaneous coronary intervention (PCI) treatment in which was successfully performed through dTRA. It is safe and feasible to perform CC via dTRA in case of SRA, and dTRA seems to be the preferred access.

Derivation and Validation of Genome‐Wide Polygenic Score for Ischemic Heart Failure

Background Despite advances in cardiovascular disease and risk factor management, mortality from ischemic heart failure (HF) in patients with coronary artery disease (CAD) remains high. Given the partial role of genetics in HF and lack of reliable risk stratification tools, we developed and validated a polygenic risk score for HF in patients with CAD, which we term HF‐PRS. Methods and Results Using summary statistics from a recent genome‐wide association study for HF, we developed candidate PRSs in the Mount Sinai Bio Me CAD patient cohort (N=6274) by using the pruning and thresholding method and LDPred. We validated the best score in the Penn Medicine BioBank (N=7250) and performed a subgroup analysis in a high‐risk cohort who had undergone coronary catheterization. We observed a significant association between HF‐PRS score and ischemic HF even after adjusting for evidence of obstructive CAD in patients of European ancestry in both Bio Me (odds ratio [OR], 1.14 per SD; 95% CI, 1.05–1.24; P =0.003) and Penn Medicine BioBank (OR, 1.07 per SD; 95% CI, 1.01–1.13; P =0.016). In European patients with CAD in Penn Medicine BioBank who had undergone coronary catheterization, individuals in the top 10th percentile of PRS had a 2‐fold increased odds of ischemic HF (OR, 2.0; 95% CI, 1.1–3.7; P =0.02) compared with the bottom 10th percentile. Conclusions A PRS for HF enables risk stratification in patients with CAD. Future prospective studies aimed at demonstrating clinical utility are warranted for adoption in the patient setting.

Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary Catheterization: A Randomized Controlled Trial

Background: Hyperhomocysteinemia is a risk factor for contrast-induced nephropathy. Folic acid can attenuate such nephropathies in rats. The protective effect of folic acid against contrast-induced nephropathy has not been studied in humans. We aimed to investigate the effect of folic acid on the incidence of contrast-induced nephropathy (CIN) after coronary catheterization in patients with hyperhomocysteinemia.Methods: This was a single-center, prospective, double-blind, randomized controlled trial (ClinicalTrials.gov, NCT02444013). In total, 412 patients (mean age: 65 ± 12 years, 268 male) with plasma homocysteine ≥15 μM, who underwent coronary arteriography (CAG) or percutaneous coronary intervention (PCI) from May 2015 to August 2018, were enrolled. Patients were randomly assigned to two groups: a treatment group (n = 203), taking 5 mg of folic acid (orally, three times/day) immediately after enrollment and for 72 h after operation, and a control group (n = 209), taking placebo. Contrast-induced nephropathy was defined as an increase in serum creatinine of >25% or 44 μM within 48 or 72 h after contrast medium administration.Results: In total, 50 (12%) patients developed CIN after 48 h after catheterization, including 16 (8%) in the treatment group and 34 (16%) in the control group (P = 0.009). Meanwhile, 53 (13%) patients developed CIN after 72 h of CAG/PCI, including 18 (9%) in the treatment group and 35 (17%) in the control group (P = 0.017). The incidence of contrast-induced nephropathy in the treatment group was lower than that in the control group (P = 0.017). Logistic regression analysis confirmed that administration of folic acid was a protective factor against contrast-induced nephropathy (RD = 0.0788, 95%CI: 0.0105–0.1469, P = 0.019). We found no serious adverse events associated with folic acid. No death or hemodialysis occurred in either group.Conclusions: Perioperative administration of folic acid attenuates the incidence of contrast-induced nephropathy after coronary catheterization in patients with hyperhomocysteinemia.Clinical Trial Registration:ClinicalTrials.gov, identifier [NCT02444013].

The Yentl Syndrome: A Case Report

Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a “man’s disease” is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.

Comparison the Effect of Organized education by Group discussion and film screening on Anxiety and Contrast-induced nephropathy in Coronary catheterization Patients; A Randomized Clinical Trial

Background: Anxiety is one of the most prevalent psychological complications in patients undergoing cardiac catheterization that can be effective on the patients' understanding to do self-care to prevent some complications such as contrast induced nephropathy. The aim of this study was to compare the effect of education by group discussion with videotape on anxiety and contrast induced nephropathy of Coronary catheterization patients. Method: A randomized clinical trial was implemented with 213 patients in three groups at Javad-Al-Aemeh Hospital, Mashhad, Iran, during February to September 2018. An organized educational program was first developed based on an integrative review. The patients were randomly allocated to three groups: group discussion (n=71), film (n=73) and control (n=69) using randomized time blocks. Anxiety was assessed using Spiel Berger Inventory before and 1 hour after the education, before transferring to Cat Lab. The serum creatinine was assessed on arrival, 24 and 72 hours after the procedure. The data were analyzed using ANOVA, Tukey, repeated ANOVA, paired t test and chi square tests by SPSS16. Results: There was no significant difference in mean anxiety between groups before the intervention (P= 0.64), but the anxiety in the videotape group and group discussion decreased significantly after the intervention (p<0.001). There wasn't any significant clinical increase in serum creatinine in all three groups after 72 hours.Conclusion: Using Group discussion and film screening can be recommended to the community nurses to reduce the cardiac catheterization candidate patient's anxiety and prevent contrast-induced nephropathy.The present study was registered in the Iranian Registry of Clinical Trials with a code of IRCT2016022626776N1.Registration date in IRCT : 2017-07-23, 1396/05/01https://www.irct.ir/trial/22094

Non-surgical treatment of a coronarography-induced iatrogenic aortic dissection

Coronary dissection is an extremely rare but known complication of coronary catheterization and angioplasty. Due to its rarity, there are no management recommendations. However, surgery immediately after an endovascular procedure is frequently carried out under major antithrombotic treatment. The surgery and the postoperative consequences are therefore very complex. We report here the documented case of a type A aortic dissection after coronary catheterization. Despite extension to the entire ascending aorta which indicated surgical management, the benefit-risk balance argued for armed surveillance to avoid surgery under antiplatelets drugs without known antidote. We believe this case should lead us to systematically weigh the data before considering that any iatrogenic dissection of Dunning class 3 should be operated.