- Email: [email protected]
Radial access for complex coronary intervention is safe and feasible with excellent immediate outcome
S230
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
522 Q WAVE EVOLUTION AFTER PRIMARY ANGIOPLASTY FOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION Saurabh Kumar, Hera Chan, Alisdair Ryding, Calvin Hsieh, Arun Narayan, Norman Sadick, Pramesh Kovoor Department of Cardiology, Westmead Hospital, New South Wales, Australia Aim: To examine the significance of Q wave status after primary PCI for STEMI. Methods: Patients with a fresh STEMI (n = 670) had assessment of Q wave status prior to, immediately post and on day three post primary PCI. Assessment of left ventricular ejection fraction (LVEF) and abnormal regional wall motion (at least severely impaired wall motion) was made at median of 3 days post primary PCI. Patients with Q waves on presentation and on day three constituted Group A: n = 333; those with no Q waves on presentation with subsequent Q waves on day three constituted Group B: n = 241; those with no Q waves on presentation and no Q waves on day three constituted Group C: n = 96. LVEF and incidence of abnormal regional wall motion were similar in Groups B and C, but worse in Group A (LVEF 44% vs. 53% vs. 54%; abnormal regional wall motion: 18% vs. 26% vs. 46% in Groups A, B and C respectively). At 90 days, the composite endpoint of death, shock, heart failure did not significantly differ between Groups B and C (6.5% vs. 5.3%; p = 0.74) but was higher in Group A (18.6%; p < 0.001 compared with Group B or C). Conclusion: STEMI patients with no Q waves on presentation who subsequently develop Q waves on day three have equivalent outcomes, ventricular wall motion and ejection fraction compared with those who do not develop Q waves on day three post primary PCI. However, patients with Q waves on presentation have the worse outcomes. doi:10.1016/j.hlc.2009.05.568 523 RADIAL ACCESS FOR COMPLEX CORONARY INTERVENTION IS SAFE AND FEASIBLE WITH EXCELLENT IMMEDIATE OUTCOME J. Koutsoubos, Y. Malaiapan, I.T. Meredith Monash Cardiovascular Research Centre, MonashHEART, Monash University, Department of Medicine (MMC), Melbourne, Australia Background: Radial access for percutaneous coronary intervention (RPCI) is a safe and effective alternative to femoral access (FPCI). However there is limited data on complex PCI done transradially. Aim: To study the safety, feasibility and procedural outcome of complex RPCI. Methods: A cohort study was done in 94 patients undergoing complex PCI from February 2005 to October 2008 (47 RPCI patients were age, sex, vessel matched with 47 FPCI
patients). Data was collected prospectively for RPCI, and retrospectively for the FPCI cohorts using the institutional PCI database. Complex PCI was defined as bifurcation, CTO, ostial, calcific, long lesions (>20 mm) and small vessels (<2.5 mm). Results: Cardiovascular risk factors and morphometric characteristics were comparable in both groups. 6F sheaths were used in 46 (98%) of RPCI and 32 (66%) FPCI cases, (P = 0.002). Median puncture, procedure and fluoroscopy times were 4 min (1.2–5) vs. 2 min (1–3) (P = 0.003); 80 min (65–105) vs. 75 min (46–91); (P = 0.14) and 25.4 min (18–34) vs. 16.2 min (9.6–22.3) (P = 0.002) respectively. Complex lesions included bifurcations in 28 (59%) vs. 34 (72%), CTO in 2 (4%) vs. 5 (10%), severely calcified lesions requiring rotational atherectomy in 4 (9%) vs. 4 (9%), long lesions in 39 (83%) vs. 43 (91%), (P = NS) for all, and ostial lesions in 14 (30%) vs. 4 (9%), (P = 0.02). TIMI 3 flow was achieved in 46 (98%) vs. 47 (100%) (P = NS). GPI use was 16 (34%) vs. 19 (40%) (P = NS). Median length of stay was 2.2 ± 1.5 vs. 3.1 ± 2.7 (P = NS). Conclusions: Complex RPCI using 6Fr guiding catheter can be performed with a high degree of safety and success with no addition to procedure time. This finding needs to be confirmed with prospectively collected and randomised data. doi:10.1016/j.hlc.2009.05.569 524 RADIAL V FEMORAL APPROACH TO PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION: SAFETY AND OUTCOMES G. Liew 1,2, , G. Chacko 1 , M. Worthley 1,2 , S. Worthley 1,2 1 Cardiovascular
Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia 2 Department of Medicine, University of Adelaide, Adelaide, Australia Background: The radial approach to performing percutaneous coronary intervention (PCI) has been shown to have reduced morbidity for patients, but its benefits in the acute setting of ST elevation myocardial infarction (STEMI) remains unclear. We sought to determine the safety and outcomes of radial approach for STEMI patients. Methods: Sequential patients with STEMI undergoing PCI via radial (n = 103) from 2005 to 2008 were compared to their age-sex matched femoral counterparts (n = 103). Follow-up was via medical records and statewide computer database (OASIS) which captures hospital admissions, length of stay (LOS) and deaths. Results: Cohort consists of 74.8% males; age 62.9 ± 12.8 years without significant differences in cardiac risk factors. No significant differences in absolute and adjusted fluoroscopy time, radiation or contrast volume (adjusted for number of stents inserted). Two cases of major bleeding requiring transfusion in femoral group v none in
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
522 Q WAVE EVOLUTION AFTER PRIMARY ANGIOPLASTY FOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION Saurabh Kumar, Hera Chan, Alisdair Ryding, Calvin Hsieh, Arun Narayan, Norman Sadick, Pramesh Kovoor Department of Cardiology, Westmead Hospital, New South Wales, Australia Aim: To examine the significance of Q wave status after primary PCI for STEMI. Methods: Patients with a fresh STEMI (n = 670) had assessment of Q wave status prior to, immediately post and on day three post primary PCI. Assessment of left ventricular ejection fraction (LVEF) and abnormal regional wall motion (at least severely impaired wall motion) was made at median of 3 days post primary PCI. Patients with Q waves on presentation and on day three constituted Group A: n = 333; those with no Q waves on presentation with subsequent Q waves on day three constituted Group B: n = 241; those with no Q waves on presentation and no Q waves on day three constituted Group C: n = 96. LVEF and incidence of abnormal regional wall motion were similar in Groups B and C, but worse in Group A (LVEF 44% vs. 53% vs. 54%; abnormal regional wall motion: 18% vs. 26% vs. 46% in Groups A, B and C respectively). At 90 days, the composite endpoint of death, shock, heart failure did not significantly differ between Groups B and C (6.5% vs. 5.3%; p = 0.74) but was higher in Group A (18.6%; p < 0.001 compared with Group B or C). Conclusion: STEMI patients with no Q waves on presentation who subsequently develop Q waves on day three have equivalent outcomes, ventricular wall motion and ejection fraction compared with those who do not develop Q waves on day three post primary PCI. However, patients with Q waves on presentation have the worse outcomes. doi:10.1016/j.hlc.2009.05.568 523 RADIAL ACCESS FOR COMPLEX CORONARY INTERVENTION IS SAFE AND FEASIBLE WITH EXCELLENT IMMEDIATE OUTCOME J. Koutsoubos, Y. Malaiapan, I.T. Meredith Monash Cardiovascular Research Centre, MonashHEART, Monash University, Department of Medicine (MMC), Melbourne, Australia Background: Radial access for percutaneous coronary intervention (RPCI) is a safe and effective alternative to femoral access (FPCI). However there is limited data on complex PCI done transradially. Aim: To study the safety, feasibility and procedural outcome of complex RPCI. Methods: A cohort study was done in 94 patients undergoing complex PCI from February 2005 to October 2008 (47 RPCI patients were age, sex, vessel matched with 47 FPCI
patients). Data was collected prospectively for RPCI, and retrospectively for the FPCI cohorts using the institutional PCI database. Complex PCI was defined as bifurcation, CTO, ostial, calcific, long lesions (>20 mm) and small vessels (<2.5 mm). Results: Cardiovascular risk factors and morphometric characteristics were comparable in both groups. 6F sheaths were used in 46 (98%) of RPCI and 32 (66%) FPCI cases, (P = 0.002). Median puncture, procedure and fluoroscopy times were 4 min (1.2–5) vs. 2 min (1–3) (P = 0.003); 80 min (65–105) vs. 75 min (46–91); (P = 0.14) and 25.4 min (18–34) vs. 16.2 min (9.6–22.3) (P = 0.002) respectively. Complex lesions included bifurcations in 28 (59%) vs. 34 (72%), CTO in 2 (4%) vs. 5 (10%), severely calcified lesions requiring rotational atherectomy in 4 (9%) vs. 4 (9%), long lesions in 39 (83%) vs. 43 (91%), (P = NS) for all, and ostial lesions in 14 (30%) vs. 4 (9%), (P = 0.02). TIMI 3 flow was achieved in 46 (98%) vs. 47 (100%) (P = NS). GPI use was 16 (34%) vs. 19 (40%) (P = NS). Median length of stay was 2.2 ± 1.5 vs. 3.1 ± 2.7 (P = NS). Conclusions: Complex RPCI using 6Fr guiding catheter can be performed with a high degree of safety and success with no addition to procedure time. This finding needs to be confirmed with prospectively collected and randomised data. doi:10.1016/j.hlc.2009.05.569 524 RADIAL V FEMORAL APPROACH TO PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION: SAFETY AND OUTCOMES G. Liew 1,2, , G. Chacko 1 , M. Worthley 1,2 , S. Worthley 1,2 1 Cardiovascular
Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia 2 Department of Medicine, University of Adelaide, Adelaide, Australia Background: The radial approach to performing percutaneous coronary intervention (PCI) has been shown to have reduced morbidity for patients, but its benefits in the acute setting of ST elevation myocardial infarction (STEMI) remains unclear. We sought to determine the safety and outcomes of radial approach for STEMI patients. Methods: Sequential patients with STEMI undergoing PCI via radial (n = 103) from 2005 to 2008 were compared to their age-sex matched femoral counterparts (n = 103). Follow-up was via medical records and statewide computer database (OASIS) which captures hospital admissions, length of stay (LOS) and deaths. Results: Cohort consists of 74.8% males; age 62.9 ± 12.8 years without significant differences in cardiac risk factors. No significant differences in absolute and adjusted fluoroscopy time, radiation or contrast volume (adjusted for number of stents inserted). Two cases of major bleeding requiring transfusion in femoral group v none in