Background: With the increasing demand for catheter based revascularization for coronary artery disease, the practice of percutaneous coronary intervention (PCI) in centres without cardiac surgical...
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Background: Percutaneous coronary intervention (PCI) via the transradial (TR) route is an increasingly popular alternative to the transfemoral (TF) route. However, there are limiting factors to its adoption. We report the learning curve... more
Background: Percutaneous coronary intervention (PCI) via the transradial (TR) route is an increasingly popular alternative to the transfemoral (TF) route. However, there are limiting factors to its adoption. We report the learning curve over 5 years in a high-volume PCI center during the crossover from TF to TR access for PCI. Objective: To evaluate clinical characteristics, radiation doses, screening times, and subsequent clinical outcomes in subjects with femoral and radial access sites for PCI. Design: We retrospectively analyzed our databases for PCI procedures/outcomes of all patients from 2006-2010. Setting: A university teaching hospital PCI center performing cases predominantly femorally at the beginning of the study period, and transitioning to a predominantly radial access center at the end of the study period. Patients: All patients undergoing PCI via either femoral or radial approach over a 5-year period. Results: In year 1, TR access was used in 31.4% of cases; this rate increased to 90.1% in year 5. The switch from TF to TR access was observed among all operators and all groups of patients regardless of presentation, gender, age, and lesion complexity. In year 1, fluoroscopy times and radiation doses were higher in the TR group, but equalized in years 2 and 3 and reversed during years 4 and 5 when the TR rate was >90%. Over 5 years, the rates of vascular complications and major bleeding were higher in the TF cohort and were associated with longer hospital stay. In-hospital mortality was lower in the TR group. Conclusion: The change from TF to TR approach for PCI in a high-volume center is achievable within 5 years, and results in marked clinical benefits. There was an initial learning curve for fluoroscopy time and radiation dose, but this improved once an operator performed >60% of cases radially.
Research Interests: Quality Improvement, Medicine, Continuing Medical Education, Humans, Wales, and 15 moreFemale, Pubmed, Fluoroscopy, Male, Follow-up studies, Aged, Cardiac Catheterization, Middle Aged, Percutaneous Coronary Intervention, Teaching Hospitals, Utilization review, Cohort Studies, Radial Artery, Femoral Artery, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Treatment Outcome, Medicine, Stents, Prospective studies, and 15 moreHumans, Internal Medicine, Nitric oxide, Nitrates, Haemostasis and Thrombosis, Clinical Sciences, Percutaneous Coronary Intervention, Time Factors, Biological markers, Clopidogrel, Coronary Artery Disease, cyclic GMP, Nitrites, Platelet Aggregation Inhibitors, and Cardiovascular medicine and haematology
Research Interests: Pharmacology, Chemistry, Atherosclerosis, Medicine, Humans, and 14 moreNitric oxide, Nitrates, Nitrogen, Clinical Sciences, Acute Coronary Syndrome, Oxygen, Pyridines, Biotransformation, Stomach, Hydrogen-Ion Concentration, R, Blood platelets, Platelet Aggregation Inhibitors, and Cardiovascular medicine and haematology
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Research Interests: Chemistry, Mass Spectrometry, Medicine, Cardiovascular Pharmacology, Animals, and 14 moreMale, Glutathione, Platelet activation mechanism, Ozone, Clopidogrel, Rabbits, Sodium Nitrite, Vasodilation, Hydrogen-Ion Concentration, Guanylate Cyclase, Molecular Structure, Cardiovascular medicine and haematology, Pharmacology and pharmaceutical sciences, and In Vitro Techniques
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Research Interests: Cardiology, Medicine, Catheterization, Humans, Internal Medicine, and 15 moreFemale, Male, Mace, Aged, Great Britain, Middle Aged, Acute Coronary Syndrome, Drug Eluting Stents, Analysis of Variance, Angina pectoris, Coronary artery bypass surgery, Angina, Myocardial Ischemia, Cardiovascular medicine and haematology, and Coronary Artery Bypass
Dear Editor, We are looking to move our cardiac unit to a modern and larger site in South East Wales imminently. With this in mind, we sought to maximise capacity and efficacy of our local cardiac ...
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minimum lumen diameter (MLD) and area (MLA), and lesion length (LL) were recorded from the C7XR console. Diameter stenosis (DS%) and area stenosis (AS%) were calculated. RESULTS: The median of OCT parameters was not significantly... more
minimum lumen diameter (MLD) and area (MLA), and lesion length (LL) were recorded from the C7XR console. Diameter stenosis (DS%) and area stenosis (AS%) were calculated. RESULTS: The median of OCT parameters was not significantly different between Non-ACS (MLD 1.35; MLA 2.24; LL 11.5; DS% 53; AS% 68) and ACS groups (MLD 1.36; MLA 2.26; LL 9.5; DS% 43; AS% 64). OCT parameters showed modest correlation to FFR in the Non-ACS group (MLD 0.65; MLA 0.66; LL -0.57; DS% -0.56; AS% -0.53) but not in the ACS group. Stepwise logistic regression of OCT parameters found DS% an independent predictor of FFR 0.80 (p 0.03) in NonACS only, correctly classifying 76% of lesions (ROC optimal cut-off DS% 55%; sensitivity 61%, specificity 100%, AUC 0.87). CONCLUSION: OCT parameters correlate with FFR in NonACS presentations and OCT diameter stenosis independently predicts FFR 0.80. However, OCT in ACS does not correlate with or predict FFR.
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IntroductionLeft main stem percutaneous coronary intervention (LMS‐PCI) is a complex high‐risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn‐down patients or where... more
IntroductionLeft main stem percutaneous coronary intervention (LMS‐PCI) is a complex high‐risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn‐down patients or where there is equipoise in percutaneous versus surgical strategies. Current guidelines suggest that PCI is an appropriate alternative to CABG in patients with unprotected LMS disease and low SYNTAX score. However, “real world” data on outcomes of LMS‐PCI remain limited. This study aims to quantify and determine predictors of mortality following LMS‐PCI.MethodsUsing local coronary angioplasty registries from two UK centers, all LMS‐PCI cases were identified from 2016 to 2020. Descriptive statistics and multivariate logistic regressions were used to examine the association between baseline and procedural characteristics with 30‐day and 12‐month mortality.ResultsWe identified 484 cases of LMS‐PCI between 2016 and 2020. There was a year‐on‐year increase in the ...
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Purpose of studyThis study examines the associations between dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB), to explore possible predictors of outcomes.Study... more
Purpose of studyThis study examines the associations between dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB), to explore possible predictors of outcomes.Study designRetrospective analysis of 3342 patients who underwent PCI between 1 August 2011 and 31 December 2018 in a single centre was carried out. Oesophagogastroduodenoscopies (OGDs) for patients 12 months post-PCI were analysed.ResultsBlood loss occurred in 2% of all (3342) patients post-PCI within 12 months. 128 patients (63% male, mean age (SD) of 69.8 (10) years) who had PCI subsequently underwent an OGD within 12 months of the index PCI procedure. GIB occurred within the first 30 days of DAPT in 36% (n=13/36) of cases. There were no thrombotic events associated with cessation of one antiplatelet agent. Increased age, haemoglobin (Hb) ≤109 g/L and Glasgow-Blatchford score ≥8 were associated with increased 12-month mortality. An Hb drop of ≥30 g/L was a sensit...
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Percutaneous coronary intervention (PCI) via the transradial (TR) route is an increasingly popular alternative to the transfemoral (TF) route. However, there are limiting factors to its adoption. We report the learning curve over 5 years... more
Percutaneous coronary intervention (PCI) via the transradial (TR) route is an increasingly popular alternative to the transfemoral (TF) route. However, there are limiting factors to its adoption. We report the learning curve over 5 years in a high-volume PCI center during the crossover from TF to TR access for PCI. To evaluate clinical characteristics, radiation doses, screening times, and subsequent clinical outcomes in subjects with femoral and radial access sites for PCI. We retrospectively analyzed our databases for PCI procedures/outcomes of all patients from 2006-2010. A university teaching hospital PCI center performing cases predominantly femorally at the beginning of the study period, and transitioning to a predominantly radial access center at the end of the study period. All patients undergoing PCI via either femoral or radial approach over a 5-year period. In year 1, TR access was used in 31.4% of cases; this rate increased to 90.1% in year 5. The switch from TF to TR ac...
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ABSTRACT Introduction Antiplatelet therapy in large focuses on the efficiency of inhibition of platelet aggregation. Relatively little is known about the short- and long-term influence of antiplatelet drugs on the function of vascular... more
ABSTRACT Introduction Antiplatelet therapy in large focuses on the efficiency of inhibition of platelet aggregation. Relatively little is known about the short- and long-term influence of antiplatelet drugs on the function of vascular endothelium, including their effects on NO metabolism in patients. This study demonstrates the profile of NO metabolites and how it correlates with different levels of cGMP and the antioxidant status in plasma in patients receiving clopidogrel. Methods 52 CAD patients receiving clopidogrel were recruited into the study. In the clopidogrel naive group (30 subjects) the blood was taken before and 2 h after receiving a standard loading dose of clopidogrel (600 mg). In the clopidogrel chronic group (22 subjects) the blood was taken after at least 2 months of being on a maintenance dose (75 mg). All plasma samples were measured for NO metabolites, cGMP and ORAC index. Results In the acute setting, nitrite was increased from 157.1 ± 82.4 to 194.2 ± 87.64 nM (p = 0.0674), as well as cGMP from 214.2 ± 124.4 to 231.5 ± 107.8 pmol/ml (p = 0.0586) and ORAC index from 60.66 ± 11.45 to 64.15 ± 10.61% (p = 0.0372). In the chronic setting, nitrite was increased from 157.1 ± 82.4 to 254.3 ± 139.4 nM (p = 0.0028), as well as cGMP from 214.2 ± 124.4 to 276.9 ± 72.15 pmol/ml (p = 0.0519). In both acute and chronic groups RSNO did not change. Conclusions Patients receiving short- or long-term clopidogrel exhibit a time-proportional increase in NO bioavailability and effective vasodilation, as reflected by higher levels of nitrite and cGMP. The increased ORAC index in the acute group also suggests a parallel positive influence on the total antioxidant capacity of plasma.