Validity of a PCI Bleeding Risk Score in patient subsets stratified for body mass index

Dobies, David; Barber, Kimberly; Cohoon, Amanda L

doi:10.1136/openhrt-2014-000088

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Current rates of major bleeding are below 2% on average and other studies have suggested equivalent bleeding rates between access site when bivalirudin is used. 2 17 18 This finding is confirmed in this large multisite clinical registry. Among 58 862 PCI procedures of all comers across 137 hospitals, our analysis demonstrated no difference in major bleeding rates for patients receiving bivalirudin ( figure 2 ).…”

Section: Discussionsupporting

confidence: 79%

Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry

2016

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ObjectiveUsing a multisite, contemporary registry of 58 862 percutaneous coronary intervention (PCI) procedures in a national healthcare system, the present study compared radial access with femoral access on safety and efficacy outcomes.MethodsThis is a real-world, large-scale, retrospective study using clinical data from a 137-hopsital System and reported to a multisite clinical registry. All patients undergoing a cardiac catheterisation procedure were included in this database. The primary end points were major bleeding and radiation exposure. Multivariate logistic regression modelling was used to compare access groups.ResultsFemoral access (n=55 729) accounted for 94.7% and radial access (n=3137) for 5.3%. There were fewer bleeding events in the radial group (n=28, 0.9%) than those in the femoral group (n=1234, 2.2%) in the unadjusted analysis. For patients receiving bivalirudin, bleeding occurred in 337 patients (1.6%), and there was no difference in rates between radial access (n=13, 1.1%) and femoral access (n=327, 1.7%) (OR=0.65, CI 0.40 to 1.22, p=0.19). The radial technique resulted in higher radiation exposure in each case, but particularly for procedures involving prior coronary artery bypass graft history and non-ST-elevated myocardial infarction patients. The mean fluoroscopy time among femoral access procedures was 15.68 min (SD=11.7) versus 19.86 min (SD=13.8) for radial access procedures (p<0.0001).ConclusionsRadial access for PCI is associated with higher fluoroscopy times but not with less major bleeding when bivalirudin is used. Our analysis, combined with other study findings, suggest that the safest route for PCI may be the use of femoral access with bivalirudin.

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Section: Discussionsupporting

confidence: 79%

Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry

2016

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“…The use of a bare steel needle, which aids in reducing the puncture angle to increase the contact area between the needle and blood vessel, may be beneficial for improving the success rate. Moreover, studies [ 26 , 27 ] have shown that low BMI is strongly correlated with adverse cardiovascular events and that low BMI increases the risk of bleeding after coronary stenting. However, there are few studies on the safety and efficacy of coronary intervention via dTRA (compared with cTRA) in patients with low BMI.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index

Zhang

Huang

et al. 2022

Journal of Interventional Cardiology

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The study aimed to investigate the efficacy and safety of coronary intervention via distal transradial access (dTRA) in patients with low body mass index (BMI). A total of 67 patients with low BMI who underwent coronary intervention, comprising 29 patients via dTRA and 38 patients via conventional transradial access (cTRA), were retrospectively included. There was no significant difference in the puncture success rate between the two groups (dTRA 96.6%, cTRA 97.4%, P = 0.846 ). Compared with the cTRA group, the success rate of one-needle puncture in the dTRA group was lower (51.7% vs. 81.6%, P = 0.020 ). The compression haemostasis time in the dTRA group was shorter than that in the cTRA group ( P < 0.001 ). However, the incidence of radial artery occlusion was lower in the dTRA group than in the cTRA group (4.0% vs. 33.3%, P = 0.007 ). In conclusion, coronary intervention via dTRA was safe and effective in patients with low BMI.

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“…Though these procedures are lifesaving, if done in patients who suffer from chest pain due to noncoronary artery disease related lesions, they may prove unnecessary adding to expenses, waste of resources, and lead to life threatening complications as well as. [1][2][3][4] The ST segment is the flat, iso-electric section of the ECG which represents the interval between ventricular depolarization and repolarization. 5 Injury currents flowing from the depolarized ischemic regions to normal regions result in the appearance of ST segment elevation where the ischemic region is transmural.…”

Section: Introductionmentioning

confidence: 99%

Recommendation for Inclusion of Surface Echocardiography in Evaluation of Chest Pain in Acute Emergency Care

Wilben

Limbad

et al. 2021

Journal of Cardiac Critical Care TSS

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Objective A significant number of conditions may mimic acute myocardial infarction when patients present to acute emergency care (AEC) with chest pain. A proportion of such patients may exhibit ST segment abnormality on the electrocardiogram (ECG) which is due to conditions other than acute coronary syndromes (ACS) or myocardial infarction. The American Heart Association/American College of Cardiology guidelines (2015) algorithm for ACS does not include echocardiographic evaluation in the assessment of chest pain. Patients with chest pain may be subjected to investigations and interventions based on ECG leading unwarranted invasive procedures, which may prove unnecessary, futile, and even detrimental. This study was performed to determine if a bedside echocardiography would help identify the conditions that do not need intervention and might possibly change the treatment pathway at the right time. Materials and Methods In a prospective observational study design, adult patients presenting to AEC with chest pain were included in the study. After the assessment of airway, breathing and circulation, and initiation of bed side monitoring, a 12-lead ECG was obtained. Patients exhibiting a significant ST change on ECG were subjected to bedside echocardiography, that is, two-dimensional (2D) transthoracic echocardiography (2D-TTE) with a cross reference to a consultant cardiologist for the precise assessment and diagnosis. The findings of echocardiography were correlated with electrocardiogram for possible diagnostic coronary angiography and percutaneous coronary intervention. The results of ECG, echocardiography, and coronary angiography (if done) were analyzed to determine the sensitivity and specificity of echocardiography for ACS. Results Among 385 patients in the study, 312 were suspected to suffer acute coronary syndrome; among these patients, eight patients turned out to have chest pain due to non-ACS. Of the 73 patients, the chest pain was suspected to be not of cardiac ischemia origin; among these patients, 66 patients were true negative and 7 patients were false positive. Echocardiography was the predictive of ischemic chest pain with a predictive value of 97.7%. The specificity of echocardiography calculated from the above confusion matrix was 90.4% and sensitivity was 97.4%. The positive predictive value of 2D-TTE was 97.7% and negative predictive value was 89.1%. The overall accuracy of bedside 2D-TTE was 96.1%. Conclusion Echocardiography was found to be an effective tool in aiding diagnosis of a patient presenting to AEC with chest pain and ST-T changes in ECG. A significant percentage of patients (18.7%) presented to AEC with chest pain, ST-T changes and found to have causes other than ACS, and screening echocardiography (2D-TTE) was able to identify 90.4% of those cases. From this study, we conclude that bedside echocardiography had high specificity (90.4%) and sensitivity (97.43%) in identifying regional wall motion abnormality due to ACS. Hence, bedside echocardiography is recommended in patients with chest pain and ST-segment abnormality to avoid unnecessary delay in diagnosis and invasive interventions in non-ACS.

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Validity of a PCI Bleeding Risk Score in patient subsets stratified for body mass index

Cited by 7 publications

References 23 publications

Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry

Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry

Efficacy and Safety of Coronary Intervention via Distal Transradial Access (dTRA) in Patients with Low Body Mass Index

Recommendation for Inclusion of Surface Echocardiography in Evaluation of Chest Pain in Acute Emergency Care

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