Radial artery ultrasound predicts the success of transradial coronary angiography

Background: The transradial approach has become the preferred vascular access during conventional coronary angiography (CCA). Hereby, we evaluated the impact of pre-procedural radial artery diameter (RAD), the cross-sectional area (CSA), and the perimeter on vascular complications (VACs). Methods: We conducted a single-center prospective analysis of 513 patients who underwent CCA. Radial artery ultrasonography was performed before and after CCA to measure the RAD, CSA, and perimeter. Results: The average RAD, CSA, and perimeter were 2.60 ± 0.48 mm, 6.2 ± 3.0 mm2, and 8.9 ± 1.7 mm, respectively. Vascular complications were reported in 56 (11%) patients. The RAD, CSA, and perimeter were significantly smaller in patients in whom procedure-related VACs were observed than in those with no complications: 2.3 ± 0.5 vs. 2.70 ± 0.54 mm (p = 0.0001), 4.9 ± 2.1 vs. 6.4 ± 3 mm2 (p = 0.001), and 7.6 ± 2.1 vs. 9.2 ± 1.6 mm (p = 0.0001), respectively. Univariate logistic regression showed that RAD, CSA and perimeter can independently predict VACs (OR 0.833, 95% CI 0.777–0.894, p < 0.0001; OR 0.647, 95% CI 0.541–0.773, p < 0.0001; OR 0.545, 95% CI 0.446–0.665, p < 0.0001, respectively). Conclusions: Ultrasonographic study of the radial artery before CCA can provide valuable information regarding vascular access.  

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Public knowledge, beliefs, psychological responses, and behavioural changes during the outbreak of COVID - 19 in the Middle East

Objective : To evaluate the knowledge, believes, psychological and behavioural impact of COVID - 19 on the general population in the Middle East, exploring how it impacted public lives. Methods : A descriptive cross - sectional online survey was sen t to a convenience sample in the Middle East through social media (Facebook and WhatsApp) between 16 th of June and 30 th of June 2020. The questionnaire was designed to collect the demographic, participant’s source of information regarding COVID - 19, knowled ge and believes about COVID - 19, the psychological consequences of COVID - 19, impact of COVID - 19 on participant’s behaviour. The final version of the questionnaire was further tested for content validity by experts in the field. Results : A total of 2,061 par ticipants completed the survey, with the majority being females (n=1394, 67.6%), from urban areas (n=1896, 92%) and the majority were from countries of The Levant (n=1199, 58.1%), followed by the Arabian Peninsula (n=392, 1 9.1%), Iraq (n=300, 14.6%) and Eg ypt (n=138, 6.7%). Few participants (3.0%) reported to have been infected and many (n=1847, 89.6%) were committed to quarantine at home. Social media platforms were the most common sources of information (41.2%). Many (63%) believed that COVID - 19 is a biol ogical weapon and were afraid of visiting crowded places (85%). The majority avoided public facilities (86.9%) such as prayer places and believed that the news about COVID - 19 made them anxious (49.5%)

The prevalence of coronary artery anomalies in Qassim Province detected by cardiac computed tomography angiography

Background: Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA. Objective: The aim of our work is to estimate the frequency of CAAs in Qassim province among patients underwent cardiac CTA at Prince Sultan Cardiac Center. Methods: Retrospective analysis of the CTA data of 2235 patients between 2009 and 2015. Results: The prevalence of CAAs in our study was 1.029%. Among the 2235 patients, 241 (10.78%) had CAAs or coronary variants, 198 (8.85%) had myocardial bridging, 34 (1.52%) had a variable location of the Coronary Ostia, Twenty two (0.98%) had a separate origin of left anterior descending (LAD) and left circumflex coronary (LCX) arteries, ten (0.447%) had a separate origin of the RCA and the Conus artery. Seventeen (0.76%) had an anomalous origin of the coronaries. Six (0.268%) had a coronary artery fistula, which is connected mainly to the right heart chambers, one of these fistulas was complicated by acute myocardial infarction. Conclusions: The incidence of CAAs in our patient population was similar to the former studies, CTA is an excellent tool for diagnosis and guiding the management of the CAAs

Interrupted aortic arch with isolated persistent left superior vena cava in patient with Turners syndrome

We present a case of 13-year-old female with Turner syndrome (TS), who presented with unexplained lower limbs swelling and ejection systolic murmur at the left second intercostal space. Suspicion of mild aortic coarctation was made by echocardiography. Computed tomography angiography (CTA) showed a complete interruption of the aortic arch (IAA) below the left subclavian artery with persistent left superior vena cava (PLSVC) and absent right SVC, defined as an isolated PLSVC. The patient underwent successful surgical correction after unsuccessful trial of transcatheter stent placement. We present this case of asymptomatic IAA to draw attention to the importance of CTA in diagnosing such rare anomalies and ruling out asymptomatic major cardiovascular abnormalities in patient with TS

Impact of coronary artery calcification on percutaneous coronary intervention and postprocedural complications

AbstractBackgroundExcessive coronary calcification can lead to adverse outcomes after percutaneous coronary intervention (PCI). We therefore evaluated the impact of coronary calcium score (CCS) measured by multidetector computed tomography (MDCT) on immediate complications of PCI and rate of restenosis.MethodsWe performed a single-center retrospective analysis of 84 patients with coronary stenosis diagnosed by MDCT who underwent PCI. The Agatston method was used to measure total, target-vessel, and segmental (stent deployment site) CCS.ResultsIn 108 PCI procedures, 32 lesions (29.5%) were American College of Cardiology/American Heart Association type A, 60 (55.5%) were type B, and 16 (15%) were type C. ANOVA showed significantly higher segmental CCS in type C than in type A lesions (29±51 vs. 214±162; p=0.03). Six patients (7.1%) had periprocedural complications and seven (8.3%) had in-stent restenosis and angina. Mean total, target-vessel, and segmental CCS was significantly higher in complicated than in successful PCI (199±325 vs. 816±624, p=0.001; 92±207 vs. 337±157, p=0.001; and 79±158 vs. 256±142, p=0.003, respectively), but there was no significant difference in CCS between successful PCI and PCI complicated by late restenosis.ConclusionsCCS measured by MDCT has an important role in predicting early, but not late, complications from PCI

19. Radial artery ultrasound predicts the success of transradial coronary angiography

Smaller radial artery diameter, CSA, and perimeter is associated with higher vascular access complications during coronary angiography. The transradial approach has become the preferred vascular access during conventional coronary angiography (CCA). A small mean radial artery diameter (RAD), however, may lead to higher rates of vascular access complications (VAC). To date, there are no data regarding the effect of the radial artery cross-sectional area (CSA) and perimeter. We evaluated the impact of preprocedure radial artery diameters, the CSA, and the perimeter on vascular complications. We conducted a single-center prospective analysis of 513 patients who underwent CCA. Radial artery ultrasonography was performed before and after CCA to measure the RAD, CSA, and perimeter.The average RAD, CSA, and perimeter were 2.60 ± 0.48 mm, 6.2 ± 3.0 mm2, and 8.9 ± 1.7 mm, respectively. The same measurements were significantly larger in men than in women: 2.8 ± 0.5 vs. 2.4 ± 0.4 mm (P < 0.0001), 6.6 ± 3.4 vs. 5.3 ± 1.5 mm (P < 0.0001), and 9.3 ± 1.7 vs. 8.2 ± 1.5 mm (P< 0.0001), respectively. In all, 56 patients (11%) had VACs. The RAD, CSA, and perimeter were significantly smaller in patients whose procedures had VACs than in those with no complications: 2.3 ± 0.5 vs. 2.70 ± 0.54 mm (P = 0.0001), 4.9 ± 2.1 vs. 6.4 ± 3 mm2 (P = 0.001), and 7.6 ± 2.1 vs. 9.2 ± 1.6 mm (P = 0.0001), respectively. Univariate logistic regression showed that radial ultrasonographic parameters can independently predict VACs as follows: odds ratio (OR) 1.2, 95% CI 1.12–1.28 (P < 0.0001) for RAD; OR 1.55. 95% CI 1.29–1.84, (P < 0.0001) for CSA; OR 1.83, 95% CI 1.5–2.46 (P < 0.0001) for the perimeter.Ultrasonographic study of the radial artery before CCA can provide important information regarding vascular access. We found that a small radial diameter, CSA, and perimeter are associated with higher VAC rates