The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure

  Background: Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. Methods: This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6–15 months following the in­tervention. Results: RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 ± 9.7 vs. 59.1 ± 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8%) was lower (p < 0.001) than the observed incidence (23%) in non-hypertensive patients. RAO group had higher rate (28%, p = 0.027) of post­-procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. Conclusions: The present study reveals that the long-term incidence of RAO is 16.4%. Hy­pertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term.

Comparison of hypertension prevalence and the use of renin-angiotensin-aldosterone system blockers in hospitalized patients with COVID-19 and non-COVID-19 viral pneumonia

Objective: To compare the prevalence of hypertension and pre-existing use of renin-angiotensin-aldosterone system blockers in patients with coronavirus disease (COVID-19) and non-COVID-19 viral pneumonias

Pregnancy-associated plasma protein A (PAPP-A) and severity of coronary atherosclerosis assessed by angiographic Gensini score

Background: Pregnancy-associated plasma protein A (PAPP-A) is a potentially proatherosclerotic metalloproteinase, which has been shown to be abundantly expressed in ruptured unstable plaques. However, changes of the PAPP-A blood levels in patients with coronary artery disease (CAD) according to the Gensini score is unknown in Turkish population

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options

ConclusionsHemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction. (J Interven Cardiol 2015;28:305-312

Zależność między punktacją w skali Gensiniego a rezolucją uniesienia odcinka ST u chorych z ostrym zawałem serca z uniesieniem odcinka ST poddanych pierwotnej przezskórnej interwencji wieńcowej

Background: Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis.Aim: To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI).Methods: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplastyand 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(–), and those with STR(+). Patients were also analysed according to the infarct-related artery.Results: GS-pPCI was significantly higher in patients with STR(–) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = –0.287, p = 0.002). In subgroup analysis, patients in the STR(–) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(–) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03–1.12, p = 0.001 and OR 3.28, 95% CI1.11–9.72, p = 0.03, respectively).Conclusions: GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI. Wstęp: Stan kliniczny chorych, którzy przebyli zawał serca, zależy głównie od skutecznego przywrócenia perfuzji mięśnia sercowego i nasilenia zmian miażdżycowych w naczyniach wieńcowych.Cel: Celem pracy była ocena wartości predykcyjnej punktacji w skali Gensiniego w odniesieniu do rezolucji uniesienia odcinka ST (STR) u osób poddanych pierwotnej przezskórnej interwencji wieńcowej (pPCI) z powodu ostrego zawału serca z uniesieniem odcinka ST (STEMI).Metody: Do badania włączono 114 kolejnych pacjentów (średnia wieku 54 ± 10 lat, 15 kobiet) ze STEMI, u których wykonano — zakończony powodzeniem — zabieg pPCI. Obliczono łączne uniesienie odcinka ST w milimetrach przed angioplastyką i 60 min po pPCI. ΣSTR < 50% uznano za elektrokardiograficzny wskaźnik zjawiska no-reflow. Stopień obciążenia skrzeplinami określono na podstawie koronarografii, a punktację w skali Gensiniego (GS-pPCI) obliczono po przeprowadzeniu pPCI, nie uwzględniając zmiany odpowiedzialnej za powstanie zawału. Pacjentów podzielono na dwie grupy w zależności od STR:STR(–) i STR(+). Chorych analizowano również w zależności od tętnicy odpowiedzialnej za zawał.Wyniki: U pacjentów z STR(–) wartość GS-pPCI była istotnie wyższa (10,1 ± 11,8 vs. 22 ± 18,6; p = 0,005). Stwierdzo noujemną korelację między GS-pPCI i STR (r = –0,287; p = 0,002). W analizie podgrup wykazano ponadto, że u chorych z grupy STR(–), u których zmiana będąca przyczyną zawału (culprit lesion) znajdowała się w gałęzi międzykomorowej przedniej lub gałęzi okalającej, wartości GS-pPCI były wyższe (odpowiednio 10,9 ± 13,5 vs. 23,5 ± 21,3; p = 0,03 i 9,6 ± 8,7 vs. 24,1 ± 21; p = 0,04). U pacjentów z STR(–) częściej stwierdzano również duże obciążenie skrzeplinami (68% vs. 43%, p = 0,03). W wieloczynnikowej analizie regresji logistycznej wykazano, że GS-pPCI i duże obciążenie skrzeplinami były niezależnymi czynnikami predykcyjnymi niedostatecznej STR (odpowiednio, OR 1,07; 95% CI 1,03–1,12; p = 0,001 i OR 3,28; 95% CI 1,11–9,72; p = 0,03).Wnioski: Wartość GS-pPCI i duże obciążenie skrzeplinami są ważnymi czynnikami predykcyjnymi niedostatecznej STR u chorych ze STEMI poddanych pPCI.

Journal of Cardiovascular Magnetic Resonance / Pulmonary artery to aorta ratio for the detection of pulmonary hypertension : cardiovascular magnetic resonance and invasive hemodynamics in heart failure with preserved ejection fraction

Background Previous work indicates that dilatation of the pulmonary artery (PA) itself or in relation to the ascending aorta (PA:Ao ratio) predicts pulmonary hypertension (PH). Whether these results also apply for heart failure with preserved ejection fraction (HFpEF) is unknown. In the present study we evaluated the diagnostic and prognostic power of PA diameter and PA:Ao ratio on top of right ventricular (RV) size, function, and septomarginal trabeculation (SMT) thickness by cardiovascular magnetic resonance (CMR) in HFpEF. Methods and Results 159 consecutive HFpEF patients were prospectively enrolled. Of these, 111 underwent CMR and invasive hemodynamic evaluation. By invasive assessment 64 % of patients suffered from moderate/severe PH (mean pulmonary artery pressure (mPAP) 30 mmHg). Significant differences between groups with and without moderate/severe PH were observed with respect to PA diameter (30.9 5.1 mm versus 26 5.1 mm, p < 0.001), PA:Ao ratio (0.93 0.16 versus 0.78 0.14, p < 0.001), and SMT diameter (4.6 1.5 mm versus 3.8 1.2 mm; p = 0.008). The strongest correlation with mPAP was found for PA:Ao ratio (r = 0.421, p < 0.001). By ROC analysis the best cut-off for the detection of moderate/severe PH was found for a PA:Ao ratio of 0.83. Patients were followed for 22.0 14.9 months. By Kaplan Meier analysis event-free survival was significantly worse in patients with a PA:Ao ratio 0.83 (log rank, p = 0.004). By multivariable Cox-regression analysis PA:Ao ratio was independently associated with event-free survival (p = 0.003). Conclusion PA:Ao ratio is an easily measureable noninvasive indicator for the presence and severity of PH in HFpEF, and it is related with outcome.(VLID)486713