Hand dysfunction after transradial artery catheterization for coronary procedures

AIM To sythesize the available literature on hand dysfunction after transradial catheterization. METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized. RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction (6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included. CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel

Effect of Gender On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmissions Database)

Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs$12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes

In-hospital Upper Gastrointestinal Bleeding Following Percutaneous Coronary Intervention

Objectives This study aims to examine in-hospital gastrointestinal (GI) bleeding, its predictors and clinical outcomes, including long-term outcomes, in a national cohort of patients undergoing percutaneous coronary intervention (PCI) in England and Wales. Background GI bleeding remains associated with significant morbidity, mortality and socioeconomic burden. Methods We examined the temporal changes in in-hospital GI bleeding in a national cohort of patients undergoing PCI between 2007-2014 in England and Wales, its predictors and prognostic consequences. Multivariate analysis was performed to identify independent risk factors between GI bleeding and 30-day mortality. Survival analysis was performed comparing patients with, and without, GI bleeding. Results There were 480 in-hospital GI bleeds in 549,298 patients (0.09%). Overall, rates of GI bleeding remained stable over time but a significant decline was observed for patients with ST segment elevation myocardial infarction (STEMI). The strongest predictors of bleeding events were STEMI - odds ratio (OR) 7.28 (95% confidence interval (95% CI) 4.82-11.00), glycoprotein IIb/IIIa inhibitor use OR 3.42 (95% CI 2.76-4.24) and use of circulatory support OR 2.65 (95% CI 1.90-3.71). Anti-platelets/coagulants (clopidogrel, prasugrel and warfarin) were not independently associated with GI bleeding. GI bleeding was independently associated with a significant increase in all-cause 30-day mortality (OR 2.08 (1.52-2.83)). Patients with in-hospital GI bleed who survived to 30-days had increased all-cause mortality risk at 1 year compared to non-bleeders (HR 1.49 (1.07-2.09)). Conclusions In-hospital GI bleeding following PCI is rare but is a clinically important event associated with increased 30-day and long-term mortality

Incidence and clinical course of limb dysfunction post cardiac catheterization: a systematic review

BackgroundWe sought to systematically review the available literature on limb dysfunction after transradial or transfemoral cardiac catheterization.Methods & ResultsMEDLINE and EMBASE were searched for studies evaluating any transradial or transfemoral procedures and limb function outcomes. Data was extracted, results were narratively synthesized with similar treatment arms. 15 studies with 3616 participants were included in transradial access (TRA) group. 3 studies reported nerve damage with a combined incidence of 0.16%, 4 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.61%. Pain after TRA was the most common form of limb dysfunction (7.77%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or neuropathy was low at 0.49%. Although RAO was not a primary end point for this review, it was observed in 3.57% of the participants in a total of 8 studies included.4 studies with 15,903,894 participants were included in the transfemoral access (TFA) group. Rate of peripheral neuropathy was observed at 0.004%, sensory neuropathy due to local groin injury and retroperitoneal haematomas was 0.04% and 0.17% respectively, whereas motor deficit due to femoral and obturator nerve damage was 0.13%.ConclusionsLimb dysfunction post cardiac catheterization is rare, patients may have nonspecific sensory and motor complaints that resolve over a period of time

5258Trends and outcomes of use of coronary angiography in management of non-ST-Elevation acute coronary syndromes (NSTEACS), a population based cohort study

Background: Non-ST-elevation acute coronary syndromes (NSTEACS) remains most vulnerable phenotype of acute myocardial infarction despite significant improvements in treatment and provision of guideline-recommended care. Coronary angiography (CA) is the mainstay of an invasive strategy in this cohort of patients. There is limited data on temporal trends in utilization of CA in real-world population-based settings.Purpose: We sought to investigate temporal trends in utilization of coronary angiography, a difference in clinical characteristics of patients and receipt of coronary angiography, and predictor of coronary angiography. We also studied the associations between use of CA and in-hospital outcomes of death, major bleeding, cardiac and vascular complications.Methods: We analyzed data from National Inpatient Sample (NIS) from 2004–2014. We identified all inpatient admissions age ≥18 with a primary diagnosis of NSTEACS during the study period. Descriptive statistics were employed in the weighted data to illustrate temporal trends in utilization of CA in patients stratified according to age, comorbidity burden, gender, and ethnicity. Multivariate logistic regression models were used to investigate predictors and association of CA with above-noted outcomes.Results: From a total of 4,380,827 inpatient records with a diagnosis of NSTEACS, 57.5% received CA during the timeframe studied. Patients receiving CA were more likely to be male (61.7% vs 49.7%, p<0.001), younger (Median age 65 (IQR 46–75)) and less comorbid as defined per chalrson comorbidity index (CCI) (CCI=0 66.8% vs 33.2%, p<0.001). The proportions of patients receiving CA increased from 48.5% to 68.5%, and similar increasing trends were observed across different groups stratified according to age, gender, ethnicity and comorbidity burden. Non-cardiac comorbidities such as dementia (OR 0.32 95% CI 0.31–0.33), renal failure (OR 0.66 95% CI 0.65–0.67), metastatic cancer (OR 0.33 95% CI 0.31–0.35) and liver disease (OR 0.76 95% CI 0.72–0.80) had strong inverse relationship with receipt of CA. Finally, utilization of CA was strongly associated with decreased odds of in-hospital mortality (OR 0.38 95% CI 0.36–0.40).Conclusion: In this one of the largest population-based study of over 4.3 million inpatient admissions, we observed a temporal increase in utilization of CA. There was significant heterogeneity in receipt of CA across different group wherein older, females and more comorbid were less likely to receive CA