Albert Fenech

A comparison between dual axis rotational coronary angiography and conventional coronary angiography

Background: Coronary angiography remains the gold standard for the investigation of coronary artery disease, and is carried out in multiple, predefined stationary views, at different angulations around the patient, for both left and right coronary arteries. Dual axis rotational coronary angiography (DARA) is an alternative technique wherein the c‐arm rotates around the patient in a preprogrammed single acquisition, exposing the entire coronary artery at different angulations. The DARA system has been recently installed in the Cardiac Catheterisation Suite at Mater Dei Hospital, Malta, where a monoplane and a biplane machine are available. This study was carried out in order to compare DARA with conventional single and biplane coronary imaging, with respect to radiation dose, contrast loads, and procedure time. Methods: This study was carried out over the period from September to December 2010. Four hundred sixty‐three patients were studied. Patients referred for the investigation of native coronary anatomy, for whatever indication, were consented and included, and randomly assigned to one of four groups depending on which machine and modality was used: monoplane conventional, monoplane DARA, biplane conventional, and biplane DARA. Results: DARA was statistically significantly superior in dose area product, fluoroscopy time, amount of contrast used, and procedure time. These reductions ranged between 12 (contrast used) and 71% (procedure time). Conclusions: The advantages of such systems are obvious to both patient and healthcare provider, and DARA may prove to be an important and useful tool in the refinement of diagnostic coronary angiography by reducing patient contrast and radiation doses and reducing procedure time.

Greater radiation savings at higher body mass indexes with dual axis rotational coronary angiography

In a recent article that compared monoplane conventional with monoplane dual-axis rotational (monoplane swing) angiography, and biplane conventional with biplane dual-axis rotational (biplane swing) angiography, we showed that dual axis rotational coronary angiography (DARA) was statistically significantly superior in dose area product (DAP), fluoroscopy time, amount of contrast used, and procedure time. These reductions

CYP2C19*2 Allele Carrier Status and Coronary In-stent Restenosis: Is There an Association?

The CYP2C19*2 allele is associated with reduced clopidogrel bioactivation, increasing the risk of complications after percutaneous coronary intervention (PCI), particularly stent thrombosis. Recently published data suggests that CYP2C19*2 allele carriers have a higher risk for in-stent restenosis (ISR) after endovascular treatment. Very few studies have investigated the relationship between CYP2C19*2 and coronary ISR, with no significant association reported. The objective of this study was to assess the relationship between CYP2C19*2 allele carrier status and coronary ISR.

PKP-007 Pharmacist led rapid point of care cytochrome p 2C19 genotyping for individualisation of antiplatelet therapy

Background The presence of the CYP2C19 loss of function *2 allele is associated with a decreased antiplatelet effect in clopidogrel treated patients. Since about 50% of major adverse cardiac events occur within the first 2 days post-percutaneous coronary intervention (PCI), a rapid CYP2C19*2 genotype result is important to individualise antiplatelet therapy at the start of treatment. Purpose To apply a pharmacist led process to individualise antiplatelet therapy guided by CYP2C19*2 genotyping using the rapid point of care (POC) Spartan RX assay (Spartan Bioscience) in patients undergoing PCI. Material and methods Following ethics approval and written informed consent, patients undergoing PCI with stent deployment for acute coronary syndrome or stable angina, and who were candidates for dual antiplatelet therapy, were recruited over a 3 month period by non-probability sampling. Exclusion criteria were patients <18 and >75 years old, body weight <60 kg, history of stroke or transient ischaemic attack, active bleeding, coagulation or platelet disorders, and/or chronic liver disease. A buccal sample was collected for automated CYP2C19*2 genotyping with the Spartan RX system within 1 h. Each patient was genotyped as a non-carrier of the *2 allele (*1/*1), a carrier of one *2 allele (*1/*2) or a carrier of two *2 alleles (*2/*2). Actionable genotypes (*1/*2, *2/*2) with therapy recommendations according to the 2013 Clinical Pharmacogenetics Implementation Consortium guidelines were communicated to the cardiologist. Results The patient cohort consisted of 34 patients. 25 patients were male and 9 were female, mean age was 66 years (range 49–75) and all patients were Caucasian. 21 patients were genotyped as non-carriers of the *2 allele, 12 patients were genotyped as carriers of one *2 allele and 1 patient was genotyped as a carrier of two *2 alleles. For the 13 patients with an actionable genotype, the pharmacist discussed choice of antiplatelet therapy with the cardiologist since they were candidates for an alternative to clopidogrel. Conclusion This POC assay was user friendly and rapidly identified carriers of the *2 allele. This study demonstrated the feasibility of this POC test to be implemented for pharmacist led CYP2C19*2 genotype guided individualisation of antiplatelet therapy during the critical period post-PCI. References and/or Acknowledgements University of Malta Faculty of Medicine and Surgery Dean’s Initiative, Technoline Ltd, Malta Heart Foundation, Orme Scientific Ltd No conflict of interest.

Early ambulation and discharge after four French femoral artery catheterisation for diagnostic coronary angiography

One of the bottlenecks experienced by cardiac catheterisation laboratories is the amount of time that patients must remain on the unit after femoral artery puncture. This remains a contentious issue and there are a few studies to guide units with regard to how early it is possible to safely ambulate and discharge patients home. (Published: 20 April 2012) Citation: Libyan J Med 2012, 7 : 18376 - http://dx.doi.org/10.3402/ljm.v7i0.18376