Cathy Jeon

Comparison of procedural times, success rates, and safety between left versus right radial arterial access in primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

Objective: To evaluate if there are differences in procedural times, success rates, and safety between left and right radial approach (LRA and RRA, respectively) in primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI). Background: Given conflicting reports of different procedural success with LRA vs. RRA, it is unclear if the side of radial access impacts in‐room procedural times and success rates in primary PCI. At our institution the LRA has been commonly used in certain STEMI patients. Our clinical database was reviewed to see if routine use of the LRA could generate favorable technical success and reperfusion times as compared to the RRA. Methods: We retrospectively analyzed 135 consecutive STEMI patients treated with primary PCI performed via the left and right radial approach at our institution. Results: There were 50 cases in the LRA group and 85 in the RRA group. There was no difference in median procedural times including total procedure time (LRA 53.5 mins vs. RRA 52 mins, P = 0.95), room‐to‐cannulation (LRA 12 min vs. RRA 13 min, P = 0.40) or room‐to‐balloon times (LRA 30 min vs. RRA 31 min, P = 0.74). There were no significant differences in procedural success rates (LRA 100% vs. RRA 97.6%, P = 0.27), or procedure‐related complications or death between the two groups. Conclusions: Left and right trans‐radial approach for primary PCI have similar in room procedural times, success rates, and comparable safety. Trans‐radial PCI through either arm is a feasible and safe approach in patients with STEMI.

Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures

Background—Reducing digital pulse rates (PR) are known to reduce total energy during invasive cardiovascular procedures, which likely has benefits for patients and staff. Physicians may be reluctant to reduce these parameters because they fear a decline in image quality that could affect procedural outcomes. We sought to assess the effect of default rates of fluoroscopy (Fluoro) and CINE-acquisition (CINE) on total x-ray dose and image quality during invasive cardiovascular procedures. Methods and Results—We retrospectively reviewed procedures done with 2 default PRs: a standard dose cohort (PR, 15 for Fluoro and CINE), and a reduced dose cohort (PR, 10 for Fluoro and CINE). Total x-ray dose, Fluoro time, and contrast use were compared between groups. A blinded angiographic image quality assessment was then performed using an objective 10-point angiographic quality score. There were no significant differences between cohorts for fluoroscopy time or contrast use. The reduced dose cohort has a significant reduction in mean total x-ray dose (PR 15, 1763.1 mGy; PR 10, 1179.1 mGy; P<0.0001). When adjusted for potential confounders, a 38% reduction in total x-ray dose was identified (P<0.0001). There was no difference in adjusted angiographic quality score between the cohorts (PR 15, 7.90; PR 10, 8.00; P=0.67), indicating no decline in image quality with PR reduction. Conclusions—Reducing default PRs during invasive cardiovascular procedures yields large and significant reductions in total x-ray energy with no decline in angiographic image quality.

Right heart catheterization using antecubital venous access: feasibility, safety and adoption rate in a tertiary center.

To determine feasibility, safety, and adoption rates of right heart catheterization (RHC) using antecubital venous access (AVA) as compared to using the traditional approach of proximal venous access (PVA).

Relative spatial distributions of coronary artery bypass graft insertion and acute thrombosis: A model for protection from acute myocardial infarction

BACKGROUND Randomized trials have demonstrated coronary artery bypass surgery (CABG) to be superior to percutaneous coronary intervention with respect to long-term mortality and morbidity from myocardial infarction within specific high-risk cohorts. The purpose of this study was to analyze the spatial distribution of coronary artery bypass graft anastomoses relative to acute thromboses in native coronary arteries. We hypothesized that insertion sites of bypass grafts are located distal to sites of acute thrombosis and consequently decrease cardiac morbidity and mortality associated with plaque rupture. METHODS We analyzed 168 patients with prior CABG and 208 patients with ST-segment elevation myocardial infarctions (STEMI) presenting to the Brigham and Womens Hospital who underwent coronary angiography. We constructed a spatial map of the coronary arterial bypass graft insertion sites and compared these locations to sites of acute thrombosis leading to STEMI. RESULTS Graft insertion sites were consistently located distal to acute thrombosis sites (left anterior descending artery median graft insertion versus median thrombosis site = 72 versus 34 mm, right coronary artery 91 versus 42 mm, left circumflex artery 44 versus 37 mm). Greater than 97% of thrombosis sites were located proximal to 75% of graft insertion sites. CONCLUSIONS Coronary arterial bypass grafts provide the coverage of anatomic zones at risk for STEMI. The superior performance of CABG in high risk patients may be attributed to targeting of proximal coronary locations where thrombosis risk is clustered.

Rationale and design of the MASS COMM trial: A randomized trial to compare percutaneous coronary intervention between MASSachusetts hospitals with cardiac surgery on-site and COMMunity hospitals without cardiac surgery on-site.

BACKGROUND Emergency surgery has become an increasingly rare event after percutaneous coronary intervention (PCI). There have been no randomized trials evaluating whether cardiac surgery services on-site are essential for patient safety and optimal outcomes during and after PCI. STUDY DESIGN The MASS COMM trial (ClinicalTrials.gov no. NCT01116882) is a randomized trial comparing the safety and effectiveness of nonemergency PCI at hospitals without surgery on-site (SOS) (non-SOS hospitals) and hospitals with SOS (SOS hospitals). A total of 3,690 subjects will be randomized in a 3:1 fashion to undergo PCI at non-SOS and SOS hospitals, with follow-up at hospital discharge, 30 days, and 12 months after PCI. The rate of major adverse cardiac events (all-cause mortality, myocardial infarction, repeat revascularization, and stroke) will serve as the primary safety end point at 30 days and the primary effectiveness end point at 12 months. The design is a 1-way randomized trial with a statistical hypothesis of noninferiority of nonemergency PCI at non-SOS hospitals for both safety and effectiveness end points. CONCLUSIONS This multicenter, randomized trial will compare the relative safety and effectiveness of nonemergency PCI at sites with and without cardiac SOS.

IMPACT ON ANGIOGRAPHIC IMAGE QUALITY OF A DECREASE IN DEFAULT LABORATORY PULSE RATES FOR FLULROSCOPY AND CINEANGIOGRAPHY DURING CORONARY PROCEDURES

In 2012, in an effort to reduce radiation exposure during coronary procedures, our institution reduced the standard setting for x-ray digital pulse rates (DPF) from 15 frames per second (FPS) to 10 FPS for fluoroscopy and cine-angiography. Previous work in our institution demonstrated this