Lv Qiang

Angiographic evaluation of a new technique for common femoral artery access: the inguinal ligament-guided

Objective Various techniques have been used to acquire common femoral artery (CFA) access which was proved to be safe with lower risk of complications in percutaneous catheterisation. In order to increase the success rate of CFA puncture, a relatively simple, safe and reliable technique was developed. Methods We introduced a new inguinal ligament-guided technique and inguinal division. Clinical data were collected on 822 unselected patients undergoing transfemoral percutaneous coronary catheterisation between 2004 and 2009. Inguinal ligament was utilised as a reference to conduct artery puncture site. After palpating anterior superior iliac spine and pubic symphysis with caution to locate the inguinal ligament, medius pinpointed the intersection of inguinal ligament and femoral artery. Thereafter, place forefinger beside the medius, perform artery puncture at the inferior margin of forefinger with 45° modified seldinger technique. By femoral angiogram, we utilised the femoral head as a landmark, of which the midpoint, inferior and superior margin were referred to borderlines, to divide the inguinal region into zone A, B1, B2 and C so as to identify the location of femoral artery cannulation. Femoral head (zone B) was defined as the optimal area of femoral artery puncture. Results Successful CFA cannulation occurred in 82.8% (681/822) of cases. Arterial puncture over the femoral head (zone B) occurred in 96.8% (796/822) of patients, 36.0% (296/822) for zone B1 and 60.8% (500/822) for zone B2, respectively. When femoral artery puncture located on zone B, B1, B2 and C, CFA cannulation occurred in 83.9% (668/796), 91.6% (271/296), 79.4% (397/500) and 40% (8/20), respectively. Conclusions Inguinal ligament is a reliable reference for guiding the puncture of CFA in transfemoral percutaneous catheterisation.

Safety evaluation of vascular closure devices in femoral artery access

Objective The aim of the study was to evaluate the in-hospital and long term safety performance of vascular closure devices (VCDs) in femoral artery access. Methods One thousand and seventy eight patients who undergoing transfemoral percutaneous cardiac catheterisations from June 2008 to October 2009 were enrolled. We compared the incidence of in-hospital vascular complications between manual compression group and VCDs group. Femoroiliac angiographic data were collected and analysed on 92 patients undergoing repeat catheterisation via ipsilateral femoral artery for which VCDs have been used for at least 3 month during index transfemoral catheterisation. The percent diameter stenosis (ΔDS%) was utilised to evaluate the long-term safety performance of vascular closure devices on femoral angiogram. Restenosis of femoral artery was defined as ΔDS% ≥50%. Results The overall in-hospital incidence of vascular complication was 0.74% (8/1078). Patients in VCDs group had relatively lower rate of in-hospital complications (p=0.039) compared with manual compression group. The median interval of femoral angiogram recheck was 232 days. Femoral restenosis at the site of vascular access occurred in 3.3% of 92 patients, but no one had complaints of limb ischemia. Conclusions VCDs demonstrated greater in-hospital and long-term safety performance compared with manual compression. Femoral restenosis at puncture site is very rare and usually asymptomatic.

Angiographic evaluation of femoral bifurcation in Chinese population

Objective Common femoral artery (CFA) access has been proved to be safe with lower risk of complications in percutaneous catheterisation. The femoral head can be utilised as a reliable landmark to locate the level of femoral bifurcation and the common femoral artery. In the present study, we evaluated the site of femoral bifurcation in Chinese population on femoroiliac angiograms. Methods We enrolled 529 patients undergoing cardiac catheterisations via femoral artery from June 2008 to October 2009. Femoral angiograms were performed in all patients preparing to use vascular closure devices. Based on the femoral head and the midpoint of pubic symphysis as landmarks, the midpoint, inferior and superior margin of the femoral head were used as borderlines to divide the inguinal region into four zones (A, B1, B2 and C). Location of femoral bifurcation and CFA were evaluated on femoral angiogram. Results Femoral bifurcations located in the area of A, B1, B2 and C with 0.2% (1/529), 2.3% (12/529), 42.4% (223/529), 55.4% (293/529), respectively. When arterial puncture located on zone B, B1, B2 and C, CFA cannulation was obtained in 85.0% (436/513), 95.8% (160/167), 79.8% (276/346) and 38.5% (5/13), respectively. Conclusions We originally introduced a reliable method for inguinal vascular zone division. The majority of femoral bifurcations located below the midpoint of femoral head in Chinese population. It is an effective measure to puncture common femoral artery between the superior and inferior border of the femoral head, especially between the superior border and the midpoint of the femoral head.

e0341 Effect of fasting glucose levels on mortality rate in patients with diabetes mellitus and coronary artery disease undergoing revascularization

Objectives We examined the association between glycaemic control determined by fasting glucose levels before elective PCI and the outcomes in diabetic patients undergoing elective revascularization. Background Patients with diabetes mellitus (DM) have a worse clinical outcome after PCI than patients without DM, but whether optimal glycaemic control before PCI could improve the prognosis is not clear. Methods The DESIRE-2 (Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1st 2003 and Sep 30th 2005. A total of 434 diabetic patients undergoing elective PCI were enrolled in this study. Optimal glycaemic control was defined as fasting glucose <126 mg/dl, and suboptimal control was defined as fasting glucose >=126 mg/dl. Median follow-up duration after the index intervention was 523 days. Results The average patient age was 61.0±9.8 years; 69.8% of the patients were men. The patients with optimal glycaemic control were older than the suboptimal control group (62.1±9.46 vs 59.6±10.41). Compared with diabetic patients with optimal glycaemic control, those with suboptimal glycaemic control had similar rates of total mortality (3.3% vs 3.9%, p=0.762) and major adverse cardiac and cerebral events (15.9% vs 12.4%, p=0.308). In a multiple Cox regression analysis, total cholesterol level (HR 1.009, 95% CI 1.002 to 1.016, p=0.013) and number of lesion (HR 2.070, 95% CI 1.340 to 3.199, p=0.001) were significant independent predictors of MACCE. Conclusions In diabetic patients undergoing elective PCI, optimal glycaemic control did not improve clinical prognosis. These data suggest that aggressive treatment of DM to achieve fasting glucose <126 mg/dl before PCI is not necessary.

e0257 Association of C reactive protein levels with the severity of coronary artery disease

Objective To explore the association of CRP levels with the severity of coronary stenosis in patients with coronary artery disease (CAD) documented by angiography. Methods A total of 368 patients with angiographically determined CAD (defined as stenosis of >= 50% in 1 or more coronary arteries) were enrolled after exclusion of patients with acute myocardial infarction, acute infectious diseases or CRP >=10 mg/l, and chronic liver or kidney diseases. Serum CRP was measured using particle enhanced immunoturbidimetric method (DiaSys, Germany). CAD severity was assessed by the number of stenotic coronary arteries and the Gensini score. In the current study, LDL-C <130 mg/dl was defined as the lower level of LDL-C and LDL-C 3130 mg/dl as the higher level of LDL-C. Results Of 368 patients, 179 patients had single-vessel stenosis, 105 had 2 stenotic vessels, and 84 had ≥3 stenotic vessels. Systolic blood pressure and triglycerides levels increased significantly with the number of stenotic arteries. Median and inter-quartile range (IQR) of CRP in patients with single-vessel stenosis and multi-vessel stenosis was 0.93 (0.44–2.41) mg/l and 1.33 (0.66–2.39) mg/l, respectively, p=0.030. Univariate analysis found that participants with CRP ≥1 mg/l had a significantly higher Gensini score (29.0 (12.0–56.0) vs 20.0 (10.0–46.2), p=0.026) and higher prevalence of multi-vessel stenosis (57.6% vs 44.1%, p=0.010) than those with CRP <1 mg/l. After age, gender, body mass index, systolic blood pressure, smoking status, fasting glucose, HDL-C and LDL-C adjustments, CRP levels remained to be associated with CAD severity. The OR was 1.77 (95% CI 1.14 to 2.76) for patients with a higher level of CRP (≥1 mg/l) versus those with a lower level of CRP (<1 mg/l). Among patients with a lower level of LDL-C, treated or not treated with statins therapy, the prevalence of multi-vessel stenosis was higher in those having a higher level of CRP than in those having a lower level of CRP (55.0% vs 41.7%, p=0.024). Further analysis was undertaken by dividing the patients into 4 categories according to CRP levels and whether or not they had statins treatment. Compared with the risk of CAD in patients with a lower level of CRP who were taking statins, the risk increased significantly when the CRP level was higher, regardless of whether they were taking statins or not. The risk was the highest (OR=2.15, 95% CI 1.08 to 4.27, p=0.029) for those with a higher level of CRP but who were not on statins therapy. Conclusion CRP is associated with the severity of CAD. It may provide additional information regarding the risk of presenting multi-vessel stenosis even in patients with lower LDL-C.

e0376 Effect of metabolic syndrome on prognosis of revascularization in patients with coronary artery disease

Background The prevalence of the cardiovascular risk factors is growing. The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in-hospital and long term prognosis of CAD with metabolic syndrome, and to determine which factor that influencing the CAD prognosis most. Methods The DESIRE (Drug-Eluting Stent Impact on Revascularization) registry represents a database of 2368 patients with coronary artery disease (CAD) between Jul, 2003 and Sep, 2004. Media long-term follow-up was 3.5 years (293–1855 days). Metabolic syndrome was based on modified the Adult Treatment Panel (ATP) III Definition of the Metabolic Syndrome in 2005, using body mass index (BMI) instead of waist circumference. We tested the ability of MS and its components to predict the incidence of major adverse cardiac and cerebral events (MACCE) in a large cohort of patients undergoing revascularization. Results Presence of MACCE was predicted only by MS (adjusted OR (OR)=1.319, 95% CI 1.020 to 1.706, p=0.035) but not other risk factors of cardiovascular (such as elder, male, smoking, high LDL cholesterol, CAD family history). MS was present in 45.6% (high FG 44.5%; high TG 45.0%; low HDL 50.8%; high BP 61.4%; high BMI 60.7%). After follow-up in 3.5 years, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (18.9% vs 15.6%, p=0.036). In multivariable model of five factors of MS, MACCE was predicted by high FG (fasting glucose) (OR=1.047, CI 1.005 to 1.091) and low HDL (OR=0.777, CI 0.610 to 0.989). MS confers a higher risk of long-term MACCE in CAD patients with (OR=1.258, CI 1.010 to 1.607) or without diabetes (OR=1.139, CI 1.004 to 1.505). Conclusions The metabolic syndrome has primary predictive ability for MACCE in CAD patients, carried primarily by high FG and low HDL. MS confers a higher risk of long-term MACCE in CAD patients with or without diabetes.

e0453 Effect of blood pressure levels on prognosis in patients of non st segment elevated acute coronary syndrome without prior history of hypertension

Background Hypertension was an independent risk factor for affecting the prognosis of patients with ACS. But the effect of blood pressure levels at admission on prognosis in ACS patients without history of hypertension was not clear. Methods The DESIRE-2(Drug-Eluting Stent Impact on Revascularization-2) was a single-center registry of coronary revascularization in our institution between July 1st 2003 and Sep 30th 2005. The study excluded the patients with prior history of hypertension and myocardial infarction, the patients admitted to hospital with ST-segment elevated myocardial infarction and stable coronary artery disease, and the patients without detailed document record. Major adverse cardiac and cerebral events (MACCE) were the combination endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke and revascularization. Results The study enrolled 982 patients and divided into three groups according to the first measurement of blood pressure levels at admission. The 207 patients with blood pressure less than 120/80 mm Hg defined as normal blood pressure group, 209 patients with blood pressure more than 140/90 mm Hg as hypertension group, other patients as prehypertension group. Among three groups, there was no difference in age, gender, prior history of diabetes mellitus, coronary revascularization and smoking, body mass index, left ventricular ejection fraction, the levels of glomerular filtration rate, haemoglobin, total cholesterol, low density lipoprotein cholesterin, fasting glucose, glycolated haemoglobin. Severity of coronary artery and utilisation ratio of aspirin, β blocker, calcium channel blocker were similar in three groups. More patients taken statins (67.7%, 55.3%, 58.3%, p=0.013) and ACEI (41.1%, 27.6%, 27.8%, p=0.002) during the hospitalisation in hypertension group. Duration of follow-up in the normal, prehypertension and hypertension group was 522 days, 539 days and 523 days respectively. The in-hospital MACCE rates was similar in three groups, but higher follow-up MACCE rates (11.0%, 5.7%, 9.5%, p=0.035) and follow-up mortality rates (2.6%, 0.8%, 0%, p=0.026) in hypertension group. Conclusion The higher blood pressure levels at admission in non ST-segment elevated ACS patients without prior history of hypertension had poorer prognosis, but the history and clinical features were similar to patients with normal blood pressure.