Nadim Shah

Complex Transradial Percutaneous Coronary Intervention Using a Sheathless Guide Catheter

BACKGROUND Radial access for percutaneous coronary intervention (PCI) has been shown to reduce access site complications, improve patient comfort and reduce mortality. Use of a sheathless guiding catheter for transradial PCI has the potential reduce trauma to the radial artery and to further expand the type of cases where this approach can be utilised. We report our initial experience with the recently developed Sheathless Eaucath. METHODS We retrospectively evaluated outcomes in consecutive patients who underwent PCI using the Sheathless Eaucath at our institution between February 2009 and November 2011. All procedures were performed via radial access. There were no exclusion criteria. RESULTS The study included 120 patients. Of these 87 (72.5%) presented with acute coronary syndromes. Primary PCI was performed in nine and rescue PCI in seven patients. Interventions were performed on a total of 147 lesions. The majority of lesions were complex (68% classified as type B2 or C). Bifurcation lesions were treated in 42.5% and chronic total occlusions in 5% of patients. Adjunctive devices including rotablation, IVUS and 6 or 7 Fr thrombus aspiration catheters were used in 30% of patients. Angiographic success was achieved in 97.5%. Five patients suffered peri-procedural non-ST-elevation myocardial infarctions. There was no in-hospital target vessel revascularisation or death. Peri-procedural radial artery occlusion was infrequent (2.3%). Haematomas larger than 5cm occurred in two patients. No other vascular complications occurred. CONCLUSION Use of the Sheathless Eaucath is safe and allows complex interventions to be undertaken transradially with a high success rate.

Screening for asymptomatic coronary heart disease in the young ‘at risk’ population: Who and how?

Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.

Outcomes Following Conservative Management of Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is a rare but a serious cause of myocardial ischaemia and infarction that occurs most frequently in younger female patients. The management of this rare condition remains controversial. In this case series we describe the spectrum of outcomes observed following conservative management.

Prevalence of Asymptomatic Coronary Heart Disease in the Siblings of Young Myocardial Infarction Patients as Detected by Coronary Computer Tomography Angiography: A Pilot Study

BACKGROUND There is little data on the prevalence of coronary heart disease (CHD) in the young. The study aimed to estimate the prevalence of asymptomatic CHD in siblings of young patients with myocardial infarction (MI) using coronary computed tomography angiography (CCTA). METHODS Prospective observational data was collected on siblings of patients aged ≤55 years presenting with acute MI and having coronary stenosis ≥50% on invasive coronary angiography in at least one epicardial coronary artery. Inclusion criteria included ages 30-55 and 30-60 years for males and females respectively. Outcome of interest was obstructive CHD by coronary computer tomography angiography (CCTA), which was defined by either moderate (50-69% stenosis) and/or severe (≥70% stenosis). RESULTS Fifty participants were studied of whom 20 (40%) were male. Thirty (60%) were current or ex-smokers, 4 (8%) had diabetes, 8 (16%) had hypertension and 26 (52%) had dyslipidaemia. Obstructive CHD by CCTA was detected in 9 (18%, 95% CI 9%-31%) participants and 3 (6%, 95% CI 1%-17%) participants were found to have severe luminal stenosis. The median radiation dose was 3.9 (IQR 0.9) mSv. CONCLUSIONS Approximately a fifth of siblings of young MI patients were found to have asymptomatic but obstructive CHD detected on CCTA of which one third was severe. This is a group in whom screening for CHD warrants further investigation.