W. van Gaal

Radiation Exposure with the Radial Approach for Diagnostic Coronary Angiography in a Centre Previously Performing Purely the Femoral Approach

INTRODUCTIONnUse of the radial approach for coronary angiography and percutaneous coronary intervention (PCI) is known to improve many patient outcome measures. However, there is some concern that it may be associated with increased patient radiation exposure. This study explores radiation exposure with the radial approach compared with the femoral approach in a centre previously performing purely femoral approach.nnnPATIENTS AND METHODSnData was collected retrospectively for all patients undergoing diagnostic coronary angiography over a six month period. PCIs and procedures with inherent technical difficulty or use of additional techniques (graft studies, optical coherence tomography, fractional flow reserve) were excluded. Dose area product (DAP) and fluoroscopy time (FT) were analysed for all remaining procedures (n=389), comparing radial (n=109) and femoral (n=280) approaches.nnnRESULTSnThe overall mean FT for transradial cases (7.45 mins) was significantly higher than for transfemoral cases (4.59 mins; p<0.001). The overall mean DAP for transradial cases (95.64 G Gycm(2)) was significantly higher than for transfemoral cases (70.25 Gycm(2), p<0.05)). Neither the FT nor the DAP decreased over the six month period.nnnCONCLUSIONnThe radial approach was associated with significantly higher DAP and FT compared to the femoral approach during an initial introductory phase which was likely insufficient to develop radial proficiency. The results of this study are consistent with previous studies and may influence choice of access for non-emergent diagnostic coronary angiography before radial proficiency has been established, particularly for patients more susceptible to radiation risks.

Results of primary percutaneous coronary intervention in a consecutive group of patients with acute ST elevation myocardial infarction at a tertiary Australian centre

Background: Multicentre randomized controlled trials (RCT) of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) have consistently shown lower mortality compared with fibrinolysis, if carried out in a timely manner. Although primary PCI is now standard of care in many centres, it remains unknown whether results from RCT of selected patients are generalizable to a ‘real‐world’ Australian setting. The primary goal of this study was to evaluate whether a strategy of routine invasive management for patients with STEMI can achieve 30‐day and 12‐month mortality rates comparable with multicentre RCT. Secondary goals were to determine 30‐day mortality rates in prespecified high‐risk subgroups, and symptom‐onset‐ and door‐to‐balloon‐inflation times.

Bleeding risk and incidence in real world percutaneous coronary intervention patients with ticagrelor

Dual antiplatelet therapy with 75-100 mg Acetyl Salicylic Acid (ASA) and a novel antiplatelet (Adenosine Diphosphate Receptor inhibitor or P2Y12 inhibitor) is the current standard of care following Acute Coronary Syndromes i.e. ST Elevation Acute Coronary Syndrome (STEACS), Non-ST Elevation Acute Coronary Syndrome (NSTEACS) and unstable angina [1]. The Platelet Inhibition and Patient Outcomes (PLATO) trial showed that the oral P2Y12 inhibitor Ticagrelor has significant clinical superiority compared with clopidogrel in the reduction of mortality, recurrent myocardial infarction, instent restenosis and stroke at one year [2]. Despite improved efficacy, Ticagrelor prescription increased peri-procedural and spontaneous bleeding ranging from minor to fatal events [3]. Reduction of blood volume and anaemia can lead to complications such as hypovolaemic shock and myocardial ischaemia due to supply and demand imbalance (type 2 myocardial ischaemia). Bleeding within 30 days post event is shown to impact long-term prognosis adversely. Furthermore, non-access site bleeding increases one year mortality rate to two-fold [4]. Multiple studies with various baseline demographics using various bleeding definitions including Thrombolysis In Myocardial Infarction (TIMI), Bleeding Academic Research Consortium (BARC) and Platelet Inhibition and Patient Trial (PLATO) show different predisposing factors