Yew Seong Goh

Feasibility of Transradial Coronary Angiography and Intervention Using a Single Ikari Left Guiding Catheter for ST Elevation Myocardial Infarction

BACKGROUND Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients. METHODS This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis. RESULTS TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 - 119.5) versus 98 (IQR 80.8 - 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 - 45.0) versus 37 (IQR 28.0 - 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups. CONCLUSION In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI.

Prasugrel versus clopidogrel in Asian patients with acute coronary syndromes: design and rationale of a multi-dose, pharmacodynamic, phase 3 clinical trial

Abstract Background: Prasugrel is a third generation thienopyridine that is more potent, rapid in onset, and consistent in inhibition of platelets than clopidogrel. However, early prasugrel dose-ranging studies and the subsequent phase 3 TRITON-TIMI 38 trial were conducted primarily in Caucasian populations. Objectives: The current clinical study is designed to confirm superior inhibition of platelet aggregation with prasugrel versus clopidogrel in the treatment of Asian subjects with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Research design and methods: This is a phase 3, randomized, double-blind, multi-dose, four-arm parallel, multinational clinical trial. East and Southeast Asian patients (N = 715) with moderate- to high-risk ACS undergoing PCI will be randomized to one of three prasugrel dosing regimens (60 mg LD/10 mg MD; 30 mg LD/7.5 mg MD; 30 mg LD/5 mg MD) or clopidogrel (300 mg LD/75 mg MD) for 90 days. Main outcome measures: The primary endpoint is inhibition of platelet aggregation measured by the point-of-care Accumetrics VerifyNow P2Y12 device, and the primary analysis will be performed in a hierarchical manner for descending doses of prasugrel. Additional key endpoints include major adverse cardiovascular events, non-coronary artery bypass-graft (CABG) surgery-related TIMI bleeding, and genetic analyses of cytochrome P450 polymorphisms. Conclusions: This study is a phase 3, multi-dose, pharmacodynamic comparison of prasugrel versus clopidogrel in Asian patients with ACS undergoing PCI. It is the first study designed to investigate prasugrel therapy specifically in Asian ACS subjects, and will inform which doses of prasugrel are effective and safe for patients of Asian ethnicity. Trial registration: ClinicalTrials.gov identifier: NCT00830960.

COMPARING UTILIZATION OF TIMI RISK INDEX VERSUS KILLIP CLASS AT PRESENTATION IN DETERMINING THE NEED OF ADMISSION TO CORONARY CARE UNIT FOR ACUTE ST ELEVATION MYOCARDIAL INFARCTION PATIENT AFTER SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION: SINGLE CENTRE STUDY

Background: With the ever-increasing number of acutely ill patients with cardiac disease that need intensive monitoring and limited resources in coronary care unit (CCU), there is a need to ensure appropriate admission to CCU. Studies have shown that Killip 1 patients who had successful primary percutaneous coronary intervention (PPCI) for ST Elevation Myocardial Infarction (STEMI) can be admitted safely to a step-down unit. However, Killip class was a subjective assessment. We attempt to compare TIMI risk index {TRI = [heart rate X (age/10)2]/systolic blood pressure} versus Killip Class at presentation in determining the need of admission to CCU for STEMI patient after successful PPCI. TRI was a robust predictor (for STEMI patients on irst arrival in hospital) and high discriminatory capacity of in-hospital events in each of the ive risk subgroups.

TRANSRADIAL PERCUTANEOUS INTERVENTION IN ACUTE ST ELEVATION MYOCARDIAL INFARCTION USING A SINGLE HEARTRAIL IKARI LEFT GUIDER

Methods: This is a single centre case series of 213 patients who underwent PTRI by a single radial interventionist between May 2007 and December 2008. In 171 patients, a 6F Heartrail IL guider was used first for diagnostic angiography of the contra-lateral artery followed by cannulation of the infarct related artery (IRA) for PTRI (IL group). In 4 patients (1.9%) the radial artery could not be cannulated. The remaining 38 patients (Non-IL group) had a diagnostic angiography done with a multipurpose catheter followed by a selective guider. The examined outcome included the rate of success of primary PTRI, door to balloon time, procedure duration and volume of contrast used between the 2 groups. Major adverse cardiac events were examined at in-hospital, 30 days and 6 months.