Diagnostic Coronary Angiogram Research Articles

Acute coronary syndrome and Khat consumption in Yemeni women admitted to Coronary Care and Intensive Care in major hospital in Yemen

Background: There is a significant percent of normal coronaries in patients with a history of documented myocardial infarction among Yemeni patients who have undergone diagnostic coronary angiogram, and they theoretically attributed that to the effect of Khat as a vasoconstrictor to the coronary artery. Also, unadjusted comparisons of mortality and major morbidity after acute myocardial infarction have generally indicated that women have a poorer outcome than men. Methods: Data was collected prospectively from 15 hospitals in 8 governorates with acute coronary syndrome registry in the Gulf countries. All female patients who were admitted in any monitored bed in Coronary Care Units (CCU) or Intensive Care Units (ICU) with a provisional diagnosis of acute coronary syndrome (ACS) were included in the study. The presentations with khat chewing were compared with all other known and documented risk factor outcomes among women using multiple logistic regressions. Results There were 50.5% regular khat chewers of female patients at presentations to the general emergency department with an attack of acute coronary syndrome; 14.4% of all female patients have no other risk factors except khat. These patients were relatively younger and had a lower body mass index (BMI) when compared with the incidence of acute events in other populations. They had no significantly worse outcome during hospitalization in comparison to the males of the same age group. Conclusions It seems likely that there is at most only an intermediate association between Khat and the development of acute coronary syndrome in females, with less mortality and morbidity after suspected acute myocardial infarction. However, a larger study is needed, with more complete adjustment for coexisting risk factors, to determine whether the female has a worse outcome, which increases with khat.

Development and validation of a novel angiography-derived index of absolute coronary blood flow and resistance.

Intracoronary continuous thermodilution has been recently proposed as an invasive method to quantify absolute coronary flow (Qabs) and resistance (Rabs) in vivo. The aim of the present study is to develop and validate of a novel pressure-wire- and microcatheter-free surrogate of coronary flow and resistance derived from a standard coronary angiogram. Angiography derived coronary flow (Qangio) and resistance (Rangio) was prospectively validated in a two-center cohort of patients from Oxford Heart Centre and the Essex Cardiothoracic Centre. Qabs and Rabs were measured during resting and hyperemic conditions with continuous thermodilution using the Rayflow microcatheter. Qangio and Rangio were computed from the diagnostic coronary angiogram in a blinded fashion in resting and hyperemic conditions. A total of 62 patients and 115 vessels were included in the present analysis. The median Qabs at rest was 75ml/min (53-95) and 151ml/min (105-203) during hyperemia; Qangio at rest was 84ml/min (66-108) and 154ml/min (115-195) during hyperemia. There was a strong correlation between Qabs and Qangio (R = 0,72; p < 0.001, R = 0,86; p < 0.001 respectively) with satisfactory interclass correlation (0.841, 95% CI 0.509-0.957; p = 0.0003). The median Rabs was 1111 mmHg/(L/min) (830-1581.4) at rest and 454 mmHg/(L/min) (348-610) during hyperemia; angiographic resistance (Rangio) was 937.4 mmHg/(L/min) (695.4-1261.9) at rest and 492.4 mmHg/(L/min) (406-697) during hyperemia. There was a strong correlation between Rabs and Rangio in both conditions (R = 0,81; p < 0.001 and R = 0,78; p < 0.001 respectively). The was a good correlation between absolute coronary flow reserve (CFR) and angiography-derived CFR (R = 0,61; p < 0.001) and between absolute microvascular resistance reserve (MRR) and angiography-derived MRR (R = 0,49; p < 0.001).

Relationship of body mass index on the radiation exposure of patient in diagnostic coronary angiogram through radial route by dose area product

Relationship of body mass index on the radiation exposure of patient in diagnostic coronary angiogram through radial route by dose area product

Impact of Diabetes in Individuals Undergoing Diagnostic Coronary Angiogram

Impact of Diabetes in Individuals Undergoing Diagnostic Coronary Angiogram

Analysis of the Weekend Effect on Mortality, Diagnostic Coronary Angiography, and Percutaneous Coronary Intervention in Acute Myocardial Infarction Across Rural US Hospitals.

Rural hospitals face several unique challenges in delivering healthcare to an underserved population. Achieving time-sensitive goals in a resource-scarce facility is often a difficult task without the right team at hand. Resources are further depleted on the weekends, exposing understaffed hospitals to poorer outcomes. Acute myocardial infarction (AMI) mortality depends on timely diagnosis and intervention. It is unknown to what extent resource shortages impact rural hospitals during weekends and how they affect AMI mortality. This cross-sectional study was performed on patients admitted on weekends with AMI using the National Inpatient Sample (NIS) 2019. Patients with type II non-ST-elevation myocardial infarction (NSTEMI) and missing information were excluded. The rates and timing of in-hospital diagnostic coronary angiograms, PCIs (percutaneous coronary interventions), and in-hospital mortality were studied. Regression models were used for data analyses. A total of 161,625 patients met the inclusion criteria (58,690 females (36%), 114,830 Caucasians (71%), 17,910 African American (11%), 13,920 Hispanic (8.6%); mean (SD) age, 66.5 (0.5) years), including 47,665 (29.5%) ST-elevation myocardial infarction (STEMI) and 113,960 (70.5%) NSTEMI. Patients admitted to rural hospitals were less likely to undergo diagnostic coronary angiogram (adjusted odds ratio (aOR), 0.69; CI, 0.57-0.83; p<0.001) and PCI (aOR, 0.83; CI, 0.72-0.96; p 0.012). Rural hospitals had lesser odds of early diagnostic angiograms (aOR, 0.79; CI, 0.67-0.95; p<0.05) and PCI (aOR, 0.78; CI, 0.66-0.92; p<0.05) within 24 hours. The mortality difference between rural and urban hospitals was not significant (aOR, 1.08; CI, 0.85-1.4; p 0.52). Diagnostic coronary angiograms and PCI are performed at a lesser rate in rural hospitals during weekends. This trend did not affect rural AMI mortality.

Prolonged turbulence and deposition of LDL cholesterol caused atherosclerotic lesion in femoral arteries and spared the iliac arteries. Why? A dynamic angiography and machine learning analysis

Abstract Background In the care of patient with atherosclerotic disease, some arterial segments were more prone to have lesion, while the whole arterial system was exposed with the same risk factors (hypertension, diabetes or hyperlipidemia, etc). Our team used the principles and practices of fluid mechanics to investigate the mechanism of atherosclerotic disease. In short, laminar flow protects the pipes or arteries while the turbulent flow damages the intima and starts the atherosclerotic process. In this study, our question is: Why many patients with peripheral arterial disease (PAD) had diffuse lesions in the femoral arteries while the iliac arteries showed only minimal or no lesion? Could a new dynamic angiographic review and Deep Learning analysis answer the above question? Method All patients who underwent diagnostic coronary angiogram or interventions were selected. After the procedure, an iliac and femoral angiogram were performed for vessel closure device deployment. At first, the iliac and femoral artery was filled completely with contrast, then the blood (in white color) moved down and replaced the black contrast. All images were recorded at 15 frames per second. The movement of blood flow, its shape (laminar or turbulent), direction (antegrade or retrograde) were identified and tabulated. At the same time, the Deep Learning models were trained based on the convolutional neural network. The U-net combined Densenet121 was used to train model number one to recognize the coronary and detect the stenosis area. Next, the CNN model was used to classify the stagnant flow. The patients with lesions in the iliac or femoral arteries were selected. The characteristics of the flow proximal and at the lesion site were selected and compared. Results 50 cases (70% male) met our criteria with 80% lesions at femoral arteries (figure 1) while only 20 % had lesions in the iliac arteries. The turbulent flow was seen in both arteries however it was persistent in the femoral arteries while in the iliac arteries, turbulent flow was intermittent with 40% of the time in laminar flow. The analysis by the Deep learning model had sensitivity in the detection of turbulent flow 0.91 and the sensitivity was 0.96. The explanation was that the persistent turbulent flow in the femoral arteries injured the intima However the laminar (non-turbulent flow) in the iliac arteries carried the LDL particle further distally and deposited them at the femoral level. This is why there were more atherosclerotic plaques in the femoral level than in the iliac arteries. Conclusion Persistent turbulence causes more damage to the intima in the femoral arteries while intermittent turbulence did less damage to the iliac arteries. LDL cholesterol while in suspension at the iliac level were carried and deposited in the femoral arteries. This sequence of event explained the predilection of femoral arteries diffuse lesions. Larger studies with more patients are needed to confirm the above results.Diffuse lesion in femoral artery

Abstract 18517: Meta-Analysis of Radiation Exposure With Transradial versus Transfemoral Access for Diagnostic Coronary Angiography and Percutaneous Coronary Intervention

Background: Transradial (TR) access for cardiac catheterization offers advantages over conventional transfemoral (TF) access by reducing bleeding and vascular complications. However, concerns exist regarding potential increased radiation exposure with TR access. The benefit-risk profile due to increased radiation exposure by this technique remains uncertain. We compared radiation exposure for diagnostic coronary angiograms (DCA) and percutaneous coronary interventions (PCI) between TR and TF access. Methods: We searched PubMed, Google Scholar, and Scopus through May 2023 for randomized control trials and observational studies comparing radiation parameters for TR and TF access sites. We compared fluoroscopy time (FT, min) and kerma-area product. The summary estimate was random-effects weighted mean differences (WMDs) with 95% confidence intervals. Results: A total of 33 studies (n = 89,366) were included in the analysis. TR was associated with increased FT (WMD 0.94 [0.61, 1.27] p&lt;0.01) vs. TF access, which was consistent for both DCA (WMD 0.71 [0.20, 23]) and PCI subgroups (WMD 1.09 [0.61, 1.58]) (p for interaction = 0.29). There were no significant differences for the kerma-area product (WMD -0.20 [-0.59, 0.19], p=0.32) between the two access sites, consistent for both DCA (WMD -0.04 [-0.40, 0.32]) and PCI (WMD -0.32 [-0.59, 0.19]) (p for interaction = 0.51) as shown in Figure 1 . Conclusion: TR was associated with increased FT; however, the two access sites had no significant differences concerning kerma-area products.

Deep Learning to Estimate Left Ventricular Ejection Fraction From Routine Coronary Angiographic Images

BackgroundCine images during coronary angiography contain a wealth of information besides the assessment of coronary stenosis. We hypothesized that deep learning (DL) can discern moderate-severe left ventricular dysfunction among patients undergoing coronary angiography. ObjectivesThe purpose of this study was to assess the ability of machine learning models in estimating left ventricular ejection fraction (LVEF) from routine coronary angiographic images. MethodsWe developed a combined 3D-convolutional neural network (CNN) and transformer to estimate LVEF for diagnostic coronary angiograms of the left coronary artery (LCA). Two angiograms, left anterior oblique (LAO)-caudal and right anterior oblique (RAO)-cranial projections, were fed into the model simultaneously. The model classified LVEF as significantly reduced (LVEF ≤40%) vs normal or mildly reduced (LVEF>40%). Echocardiogram performed within 30 days served as the gold standard for LVEF. ResultsA collection of 18,809 angiograms from 17,346 patients from Mayo Clinic were included (mean age 67.29; 35% women). Each patient appeared only in the training (70%), validation (10%), or testing set (20%). The model exhibited excellent performance (area under the receiver operator curve [AUC] 0.87; sensitivity 0.77; specificity 0.80) in the training set. The model’s performance exceeded human expert assessment (AUC, sensitivity, and specificity of 0.86, 0.76, and 0.77, respectively) vs (AUC, sensitivity, and specificity of 0.76-0.77, 0.50-0.44, and 0.90-0.93, respectively). In additional sensitivity analyses, combining the LAO and RAO views yielded a higher AUC, sensitivity, and specificity than utilizing either LAO or RAO individually. The original model combining CNN and transformer was superior to DL models using either 3D-CNN or transformers. ConclusionsA novel DL algorithm demonstrated rapid and accurate assessment of LVEF from routine coronary angiography. The algorithm can be used to support clinical decision-making and form the foundation for future models that could extract meaningful data from routine angiography studies.

A SURVIVAL STORY OF 47 YEARS OLD MALE WITH ACUTE TOTAL OCCLUSION OF LEFT MAIN AND COEXISTING OSTIAL RIGHT CORONARY ARTERY LESION

Left main coronary artery (LMCA) thrombus occlusion causing acute coronary syndrome is an uncommon event and associated with severe life-threatening presentations. The clinical outcome depends on the age of the patients, presence of cardiogenic shock and the presence of dominant Right Coronary Artery (RCA) Early reperfusion is associated with improved outcomes. A 47-years man presented with sudden substernal burning sensation and dry cough for 1 hour. Coronary angiography revealed an acute totally occlusion of ostial left main (LM) with TIMI flow grade 0 and dominant RCA with ostial 80% stenosis having TIMI flow grade 3 and Grade 1 contralateral collaterals from RCA to left system. Emergency percutaneous coronary intervention (PCI) was performed to ostial LMCA toward the proximal LAD to cover the whole LMCA and stage PCI was performed to ostial RCA. Patient was discharge on 7th day with good general condition. An electrocardiographic pattern is associated with collateral filling territories in unprotected left main (ULM) occlusion. In our case diagnosis was completely made after diagnostic coronary angiogram. Acute total occlusion of LMCA is associated with arrhythmias, cardiogenic shock and sudden death. However, Patient was hemodynamically stable that showed indubitably the importance of dominant RCA with TIMI 3 flow and Grade 1 contralateral collaterals to left coronary circulation. We perform successful primary PCI of acute total occluded LMCA which shortened the ischemic time to salvage the ischemic myocardium.

3D-Printing-Based Fluoroscopic Coronary Angiography Simulator Improves Learning Capability Among Cardiology Trainees.

One of the essential competencies of cardiology trainees is the ability to perform coronary angiography with good projection. This study is a research and development study aimed at testing the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulator as a learning medium for diagnostic coronary angiogram. Thirty-four cardiology trainees randomly were divided into two groups. Both groups took a pretest before the intervention. The first group (group A) studied using conventional learning media and underwent the first post-test. Afterward, they switched to a 3D-printing-based fluoroscopic coronary angiography simulator and underwent a second post-test. The second group (group B) studied using a 3D-printing-based fluoroscopic coronary angiography simulator, underwent the first post-test, switched to the conventional learning media, and underwent a second post-test. The delta between the post-test I and the pretest of group B was 8.53, higher than the delta between the post-test I and the pretest of group A (5.21) with a significant difference (p = 0.003). In group A, the delta between post-test II and pretest was 9.65, higher than the delta between post-test I and pretest (5.21) with a significant difference (p < 0.001). 3D-printing-based fluoroscopic coronary angiography simulator is effective as a learning medium for coronary angiogram diagnostics.

Role of albumin creatinine ratio in predicting of coronary artery disease

The present study was done to investigate the association between the level of micro albuminuria and the severity of coronary artery disease angiographically. The study is conducted on 70 patients who underwent coronary angiography in many cardiac centres (NHI, PAMCC) in National heart Institute and Arar cardiac centre Saudi Arabia. The population study was divided into 2 groups according to micro albuminuria. Group (I) include 46 patients with angiographic evidence of coronary heart disease and without micro albuminuria. Group (II) include 24 patients with angiographic evidence of coronary heart disease and having micro albuminuria. Patients are subjected to full medical history, through physical examination. 12 lead ECG, fasting blood sugar, Lipid profile, blood urea and serum creatinine levels are obtained. Urinary albumin was measured by Stanbio Total Protein LiquiColor based on the procedure developed by Watanabe et al. Creatinine was measured by creatinine jaffe`reaction.. The ratio of urine albumin to creatinine (ACR) was used to define microalbiminuria .The upper normal limit is 30 mg/g. Conventional Echo Doppler study using (Vivid 7, General Electric-Vingmed) was done to assess EF%. A diagnostic coronary angiogram was performed to assess the severity of CAD according to number of vessels affected and Gensini score estimation. Our study group comprised 70 patients; 56% were men and 44% women; 64% of them were hypertensive, 68% of them were dyslipidemics, 58 of them were smokers, 43% of them were with high BMI and 48% of them have a positive family history of CHD. The mean age was 58.850 ± 11.949 years (ranges from 33 to 81 years). As per Cath Results; 36% CA results were normal, 38% CA results had a one vessel disease and 26% CA results had multivessel disease. For Albumin Creatinine ration 60% had normal results and 40% had abnormal albumin creatinine ratio; of those with high ALB/CR ratio 42% of them had a one vessel disease and 58% of them had multivessel disease. It is also found that micro albuminuria is productive for CAD independently with other risk factors It seems that micro albuminuria increase severity and number of CAD lesions and aggressive treatment of micro albuminuria may beneficial in CAD patients

122 A SWORD IN THE STONE - A STEMI AFTER MIAVR

Abstract Background Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions (mini-sternotomy and right anterior mini-thoracotomy approaches) and minimized degree of surgical intrusiveness. Compared with conventional surgery, it has been shown to reduce postoperative mortality, providing faster and shorter recovery, requires less rehabilitations resources and consequently cost reduction. Even though MIAVR has considered as a safe and acceptable surgical technique, higher learning curve and requirement for re-training should be endorsed as procedural limitations. Among procedural related complications, embolic events still remain the most serious. Clinical case A 70-year-old man, due to increasing dyspnea and chest pain came to emergency department. His medical history was notable for cigarettes smoke, dyslipidemia, non insuline dependent type 2 diabetes mellitus and hypertension. No abnormal electrocardiografic alterations. A transtoracic echocardiogram was performed showing, Left ventricular ejection fraction 50%, no wall motion abnormalities and thickened, ipomobil and calcified aortic valve cusps assessing a diagnosis of severe aortic stenosis. He was conducted to the cath-lab for a diagnostic coronary angiogram which showed a no-significant atherosclerotic disease. After Heart Team evaluation, MIAVR was the suitable and optimal management indicated for the patient. Four hours after ending surgical procedure, ST segment elevation suddenly appears on DII, DIII and aVF leads. Emergency coronary angiogram showed an acute occlusion of the proximal circumflex artery. After several unsuccessful attempts to cross the occlusion with different types of workhorse guidewires, we considered the cause of uncrossability was not a thrombus but a debris calcium embolus detached from valve apparatus. After failed attempts using FineCross, SuperCross 90° provided adequate support to gaining access and enhancing the penetrating power of guidewire; we put the guidewire distally through the Mo2 with partial flow regain. Then we proceeded to modify the plaque geometry with a NC balloon to help crossing guidewire through distal Cx. So we’ve passed over the lesion gaining Cx periphery with a Fielder XT guidewire and we’ve proceeded to prepare the lesion thorugh progressive NC balloon dilatations. At the end we’ve implanted a 3.5/15 mm DES on mid Cx. Conclusion As MIAVR has being more common in the last twenty years, it is useful knowing how to manage any possible related peri-operative complications. Calcific valve is a very uncommon source of coronary debirs embolization. Coronary embolism is associated to worse outcomes: early diagnosis and revascularization must be required. Knowledge of CTO techniques and materials (guidewires, microcatheters) for a “non-CTO” dedicated operators could be useful in several scenarios, such as that encountered in the present case.

647 COMPLEX PERCUTANEOUS CORONARY INTERVENTION IN HIGHT BLEEDING AND THROMBOTIC RISK PATIENT: WHICH ANTITHROMBOTIC THERAPY?

Abstract Background Antiplatelet therapy is required in patients with atherosclerotic coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Current European and American guidelines recommend 6 months of DAPT in CCS and 12 months after ACS. However, a shorter duration of DAPT may be considered in high bleeding risk (HBR) patients, and a longer duration in those at higher thrombotic risk (HTR). To minimize the risk of thrombotic and bleeding events of an individual patient and therefore improve the overall outcomes of PCI, risk stratification is essential. In particular, bleeding and thrombotic characteristics must be weighed on a case-by-case basis to tailor antiplatelet therapy strategies and decisions over a patient's individual risk profile. We describe an illustrative case of complex PCI in patient with ACS in which defining the appropriate duration of DAPT is a clinical challenge. Clinical case A 68-year-old man with ACS-NSTEMI and anemia was hospitalized in intensive care unit. His medical history was notable for hypertension, dyslipidemia, diabetes mellitus, diabetic retinopathy, chronic kidney disease (CKD) and paroxysmal atrial fibrillation. A transthoracic echocardiogram showed left ventricular ejection fraction of 30% with diffuse hypokinesia, without relevant valvular disease. He was conducted to the cath-lab for a diagnostic coronary angiogram which showed a three-vessel critical CAD. After Heart Team evaluation coronary artery bypass surgery (CABG) was indicated. However, during the hospitalization in intensive care unit there was a worsening of clinical conditions with cognitive impairment due to mesencephalic stroke leading to a new Heart Team assessment that indicated PCI after stabilization of clinical scenario. After two weeks patient was conducted to the cath-lab to undergoing an IVUS guided PCI. PCI of the right coronary artery was performed with implantation of 1 DES (3.0/30 mm) on the middle segment and 1 DES (4.0/15 mm) on the ostial segment. PCI of the left main bifurcation was performed with implantation of 2 DES (4.0/28 mm) with culotte technique. Patients have both HBR and HTR, therefore, after procedure, the new trade off model score introduced by the Academic Research Consoritum (ARC) was applied. Based on his risk factor, the predicted 1-y risk of BARC type 3 to 5 bleeding (51.41%) was greater than the predicted 1-y risk of myocardial infarction or stroke (25.00%). Based on this result we decided to prescribe Triple antithrombotic therapy for 1 week, dual antithrombotic therapy for 12 months and after only oral anticoagulation. Conclusion In the context of patient with several risk factor undergoing complex PCI the stratification of bleeding and thrombotic individual risk is mandatory to define the appropriate duration of DAPT. The new trade-off model score is an important useful tool to identify patients who might benefit from individualized DAPT durations depending on the balance between HBR and HTR characteristics.

Abstract 15572: Utility Trends and Outcomes of Fractional Flow Reserve (FFR) in Diagnostic Coronary Angiograms for Patients With Stable Angina: National Readmission Database (2016-2019)

Background: In patients with intermediate severity stenosis in a coronary artery, FFR has become the gold standard to measure myocardial ischemia and facilitate the clinical decision regarding the need for revascularization. However, when compared to angiography, it is still underutilized in clinical practice to guide PCI. Our research investigates the difference in outcomes between angiography with versus without the measurement of FFR in real-world data. Methods: National readmission databases 2016-2019 were used to identify patients with CAD undergoing coronary angiogram with versus without FFR using ICD-10 codes. We excluded cases who had Acute Coronary Syndrome (ACS), revascularization by PCI or CABG in the index admission or was performed in the last 6 months of each year to allow time for follow-up. Primary outcomes of the study were 6-months ACS admissions, Secondary outcomes include 6-months revascularization by PCI or CABG and mortality. We matched both cohorts using propensity score matching (PSM) and performed logistic regression to compute the odds ratios (ORs) and corresponding 95% confidence intervals (CI). Results: Out of 1,039,508 angiography procedures done in the USA, 68,767 (6.6%) cases FFR were used, trends of FFR utilization are noted in figure 1. After propensity score matching, our cohort included 31,469 patients with angiography alone and 31,637 angiography with FFR. At six months of follow-up, there was no significant difference in readmission rates due to ACS, OR 0.84 (95%, 0.69-1.03, P=0.098) or revascularization by PCI/CABG, OR: 1.07 (95% CI, 0.92-1.23, P=0.39). However, there was a significant reduction in mortality in the FFR group compared to the angiography alone group OR 0.81 (95% CI, 0.69-0.94, P&lt;0.01). Conclusion: In this nationally representative cohort, our study shows that angiography with FFR is associated with decreased mid-term mortality. In the USA, FFR utilization rate during Angiography remains minuscule (6.6%).

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/Aims Coronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter. Methods A descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography. Results Female participants reported greater difficulty in recalling treatment information (P&lt;0.03), found discussions about alternative treatments more confusing (P&lt;0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P&lt;0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P&lt;0.002). Conclusions Patients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent.

Spanish cardiac catheterization and coronary intervention registry. 31st official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2021)

Introduction and objectivesThe Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2021. MethodsAll Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. ResultsA total of 121 centers participated (83 public and 38 private). Compared to 2020, both diagnostic coronary angiograms and percutaneous coronary interventions (PCI) increased by 11,4% and 10,3%, respectively. The radial approach was the most used access (92,8%). Primary PCI also increased by 6.2% whereas rescue PCI (1,8%) and facilitated PCI (2,4%) were less frequently conducted. Transcatheter aortic valve implantation was one of the interventions with the most relevant increase. A total of 5720 transcatheter aortic valve implantation procedures were conducted with an increase of 34,9% compared to 2020 (120 per million in 2021 and 89,4 per million in 2020). Other structural interventions like transcatheter mitral or tricuspid repair, left atrial appendage occlusion and patent foramen oval closure also experienced a significant increase. ConclusionsThe 2021 registry demonstrates a clear recovery of the activity both in coronary and structural interventions showing a relevant increase compared to 2020, the year of the COVID-19 pandemic.

Registro español de hemodinámica y cardiología intervencionista. XXXI informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2021)

Introduction and objectivesThe Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2021. MethodsAll Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. ResultsA total of 121 centers participated (83 public and 38 private). Compared to 2020, both diagnostic coronary angiograms and percutaneous coronary interventions (PCI) increased by 11,4% and 10,3%, respectively. The radial approach was the most used access (92,8%). Primary PCI also increased by 6.2% whereas rescue PCI (1,8%) and facilitated PCI (2,4%) were less frequently conducted. Transcatheter aortic valve implantation was one of the interventions with the most relevant increase. A total of 5720 transcatheter aortic valve implantation procedures were conducted with an increase of 34,9% compared to 2020 (120 per million in 2021 and 89,4 per million in 2020). Other structural interventions like transcatheter mitral or tricuspid repair, left atrial appendage occlusion and patent foramen oval closure also experienced a significant increase. ConclusionsThe 2021 registry demonstrates a clear recovery of the activity both in coronary and structural interventions showing a relevant increase compared to 2020, the year of the COVID-19 pandemic.

Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures

The aim of this study is to investigate the effectiveness of dose reducing software (ClarityIQ) on patient and staff dose during fluoroscopically guided cardiac procedures. Dose measurements were collected in a room without dose reducing software (n = 157) and compared with similar procedures performed in two rooms with the software (n = 1141). Procedures included diagnostic coronary angiography, percutaneous coronary intervention, deployment of cardiac closure devices (for occlusion of atrial septal defect, patent foramen ovale, and atrial appendage) and insertion of permanent pacemakers. The dose reducing software was found to be effective in reducing patient and staff dose by approximately 50%. This study has added to the limited literature reporting on the capability of dose reducing software to decrease radiation exposure during the implantation of cardiac closure devices, as well as demonstrating a reduction in dose to the cardiologist and nursing staff. Administrators should ensure timely upgrades to angiographic equipment to safeguard patients and staff against the potentially adverse effects of radiation exposure. Regardless of the use of dose reducing software, the mean occupational dose during closure devices was in descending order scout > scrub > cardiologist. Scrub nurse dose was found to be higher than the cardiologist during closure devices (0.98/0.26 μSv) and diagnostic coronary angiograms (1.51/0.82 μSv). Nursing staff should be aware that their levels of radiation dose during some cardiac procedures may come close to or even exceed that of the cardiologist.

Patient experience of informed consent for diagnostic coronary angiogram and follow-on treatments

Background/AimsCoronary angiography requires a complex informed consent process as a legal and ethical requirement before treatment. This process may allow percutaneous coronary intervention to be completed as a continuation of a coronary angiography. Patients routinely consent to both interventions, but over one-quarter will only receive the diagnostic angiogram. This study explored views and understandings of the informed consent process, and associations with demographic characteristics, among patients who consented to coronary angiography and same-setting percutaneous coronary intervention, but were found to be ineligible for the latter.MethodsA descriptive cross-sectional survey design was used to explore patients' views. A total of 62 participants (73% male, mean age 68.4 years) completed a 36-item survey the day after undergoing diagnostic coronary angiography.ResultsFemale participants reported greater difficulty in recalling treatment information (P&lt;0.03), found discussions about alternative treatments more confusing (P&lt;0.02), and the disclosure of comprehensive risk information more of a deterrent to consent for treatment (P&lt;0.02) compared to men. Higher levels of education were associated with greater preference for information and involvement in treatment decisions (P&lt;0.002).ConclusionsPatients who give informed consent for diagnostic coronary angiography with or without a same-setting percutaneous coronary intervention need clear comprehensive information regarding alternative options. By recognising the patient's need for information, nurses can provide an individualised explanation and reinforcement of the information provided during informed consent.

Axillary and Brachial Artery Thrombosis after Left Radial Access for Coronary Angiography

One case of brachial artery occlusion and no cases of axillary artery occlusions have been reported in the literature. Here we describe a case of a 50 years old female who presented for diagnostic coronary angiogram after having a positive stress test who developed a brachial, axillary and radial artery thrombosis after left transradial access.