Percutaneous Transluminal Coronary Angioplasty Procedures Research Articles

An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels.

The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.

Association between Pfizer-BioNTech mRNA vaccine and myocardial infarction: clinical and angiographic insights.

With the widespread administration of the BioNTech mRNA-based COVID-19 vaccine, there is a need to evaluate its potential effects on cardiovascular health, particularly its association with myocardial infarction (MI). This study aimed to investigate the relationship between BioNTech vaccination and MI, as well as its impact on clinical and angiographic parameters. A retrospective analysis was conducted at the Eskisehir Osmangazi University, Eskisehir City Hospital, between April 2020 and May 2023 on a cohort of 1 151 patients hospitalised with MI. The patients were stratified into a BioNTech+ (vaccinated) and a BioNTech- (unvaccinated) groups. Medical records were reviewed for demographic information, clinical data and angiographic findings. Statistical analyses were performed, including logistic regression models adjusting for potential confounders. The BioNTech- group had a higher mean number of percutaneous transluminal coronary angioplasty procedures and stents compared to the BioNTech+ group. Haematological parameters and lipid profiles showed some discrepancies between the two groups. The BioNTech- group had higher white blood cell and platelet counts, while also exhibiting a higher mean low-density lipoprotein cholesterol level. The prevalence of co-morbidities and cardiovascular risk factors differed between the groups. This study found associations between the BioNTech vaccination and clinical and angiographic parameters in patients with MI.

Coronary Stent Infections: A Case of Pericardial Abscess and Stent Displacement After Repeated PTCA Procedures Which Required an Emergency Surgery

We report the case of a 50-year-old male patient with hypertension, peripheral artery disease, history of smoking and drug abuse and a hypercoagulability state, who underwent several percutaneous transluminal coronary angioplasty procedures for ST-elevation myocardial infarction first and for stents thrombosis then, complicated with sepsis, epistenocardic pericarditis, left ventricle aneurism and coronary stent abscess which required an emergency surgical treatment.

EPH224 Temporal Trends of Percutaneous Transluminal Coronary Angioplasty Procedure and Mortality Rates in the Brazilian Public Healthcare: A Real World Data Analysis From 2014 to 2022

EPH224 Temporal Trends of Percutaneous Transluminal Coronary Angioplasty Procedure and Mortality Rates in the Brazilian Public Healthcare: A Real World Data Analysis From 2014 to 2022

A Study to Assess the Effectiveness of Structured Teaching Program (STP) on Knowledge Regarding Preventive Precaution of Percutaneous Transluminal Coronary Angioplasty (PTCA) Procedure Complications among Patients Completed (PTCA) Procedure in selected Cardiac Hospitals at Guntur

A Study to Assess the Effectiveness of Structured Teaching Program (STP) on Knowledge Regarding Preventive Precaution of Percutaneous Transluminal Coronary Angioplasty (PTCA) Procedure Complications among Patients Completed (PTCA) Procedure in selected Cardiac Hospitals at Guntur

Smoking and Activated Clotting Time during coronary angiography and angioplasty: protocol for the ACT-Tobacco trial

BackgroundDuring percutaneous transluminal coronary angioplasty (PTCA), activated clotting time (ACT) measurements are recommended to attest a correct anticoagulation level and, if needed, to administer further unfractionated heparin (UFH) to obtain a therapeutic ACT value. Our clinical routine led us to observe that smokers had lower ACT values after standardized UFH administration during PTCA. Procoagulant status in smokers is well documented. ObjectivesTo determine whether tobacco negatively affects UFH anticoagulation during PTCA when evaluated by ACT. MethodsThe ACT-TOBACCO trial is a single-center, noninterventional, prospective study. The primary end point is the comparison of ACT values after standardized UFH administration between active smokers and nonsmokers (active smoker group vs nonsmoker group) requiring coronary angiography followed by PTCA. The main secondary end points include ACT comparison after the first and second standardized UFH administration according to the patient’s smoking status (active, ex-, or nonsmoker) and the clinical presentation of ischemic cardiomyopathy: stable (silent ischemia or stable angina) or unstable (unstable angina or acute coronary syndrome without or with ST-segment elevation). ConclusionsTo the best of our knowledge, ACT values during PTCA between smokers and nonsmokers have not previously been compared. As current PTCA procedures increase in complexity and duration, the understanding of procoagulant risk factors such as smoking and the need for reliable anticoagulation monitoring becomes essential to balance hemorrhagic risk against thrombotic risk.

Typical effective dose values from diagnostic and interventional radiology

Effective dose (E) in medical procedures is of practical value for comparing doses from different types of procedures which is not possible with the different measurable dose quantities. In this survey we estimated and compared the values of E in 12 medical imaging procedures. The mean E for conventional X-ray in mSv were ranged between 0.01 for skull lateral to 0.5 for abdominal while the mean E for cardiac interventional radiology in mSv was up to 16 for percutaneous transluminal coronary angioplasty (PTCA). For dental radiology the mean E in μSv was 1.2 for intraoral and 10 for panoramic. In mammography the mean E was 0.5 mSv. Compared with the literature, chest postero–anterior (PA), lumbar spine AP, PTCA and mammography procedures had shown larger E values. The obtained results can help in justification of techniques.

Effect of Cardiac Rehabilitaion in Percutaneous Transluminal Coronary Angioplasty (PTCA)

Introduction: Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronaryintervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowingunobstructed blood flow to the myocardium. Cardiac rehabilitation is important role for more successful PTCA.To increase cardiac efficiency, increase exercise tolerance or endurance and to get the effective and better results.Case presentation: 45 years male admitted in emergency department with chest pain during gym workout.Blood reports, ECG, ECHO, and angiography done in investigation. In angiography RCA 99% stenosis and in D1ostial 60% stenosis. PTCA procedure done with DES to RCA. Twelve days after surgery patient came for cardiacrehabilitation in physiotherapy department.Management and Outcome: warm-up, aerobic period, and cool-down, abdominal exercise, strengthening exerciseincluded in cardiac rehabilitation. Pulse rate, blood pressure, respiratory rate, Spo2, Rate of perceived exertionscale and 6-min walk test, distance, vo2 max calculated as an outcome.Discussion: Cardiac Rehabilitation is most important for faster recovery as well as better efficiency for cardiacendurance. Maximum oxygen uptake increased after cardiac rehabilitation protocol.Conclusion: Cardiac Rehabilitation is helpful for more successful PTCA.

Should I wait or should I go? Travelling versus waiting for better healthcare

We study patient mobility in the Italian National Health System, using patient-episode level data on elective Percutaneous Transluminal Coronary Angioplasty procedures over the years 2008–2011. We examine how patients' choice of the hospital is affected by changes in waiting times and clinical quality within hospitals over time. We estimate mixed-logit specifications and show the importance of jointly controlling for time-invariant and time varying clinical quality to identify the effect of waiting times. Conversely, failure to capture variations in clinical quality over time does not affect the estimate of the discouraging effect of travel distance. We provide evidence that patients are responsive to changes in waiting times and clinical quality: average demand elasticity with respect to own waiting times and mortality is estimated to be – 0.17 and – 1.38, respectively. Patients’ personal characteristics significantly influence how they trade off distance and waiting times with quality of care. We find a higher Willigness-To-Wait and Willingness-to-Travel to seek higher quality care for patients in the younger age groups and who are more severely ill. The results convey important policy implications for highly regulated healthcare markets.

Advancements in Interventional Techniques of Percutaneous Transluminal Coronary Angioplasty (PTCA) in Acute Myocardial Infraction

Andreas Gruentzig is the father of interventional cardiology performed the first PTCA procedure in Zurich, Switzerland (1977). Later, the developments of angioplasty were done by interventional radiologist Charles Dotter. Percutaneous Transluminal Coronary Angioplasty (PTCA) is a primary procedure used in the field of interventional cardiology to treat blocked or stenosed coronary arteries. The blockages occur because of the lipid –rich plaque within the arteries causing diminished blood flow to the myocardium. In acute myocardial infarction, there is plaque rupture with platelet aggregation, and acute thrombus formation, which results in a sudden occlusion of coronary artery. The patient present with acute chest heaviness, diaphoresis, and nausea, urgent PTCA is required to save the life of the patient in order to limit the myocardial damage.

Should I Wait or Should I Go? Travelling Versus Waiting for Better Healthcare

Abstract We study patient mobility in the Italian National Health System, using patient-episode level data on elective Percutaneous Transluminal Coronary Angioplasty procedures over the years 2008–2011. We examine how patients' choice of the hospital is affected by changes in waiting times and clinical quality within hospitals over time. We estimate mixed-logit specifications and show the importance of jointly controlling for time-invariant and time varying clinical quality to identify the effect of waiting times. Conversely, failure to capture variations in clinical quality over time does not affect the estimate of the discouraging effect of travel distance. We provide evidence that patients are responsive to changes in waiting times and clinical quality: average demand elasticity with respect to own waiting times and mortality is estimated to be – 0.17 and – 1.38, respectively. Patients’ personal characteristics significantly influence how they trade off distance and waiting times with quality of care. We find a higher Willigness-To-Wait and Willingness-to-Travel to seek higher quality care for patients in the younger age groups and who are more severely ill. The results convey important policy implications for highly regulated healthcare markets.

Modelling of the electrocardiographic signal during an angioplasty procedure in the right coronary artery

Dynamical models are useful tools to generate sets of varied morphological signals by synthesizing human electrocardiograms (ECGs). These signals are used for testing and improving algorithms of ECG delineation, patient monitoring and heart disease detection. This work presents a procedure based on the ECGSYN model to synthesize ECG morphological changes induced by a percutaneous transluminal coronary angioplasty (PTCA) procedure in the right coronary artery. We provide a set of parameters to be used in ECGSYN and generate heartbeats with altered ST-T complexes. These characteristic model parameters were obtained through a non-linear fitting algorithm applied to every available heartbeat. To extend these parameters, normal distributions were generated with their means and standard deviations obtained from the STAFF III database. Parameters were presented for P, QRS and T-waves at leads II, III and aVF. The synthesis procedure shows an average correlation and positive predictive value of 92.2% and 88.2%, respectively. In conclusion, we provide a technique capable of synthesizing electrocardiographic ischemic morphology with physiological plausibility. Then, the generation of data sets for algorithm testing can benefit from this system of ECG signal synthesis.

The Effect of Foot Reflexology Applied Before Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty on Anxiety, Stress, and Cortisol Levels of Individuals: A Randomized Controlled Trial.

Coronary angiography and percutaneous transluminal coronary angioplasty procedures cause anxiety and stress in individuals. The aim of this study was to determine the effect of foot reflexology applied before coronary angiography and percutaneous transluminal coronary angioplasty on the anxiety, stress, and cortisol levels of individuals. A simple randomized trial design was used. The patients who met the inclusion criteria were divided into 4 groups including experimental and control groups of coronary angiography patients (30 patients in each group) and percutaneous transluminal coronary angioplasty (26 patients in each group) by randomization method. Data were collected with the State-Trait Anxiety Inventory and Distress Thermometer 90 minutes before coronary angiography and percutaneous transluminal coronary angioplasty and the laboratory samples were taken. After these procedures, foot reflexology was applied to both feet of the patients in the experimental group for 30 minutes, and the control group received only standard care. The inventories were reapplied 30 minutes after the reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty. Whereas there was no statistically significant difference (P > .05) between the coronary angiography and percutaneous transluminal coronary angioplasty experimental and control groups in Anxiety Inventory and stress median scores before reflexology, a significant difference was found (P < .001) 30 minutes after reflexology application and after coronary angiography and percutaneous transluminal coronary angioplasty. After the reflexology, anxiety and stress scores were significantly lower in the experimental group compared with the control group (P < .001). Whereas there was a significant difference (P < .001) in the within-group cortisol values of both reflexology groups, no significant difference was found in the control groups (P > .05). The application of reflexology before coronary angiography and percutaneous transluminal coronary angioplasty reduces the levels of anxiety, stress, and cortisol without any side effects.

Did India's price control policy for coronary stents create unintended consequences?

In February 2017, India capped the retail price of coronary stents and restricted the channel margin to bring Percutaneous Transluminal Coronary Angioplasty (PTCA) procedure, which uses coronary stents, within reach of millions of patients who previously could not afford it. Prior research shows that care providers respond to such regulations in a way that compensates for their loss in profits because of price control. Therefore, price control policies often introduce unintended consequences, such as distortions in clinical decision making. We investigate such distortions through empirical analysis of claims data from a representative public insurance program in the Indian state of Karnataka. Our data comprises 25,769 insurance claims from 69 private and seven public hospitals from February 2016 to February 2018. The public insurance context is ideal for investigating distortions in clinical decisions as the price paid by patients, and thereby access to the treatment, does not change after price control. We find that the change in the average volume of PTCA procedures per hospital per month after price control disproportionately increased when compared to the change in the clinical alternative – Coronary Artery Bypass Graft (CABG) procedures. This increase corresponds to 6% of the average number of PTCA procedures and 28% of the average number of CABG procedures before the price control. In addition, disproportionate increase in PTCA procedures occurred only among private hospitals, indicating the possibility of profit-maximization intentions driving the clinical choices. Such clinical distortions can have negative implications for patient health outcomes in the long run. We discuss alternative policies to improve access and affordability to healthcare products and services which are likely to not suffer from similar distortions.

Radiation dose from percutaneous transluminal coronary angioplasty procedure performed using a flat detector for different clinical angiographic projections

The radiation dose from complex cardiac procedures is of concern due to the lengthy fluoroscopic screening time and vessel complexities. This study intends to assess radiation dose based on angiographic projection and vessel complexities for clinical protocols used in the performance of percutaneous transluminal coronary angioplasty (PTCA). Dose–area product (DAP), reference air kerma (Ka,r) and real-time monitoring of tube potentials and tube current for each angiographic projection and dose setting were evaluated for 66 patients who underwent PTCA using a flat detector system. The mean DAP and cumulative Ka,r were 32.71 Gy cm2 (0.57 Gy), 51.24 Gy cm2 (0.9 Gy) and 102.03 Gy cm2 (1.77 Gy) for single-, double- and triple-vessel PTCA, respectively. Among commonly used angiographic projections, left anterior oblique 45°—caudal 35° reached 2 Gy in 55 min using a low-dose fluoroscopy setting and 21 min for a medium-dose setting. Use of a low-dose setting for fluoroscopic screening showed a radiation dose reduction of 39% compared with a medium-dose setting.

Knowledge and Perceived Health Benefits of Percutaneous Transluminal Coronary Angioplasty among Patients with Coronary Heart Disease

Introduction: The determination of the knowledge and perceived health benefits of Percutaneous Transluminal Coronary Angioplasty (PTCA) from the patient’s view of understanding helps to develop a holistic approach to health care. Aim: The study aimed to assess the knowledge and perceived health benefits of PTCA and to find the association of knowledge with the perceived health benefits and demographic variables among the patients with Coronary Heart Disease (CHD). Materials and Methods: A descriptive survey design was used and data were collected from 130 participants of cardiac wards of a tertiary care hospital, Karnataka, using structured knowledge questionnaire about PTCA and post-PTCA health benefits scale. Later a leaflet about PTCA was given to the participants. Subjects diagnosed with CHD and on the first post procedural day of PTCA were included in the study and patients with psychiatric disorders and medical disorders except diabetes mellitus and hypertension were excluded. Descriptive statistics was used to describe the sample characteristics, Chi-Square was used for association. Results: The mean age of the sample was 54 years, the mean knowledge score was 7.35±2.855 and 15.4%, 69.2% and 15.4% of the participants had good, moderate and poor knowledge respectively. The PTCA procedure was perceived as highly beneficial by 79.2% of participants and association was not found between knowledge and perceived health benefits of PTCA (p>0.05). Conclusion: The study highlights the need for planning programs for continuing individualised health education on PTCA for the patients and their families to make changes in the patient’s wrong perception of health benefits after PTCA.

Disentangling the Effect of Waiting Times on Hospital Choice: Evidence from a Panel Data Analysis

This study examines the effect of waiting times on hospital choice by using patient-level data on elective Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures in the Italian NHS over the years 2008-2011. We perform a multinomial logit analysis including conditional logit and mixed logit specifications. Our findings show the importance of jointly controlling for time-invariant and time varying dimensions of hospital quality in order to disentangle the effect of waiting times on hospital choice. We provide evidence that patients are responsive to changes in waiting times and aspects of clinical quality within hospitals over time, and estimate the trade-off that patients make between different hospital attributes. The results convey important policy implications for highly regulated health care markets.

A prospective observational study of radiation trends in the cardiac catheterization laboratory

Background: Radiation exposure in cardiac catheterization laboratory (cath lab) is a health hazard not only to the interventional cardiologist, but also to the support staff as well as the patients. Data about radiation exposure in cath lab are lacking in India. We undertook this study to observe the radiation trends in a high-volume cath lab at a tertiary care center in India. Materials and Methods: A prospective study of radiation trends in the cardiac catheterization laboratory was carried out with regard to mean fluoroscopic time (FT, minutes), mean total cumulative dose (Gy), and mean dose area product (DAP) (Gycm2). Radiation exposures in various diagnostic and interventional procedures with respect to the above three parameters were studied. Radiation exposure in transradial and transfemoral routes was compared in the subgroup analysis. Results: A total of 2016 cases in which cath lab procedures were done during the period of 1 year were included in the study. Mean DAP for coronary angiography was 23.72 Gycm2 and for percutaneous transluminal coronary angioplasty (PTCA) was 196.61 Gycm2. If the complex PTCA procedures were excluded, the mean DAP was 33.19 Gycm2. Radiation trends observed in our study were comparable to the international standards. Conclusions: Radiation exposure in cath lab is a health hazard and must be given due importance. By maintaining radiation hygiene and associated precautions, the radiation exposure in cath lab can be kept within acceptable limits as shown in our study.

Assessment of Patient Radiation Dose in Interventional Procedures at Shahid Madani Heart Center in Khorramabad, Iran

Introduction: Coronary angiography is the most common angiographic procedure for diagnosis and treatment of the heart diseases. Herein, we aimed to evaluate the entrance surface dose (ESD), dose area product (DAP), as well as cancer risk in interventional cardiology procedures. Materials and Methods: This study was conducted during July-December 2015 at Shahid Madani Heart Center in Khorramabad, Iran. A total of 225 adult patients including 122 females and 103 males regardless of the risk factors for coronary diseases were participated. Of them, 199 and 26 patients underwent diagnostic coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA), respectively. Each patient underwent CA or PTCA separately. All the procedures were carried out using Siemens angiography system with the pulsed fluoroscopy of 10-30 pulses/s and cine frame rate of 15 frames/s. DAP, ESD, fluoroscopy time (FT), as well as the number of sequences and frames per sequence were collected for each 199 CA and 26 PTCA procedures. Results: The median values of DAP were 19.77±14.88 and 57.11±33.36 Gy.cm2 in CA and PTCA, respectively. In addition, the median values of ESD were 323.12±245.39 and 1145.22±594.42 mGy in CA and PTCA, respectively. FTs were 114.59±74.33 s in CA and 424.15±292.93 s in PTCA. Conclusion: The average patient dose and cancer risk estimates in both CA and PTCA were consistent with the reference levels. However, in agreement with other interventional procedures, dose levels in the interventional cardiology are influenced by staff and clinical protocols, as well as the type of equipment.Â

Effectiveness of pelvic lead blanket to reduce the doses to eye lens and hands of interventional cardiologists and assistant nurses

The aim of the present study is to analyse quantitatively the potential reduction of doses to the eye lens and the hands of an operator and a nurse by the use of a pelvic lead blanket during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures. Thermoluminescent dosimeters were used to assess dose levels to the left eye lens and fingers on both hands of both physician and nurses during single procedures performed with or without the lead blanket. The measurements were carried out at one medical centre and include dosimetric data from 100 procedures. Additional measurements including physician’s and patient’s doses were made on phantoms in the laboratory. In order to determine the reduction potential of the lead blanket, the doses normalized to DAP (Dose-Area Product) corresponding to the same position of dosimeter were compared against each other for both procedure categories (with and without protection). There was no statistically significant decrease observed in physicians’ and nurses’ eye lens doses, nor in doses normalized to DAP due to the use of the lead pelvic shield in clinic. However, some trend in reducing the eye lens doses by this shield can be observed. Regarding finger doses, the differences are statistically significant but only for physicians. The mean DAP-normalised doses to the eye lens and left and right finger of physicians, in the presence of a ceiling-suspended transparent lead shield, were 2.24e-5 ± 1.41e-5 mSv/μGym2, 2.31e-4 ± 1.21e-4 mSv/μGym2, and 2.60e-5 ± 1.57e-5 mSv/μGym2 for standard procedures performed without the lead blanket, and 1.77e-5 ± 1.17e-5 mSv/μGym2, 1.70e-4 ± 1.01e-4 mSv/μGym2, and 1.86e-5 ± 1.13e-5 mSv/μGym2 for procedures performed with it. A comparison of the results from the laboratory and the clinic shows that they are consistent regarding the eye lens, while for fingers it suggests that the dose reduction properties of the lead shield are related to the physician’s work technique and both patient and lead blanket sizes or its positioning. The highest degree of reduction is observed for cranial and caudal projections together with the use of a patient-adjustable lead blanket; about a 2-fold decrease in finger doses is expected for optimum conditions. However, the laboratory measurements suggest that the use of lead blanket might slightly increase the patient dose, but only when specific projections are constantly used. This limitation should be considered by cardiologists during clinical work if this protection is used. In the light of the presented results, the ceiling-suspended transparent lead shield and the lead glasses seem to be the preferred way to reduce the doses to the eye lens, compared to the lead blanket.