Post-percutaneous Intervention Research Articles

A-39 | Impact of Obesity on In-Hospital Post Percutaneous Coronary Intervention Outcomes in Otherwise Metabolically Healthy Patients With Acute Myocardial Infarction: A Propensity Matched Analysis Using National Inpatient Sample, 2020

Obesity paradox in post percutaneous intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a well-known controversial finding. In studies that discussed the obesity paradox, patients at least had diabetes, hypertension, or hyperlipidemia. We studied the relationship between obesity and in-hospital post-PCI outcomes among AMI patients with no diabetes, hypertension, or hyperlipidemia (otherwise metabolically healthy). We extracted data from the National Inpatient Sample 2020 using the ICD-10 codes for admissions of obese and non-obese AMI patients treated with PCI. We excluded patients with diabetes, hypertension, and hyperlipidemia after identifying them through Elixhauser comorbidity software. After propensity score matching (PSM) obese and non-obese patients for age and sex, we performed multivariate regression analysis, adjusted for demographics, hospital-level factors, and comorbidities to calculate adjusted odds ratio (AOR) for in-hospital post-PCI outcomes. In 2020, 25605 otherwise metabolically healthy AMI patients had PCI; 2825 were obese, and 22780 were non-obese. However, after PSM for age and sex, there were 2795 patients in each cohort. In the obese cohort, 68.2% were males, 82.6% were white, and 54.9% were aged 45-64. Most common comorbidities in obese vs. non-obese cohorts were smoking (23.8% vs. 24.7%), chronic pulmonary disease (14.3% vs. 11.6%), and prior MI (6.3% vs. 6.1%). A statistically significant difference was not observed in in-hospital all-cause mortality (AOR 1.14, 95%CI 0.63-2.10, p=0.661), post-operative stroke (AOR 1.17, 95%CI 0.50-2.75, p=0.714), and acute kidney injury (AOR 1.20, 95%CI 0.84-1.72, p=0.322) among obese and non-obese cohorts. In this large population-based analysis, we found no statistically significant association between obesity and post-PCI outcomes in otherwise metabolically healthy patients with AMI. Larger prospective studies can help demystify the controversial "obesity paradox" in cardiovascular diseases.

A-40 | Dissecting Disparities of Post-Percutaneous Intervention Outcomes in Acute Myocardial Infarction Patients With COVID-19: Insights from National Inpatient Sample, 2020

It is well-established that COVID-19 increases the risk of cardiovascular conditions, including acute myocardial infarction (AMI) and its associated complications. Through this study, we sought to establish the association of sociodemographic attributes with in-hospital all-cause mortality among COVID-19 patients with AMI who underwent PCI. We extracted data from the National Inpatient Sample 2020 using the ICD-10-CM codes for admissions related to COVID-19 patients with AMI who underwent PCI. We performed multivariate regression analysis, adjusted for demographics and hospital-level confounders to assess the trends of the age, race, sex, and median household income-related disparities in post-PCI in-hospital all-cause mortality among COVID-19 patients with AMI. A total of 3735 COVID-19 patients admitted with AMI and who underwent PCI were included in this study. The prevalence of COVID-19 patients with AMI who underwent PCI was highest among elderly [ages >/= 65 (47.7%)], male (70.4%), white (60.6%), and lowest income quartile (35.6%) patients. Among 3735 COVID-19 patients with AMI, 20.2% had all-cause in-hospital mortality, and 3.2% had a stroke after the PCI. A statistically significant association was present between post-PCI in-hospital all-cause mortality and among elderly patients (adjusted odds ratio (aOR) 4.67, 95% confidence interval (CI) 1.64-13.31, p=0.005) and the lowermost income quartile patients (aOR 1.90, 95% CI 1.01-3.57, p=0.031). However, we did not find any statistically significant association between post-PCI in-hospital all-cause mortality and sex, race, ages 18-64, or medium lowest/medium highest/highest income quartiles. This population-based analysis revealed that elderly and lower socioeconomic class COVID-19 patients with AMI had higher odds of post-PCI in-hospital all-cause mortality. Associated comorbidities with advancing age and late access to health care among low socioeconomic classes could be the reasons for the observed disparities among these groups. Further studies are needed to understand the impact of social determinants on long-term association in a better way.

Safety and Feasibility of Day Case PCI in a Cardiac Catheter Laboratory in a Queensland Tertiary Hospital

Traditionally in Queensland, post percutaneous intervention (PCI) care involves admission to a monitored environment. The purpose of this audit was to assess the safety and feasibility of same-day discharge in appropriately selected patients undergoing PCI.

A Randomized Study Comparing Patency of Infarction Related Vessel at Time of Primary PCI in Patients Who Received Streptokinase and Who Did Not

Coronary blood flow in an infarct related artery (IRA) in patients that had streptokinase (SK), as the fibrinolytic of choice before percutaneous intervention (PCI), in comparison to the blood flow in patients that underwent primary percutaneous intervention (PPCI) has not been well understood or considered for studies in recent times. All patients presenting with STEMI diagnosis within less than 12 hours from diagnosis either at the centre or referred to the center after SK were screened. 200 patients were randomized into primary PCI (PPCI) or pharmacoinvasive PCI following SK (PhI-SK) administration 3-24 hours after SK. Failed SK patients underwent rescue PCI immediately. The outcome of IRA patency pre- and post PCI in both groups along with short term outcome of bleeding, re-infarction or cardiovascular death in 30 days were looked at. The end points were reached in 81 of 89 (91.0%) in the SK group and 21 of 98 (21.4%) in the PPCI group (p-value <0.001), while TIMI 3 flow was seen in 87 of 89 (98.7%) patients post PCI in the SK group and 69 of 98 (70.4%) patients of PPCI (p-value <0.001). The outcomes of bleeding, MI and death were not different among the groups. We concluded that Fibrinolysis with SK is a viable and safe reperfusion strategy in STEMI especially in low- and middle-income countries (LMICs), where PPCI is not commonly available within the guideline recommended time. It can reduce stress and risk of complications that can occur during PPCI. There is no any difference in the early outcomes of bleeding, MI and death between the two groups.

790 Assessment of Adherence to ACEI/ARB Post Percutaneous Intervention and Potential Effect on Outcome

There is extensive evidence supporting the use of ACE inhibitors for secondary prevention of myocardial infarction. Previous reports suggested a very high rate of discontinuation of ACEI at 1-year. We examined the adherence rate at 1-year post percutaneous coronary intervention (PCI) and the effect on outcome, using data from the Genesis Cardiovascular Outcomes Registry. Data was prospectively collected on 8572 patients (including 1953 women and 6616 men) who underwent PCI over the period from January 2009 till January 2019. Patients were assessed for adherence to ACEI/ARB and effect on outcome as measured by death, MACE, MI, TVR and unplanned readmission. The rate of adherence after 1 year for the whole cohort was 66.3%, with the rate of adherence significantly lower in women compared to men (63.4% vs 67.1%, p=0.003). When adjusted for age, sex, BMI, smoking, and PCI presentation, adherence to an ACEI/ARB at 1 year was statistically significantly associated with a reduced risk for death (HR 0.08; 95% CI 0.04-0.14, p<0.001), with similar risk reduction seen for women (HR 0.08; 95% CI 0.03-0.23, p<0.001) and men (HR 0.08; 95% CI -0.16, p<0.001). The risk of MACE at 1 year was significantly reduced (HR 0.45; 95% CI 0.35-0.59, p<0.001), with the risk reduction similar for women (HR 0.33; 95% CI 0.19-0.56, p<0.001) and men (HR 0.50; 95% CI 0.38-0.68, p<0.001). Optimising adherence to ACEI/ARB post PCI is important for improved outcome.

Assessment of impact of chronic kidney disease on platelet inhibition among post percutaneous intervention patients on antiplatelet therapy

Assessment of impact of chronic kidney disease on platelet inhibition among post percutaneous intervention patients on antiplatelet therapy

Comparision between clopidogrel and prasugrel on hsCRP levels in post percutaneous intervention patients

Comparision between clopidogrel and prasugrel on hsCRP levels in post percutaneous intervention patients

P2125Randomised placebo controlled trial evaluating the safety and efficacy of intracoronary insulin like growth factor 1 post percutaneous intervention for acute myocardial infarction

P2125Randomised placebo controlled trial evaluating the safety and efficacy of intracoronary insulin like growth factor 1 post percutaneous intervention for acute myocardial infarction

Comparision Between Clopidogrel and Prasugrel On hs-CRP Levels Post Percutaneous Intervention

AbstractAims: This study investigated the effect of clopidogrel versus prasugrel treatment on inflammatory activity as evidenced by high-sensitivity C-reactive protein (hs-CRP) levels among patients who underwent percutaneous intervention (PCI). The effect in clinical outcomes between both the treatment groups is also explored.Methods: The study included 53 patients into two cohorts with 30 from clopidogrel group and 23 from prasugrel group who underwent PCI for coronary artery disease. Patients were assigned either to clopidogrel or prasugrel group based on mehraan bleeding risk score. Hs-CRP was measured on 15thfollowup day. The predefined primary composite endpoint was myocardial infarction, stroke, vascular complications or death from cardiovascular causes.Results: In both treatment groups the changes in hs-CRP levels over time were identical (2.97±3.2 in clopidogrel vs. 4.47±4.1in prasugrel p:0.14). Clinical outcomes occurred in 3 cases in clopidogrel group and one patient had puncture site hematoma in prasugrel group (p: 0.72). In contrast no significant difference in hs-CRP was noted among those had adverse clinical outcomes (1.67±2.2 vs 3.12±3.3 p: 0.47). Baseline parameters height (158.3±7.7 vs 157.8±7.7p:0.80) weight (63.4±9.7 vs 63.8±9.6 p: 0.87) hypertension (17 vs 11 p: 0.58) diabetes (11 vs 8 p: 1.00) smokers (1 vs. 5 p: 0.06) are matched between both the groups. Clopidogrel group were elderly (63.1±9.6 vs 53.7±9.5 p: 0.001) and had higher systolic blood pressure (154.7±26.2 vs 138.7±18.7 p: 0.01). Clinical scenario like type of presentation (CSA 16 vs 9 p: 0.29) LV dysfunction (10 vs 10 p: 0.57) previousPCI (5 vs 4 p: 0.94) previous CABG (2 vs 0 p: 0.143) are identical in both groups. Lesion characteristics like calcification (15 vs 11 p:0.97) tortuosity(4 vs 3 p:0.94) angulation (2 vs 0p:0.49) ostial lesion ( 8 vs 5 p:0.75) thrombotic (0 vs 1 p:0.30) was similar in both the groups. Bifurcation lesion (6 vs 1 p:0.06) usage of Gp2B3A inhibitors(3 vs 0 p:0.06) was higher in clopidogrel group.Conclusions: Antiplatelet prasugrel and clopidogrel significantly did not affect inflammation post PCI as assessed by hs-CRP which is an established inflammatory marker. No significant difference in clinical outcomes in the follow-up between both the groups. Neither hs-CRP level was elevated in those with adverse clinical events.

Evidence of contact activation in patients suffering from ST-elevation myocardial infarction

IntroductionFactor (F) XIIa is an attractive target for anticoagulation in arterial thrombosis. The aim of this study is to investigate the degree of involvement of the contact system in cardiac infarctions. Methods and patients165 patients suffering from ST-elevation myocardial infarction (STEMI) and 100 healthy controls were included in the study. Samples were drawn at admission before percutaneous intervention (PCI), 1–3days post-percutaneous intervention (PCI) and, in one-third of the patients, 3months after PCI. In order to investigate the degree of Factor XII (FXII) activation, changes in FXIIa/AT and FXIIa/C1INH complex levels were quantified by ELISA. ResultsFXIIa/AT levels at admission (0.89±0.50; p<0.01) were significantly higher than those in normal individuals (0.39±0.28), but the levels after 1–3days (0.33±0.33; p<0.05) were essentially normalized. In contrast, the FXII/C1INH levels at admission (1.40±0.72; p<0.001) and after 1–3days (0.83±0.59; p<0.001) were both significantly higher than those in normal individuals (0.40±0.30). FXIIa/AT and FXIIa/C1INH complexes at admission (p<0.001; p<0.001) and after 1–3days (p<0.02; p<0.001) were significantly different from those at 3months. No significant differences were observed when the data were stratified for patency (open/closed culprit lesions). ConclusionBoth FXIIa/AT and FXIIa/C1INH complexes were significantly increased and reflected the activation of FXII in STEMI patients at admission. In particular, FXIIa/AT complex elevations support the hypothesis that clot propagation-mediated FXII activation had occurred, and this activation may be a target for anticoagulation in patients with cardiac infarction. Based on previous studies, the FXIIa/C1INH complex levels were primarily interpreted to reflex endothelial cell activation.

The Effect of Vitamin D Deficiency Treatment on Post-PCI Coronary Restenosis and Major Adverse Cardiac Events

Background: Evidence have shown the relationship between vitamin D deficiency and cardiovascular disease. Objectives: The present study aimed to evaluate the effect of Vitamin D deficiency treatment on the occurrence of coronary post-Percutaneous Intervention (PCI) restenosis and Major Adverse Cardiac Events (MACE). Patients and Methods: This randomized semi-experimental non-controlled study was conducted on patients with coronary artery disease who were candidate for PCI and had referred to Baqiyatallah Hospital in a 2-month period. The patients with normal Vitamin D levels were allocated to the normal group and others were randomly assigned to treatment and non-treatment groups. All the patients were followed for 9 months. Vitamin D was measured again at the end of the 9th month and the patients were reassigned to normal and mild, moderate, and severe deficiency groups with respect to Holick classification. Results: This study was performed on 150 subjects with the mean age of 62.46 ± 10.80 years and male/female ratio of 94/56. The results showed no significant difference among the three groups regarding age, gender, diabetes, number of cardiovascular risk factors, and other underlying risk factors for restenosis. However, a significant difference was found between the patients with normal and abnormal vitamin D levels regarding the number of stenotic vessels and number of PCIs (both P 0.05). At the end of the study, 32 (55.1%) out of the 58 patients (55.1%) who were deficient reached normal vitamin D levels by consuming supplements, but 7 (12%) reached normal values without using supplements (P < 0.001). Conclusions: Treatment of vitamin D deficiency could reduce restenosis of PCI. However, this protocol is efficient for patients with moderate to severe deficiency and should be changed.

Post PCI Vascular and Bleeding Complications in Patients with or Without CKD

AbstractBACKGROUND: There is increasing trend of both Cardiovascular disease (CVD) and chronic kidney diseases (CKD) in general populations. The individuals with CKD are more likely to die of CVD than of kidney failure. Both diagnostic and therapeutic interventions are crucial in management of CKD patients with coronary artery disease. As CKD itself is associated with more bleeding complications we aim to study the incidence of vascular complications (vessel thrombosis, distal embolisation, dissection, poorly controlled bleeding at puncture site, pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, and development of femoral neuropathy) in Percutaneous intervention (PCI) patients with renal failure.METHODS: 950 patients who underwent PCI procedures were classified into CKD (GFR&lt;60ml/min/m2) (n=380, 40%) and non-CKD (n=570, 60%) groups. Two groups were analyzed for the occurrence of vascular complications post PCI.RESULTS: Vascular complications were seen in 28 out of 380 patients with CKD (7.37%) and 17 out of 570 patients without CKD (2.98%). Patients with renal failure (GFR&lt;60ml/min/m2) were found to have higher risk of vascular complications post PCI. [p = 0.03, OR = 2.588 (1.344-5.017)]. Non access site complications were more common in patients with CKD compared to non CKD. 16 patients with CKD developed non access site complications compared to 9 in patients without CKD.[p=0.001, odds ratio 2.793(1.15-6.916)CONCLUSIONS: This study demonstrates higher risk of vascular complications post-PCI in patients with CKD compared to non CKD patients. Higher incidence of non access site complications was also observed in CKD patients.

Duration of Dual Anti-Platelet Therapy Post-Percutaneous Intervention: Is There A Correct Amount of Time?

Dual antiplatelet therapy (DAPT) is effective in preventing in-stent thrombosis (IST) after placement of drug-eluting coronary stents (DES) and in attenuating risk of athero-thrombotic events, primarily myocardial infarction, among patients with advanced coronary atherosclerosis. However, all studies of DAPT demonstrate an increased risk of moderate or severe bleeding for the duration of therapy. The extent of benefit and risk with various periods of DAPT after DES placement has been evaluated in multiple observational studies and randomized clinical trials. Most studies indicate little or no important reduction of ischemic events but significant increases in bleeding with prolonged treatment. The Dual Antiplatelet Therapy Study was the only randomized trial sufficiently powered to assess IST as an individual endpoint, and this study found that continuing DAPT from 12 to 30months after DES placement provided important reductions in IST and a composite of adverse ischemic events. When all data are considered, a cogent argument can be made for using just 3 to 6months DAPT in patients treated with contemporary second generation DES when the goal of treatment is to avoid IST. Longer therapy should be recommended for patients treated with first generation DESs, for whom a persisting signal of IST risk is apparent, and for patients with low risk for bleeding who wish to minimize their risk of athero-thrombotic events, both related and unrelated to DES.

Stabilizing effect of combined eicosapentaenoic acid and statin therapy on coronary thin-cap fibroatheroma

BackgroundThe addition of highly purified eicosapentaenoic acid (EPA) to statin therapy prevents cardiovascular events. However, the impact of this treatment on vulnerable plaques remains unclear. The aim of this study was to assess the impact of adding EPA to a standard statin therapy on vulnerable plaques by serial optical coherence tomography (OCT). MethodsForty-nine non-culprit thin-cap fibroatheroma (TCFA) lesions in 30 patients with untreated dyslipidemia were included. Patients were randomly assigned to EPA (1800 mg/day) + statin (23 TCFA, 15 patients) or statin only (26 TCFA, 15 patients) treatment. The statin (rosuvastatin) dose was adjusted to achieve a target low-density lipoprotein (LDL) level of <70 mg/dL. Post-percutaneous intervention and 9-month follow-up OCT were performed to evaluate morphological changes of TCFAs. The EPA/arachidonic acid (EPA/AA) ratio and pentraxin-3 (PTX3) levels were also evaluated. ResultsDespite similar follow-up LDL levels, the EPA + statin group had higher EPA/AA ratios and lower PTX3 levels than the statin group. OCT analysis showed that the EPA + statin group had a greater increase in fibrous-cap thickness, with a greater decrease in lipid arc and lipid length. Macrophage accumulation was less frequently detected in the EPA + statin group than in the statin group at follow-up. When the patients were categorized according to their follow-up PTX3 tertiles, fibrous-cap thickness showed significant increase, and the incidence of macrophages accumulation decreased with lower PTX3 levels. ConclusionThe concomitant use of EPA and rosuvastatin may stabilize vulnerable plaques better than the statin alone, possibly by suppressing arterial inflammation.

Implications of the VerifyNow P2Y12 Assay on Patient Outcomes

Background: The platelet inhibitory response of clopidogrel is substantially variable among patients, and numerous studies have shown that post-percutaneous intervention, patients with high on-treatment platelet reactivity have an increase in risk of major adverse cardiovascular events. No published studies to date have utilized platelet function monitoring assays prior to coronary artery bypass graft (CABG) surgery, but determination of patients’ antiplatelet effects prior to surgery may decrease time to surgery and length of hospital stay. The purpose of the study was to evaluate the clinical outcomes of non-elective CABG patients analyzed by the VerifyNow P2Y12 platelet-function monitoring assay prior to surgery compared to a similar set of patients not analyzed by the VerifyNow P2Y12 assay. Methods: This was a retrospective, single center, cohort study. The primary endpoints of this study were time to surgery and length of hospital stay. Results: From March 2013 to July 2013, 60 patient charts were reviewed and included in this study. 49 patients were analyzed by the VerfiyNow P2Y12 assay, and 16 of these patients underwent non-elective CABG surgery. Eleven patients underwent non-elective CABG surgery and were not analyzed by the VerifyNow P2Y12 assay. There was no difference between groups regarding time to surgery (p = 0.75) or length of stay (p = 0.42). Based on the assay’s P2Y12 reaction unit results, 69% of VerifyNow P2Y12 patients went to surgery sooner than the institution’s recommendations which generated more bleeding events, half of which were considered major bleeds. Conclusions: Utilization of the VerifyNow P2Y12 assay prior to non-elective CABG surgery does not shorten time to surgery or overall length of hospital stay. However, insufficient P2Y12 reaction units prior to surgery may lead to more bleeding events, thus the application of platelet function monitoring assays prior to procedures may be beneficial as a bleeding risk-assessment tool.

Outcomes of Percutaneous Interventions in Transposed Hemodialysis Fistulas Compared with Nontransposed Fistulas and Grafts

To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs). A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected. Cox proportional-hazards regression analyses, Fisher exact tests, and χ2 tests were performed. Mean follow-up period was 32 months. Mean access ages at initial percutaneous intervention were 260 days (tAVF), 206 days (nAVF), and 176 days (AVG; P < .01). One-year postinterventional primary patency (PIPP) rates were 25% (tAVF), 24% (nAVF), and 14% (AVG). One-year postinterventional secondary patency (PISP) rates were 77% (tAVF), 61% (nAVF), and 63% (AVG). Median PIPP durations were 138 days (tAVF), 121 days (nAVF), and 79 days (AVG; P = .0001). Median PISP durations were 1,076 days (tAVF), 783 days (nAVF), and 750 days (AVG; P = .019). Total interventions needed to maintain PISP were 2.4 (tAVF), 1.3 (nAVF), and 3.2 (AVG) per patient-year (P < .001), which included 1.9, 1.2, and 1.4 PTAs (P < .01) and 0.45, 0.15, and 1.8 declotting procedures, respectively (P < .001). Based on the number of percutaneous interventions needed to maintain PISP, these results confirm the current Dialysis Outcomes Quality Initiative access preference of nAVFs before tAVFs before AVGs. tAVFs offered superior postinterventional outcomes than AVGs. With additional interventions, tAVFs could even outperform nAVFs in terms of PISP.

Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions

To evaluate whether gender differences in terms of up to 4-year outcome still persist within patients with acute myocardial infarction (AMI) who uniformly underwent coronary revascularization, we performed a gender comparison in a large contemporary multicentre percutaneous intervention (PCI) registry. We retrospectively analyzed data from 18,351 patients with AMI, who underwent percutaneous coronary interventions (5093 women and 13,258 men) in the Emilia Romagna region of Italy between July 2002 and December 2007. Median follow-up was 1174 days. After propensity score adjustment, differences in gender-related mortality were not temporarily homogeneous: 30-day adjusted mortality was higher in women than in men [hazard ratio (HR): 1.40, P < 0.0001], whereas thereafter female gender showed a significantly lower mortality risk (HR: 0.84, P = 0.01). Notably, younger women (<50 years old) both in the acute and postacute period had more than 3.6 higher risk of mortality when compared with men, whereas older women, particularly after the first 30-day post AMI, had similar (50-80 years old) or even better (≥ 80 years old) survival compared with men. Finally 1-month adjusted risk of heart failure and post PCI vascular complications requiring surgical treatment was higher in women while there was no detectable difference in terms of early and late AMI/unstable angina, stroke and angiographic stent thrombosis. In a contemporary large real-world AMI population treated with PCI, we found gender-related temporal and age-dependent adjusted differences in mortality. Our data suggest the hypothesis that biological gender-related differences could, in part, explain these findings.

EVALUATION OF MICRO CORONARY EDGE DISSECTION AND CORONARY ARTERY PLAQUE PROLAPSE POST CORONARY ARTERY PERCUTANEOUS INTERVENTION USING OPTICAL COHERENCE TOMOGRAPHY

Prevalence, characterization and clinical relevance of intimal micro edge dissection (IMED) and Plaque Prolapse (PP) post Percutaneous Intervention (PCI) utilizing Optical Coherence Tomography (OCT). Retrospective review of 185 OCT studies performed post PCI were reviewed by two independent

TCT-368 Lower socioeconomic status predicts major adverse cardiac events (MACE) and increased mortality post-percutaneous intervention (PCI): Independent hazard vs. intersection of modifiable risk factors?

Previously we reported increased MACE in lower socioeconomic status (SES), public health system (PHS) patients (pts) undergoing PCI. We report expanded / extended analyses, focused on distribution and impact of cardiac risk factors. 2,000 pts undergoing PCI over 6 years at Cook County Hospital,

Sonographically Guided Hand Kneading and Compression for Treatment of Femoral Artery Pseudoaneurysms

The purpose of this study was to evaluate the effectiveness of sonographically guided hand kneading and compression for the treatment of femoral artery pseudoaneurysms after percutaneous intervention. Twenty-four patients who had post-percutaneous intervention femoral artery pseudoaneurysms treated with sonographically guided compression from 2001 to 2004 and 2008 to 2009 were compared with 25 patients who had postintervention pseudoaneurysms treated with sonographically guided hand kneading and compression from 2005 to 2009. All 25 patients (100%) treated with 1-stage sonographically guided hand kneading and compression had pseudoaneurysm occlusion; the median treatment time was 10 minutes. Twenty-two of the 24 patients (91.7%) treated with conventional sonographically guided compression had pseudoaneurysm occlusion. One-stage compression was successful in 10 patients; 9 and 3 patients had pseudoaneurysm occlusion after 2 and 3 compression treatments, respectively. Two other patients who underwent compression treatment 3 and 4 times did not have pseudoaneurysm occlusion and required surgery. The median treatment time for sonographically guided compression was 30 minutes. The treatment time was significantly shorter for the hand-kneading and compression technique (P < .001), and significantly fewer procedures were needed (P < .001). Sonographically guided hand kneading and compression is as effective as sonographically guided compression alone for pseudoaneurysm occlusion after femoral artery percutaneous intervention and requires significantly less time to perform.