the trans radial intervention and patient subsets (ii)
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The Trans Radial Intervention and Patient Subsets (II). The Very Old and The Very Sick Octogenerians, Acute Coronary Syndromes. M.Heigert Landeskrankenhaus Salzburg Bad Gastein 10.02.2007. - PowerPoint PPT PresentationTRANSCRIPT
The Trans Radial Intervention and Patient Subsets (II)
The Very Old and The Very Sick Octogenerians, Acute Coronary Syndromes
M.Heigert Landeskrankenhaus Salzburg
Bad Gastein 10.02.2007
The Transradial Access: A way to prevent entry site
complications and thus adverse Outcomes of Cardiac
Interventions in the high risk subset of the elderly?
Aren`t the patients too sick and the access too complicateted ?
The Salzburg Experience n=2833 Patient Demografics and Procedural Data
irrespective of age radial(n=577) femoral (n=2256)
age 65,25 ±11,8 65,8 ±11,4
Gender (f/m) 190/387 (33% f) 773/1532 (34% f)
access without success* 28 (4,8%) 15 (0,6%)
exclusion or non significant CHD
34,2% 38,8%
3VD ± LM 27,8% 32,2%
exam.-time (median) 39min (12-167) 37min (6-207)
fluoroscopy time (median) 5min (1-50) 5min (1-69)
contrast-media 174,7 ± 91,9 ml 182,7 ± 107,9 ml
PCI-rate 48,5% 53,9%
acute or urgent PCI 16,1% 14%
exam.-time(only PCI, median)
60min (16-175) 49min (14-190)
The Salzburg Experience: Complications
radial(n=577)femoral (n=2256)
dissection/perfor. 4 (0,7%) 0
relev.bleeding* 2 (0,3%, konserv.) 25 (1,2%, 2 OP)
aneurysma spurium 0 22 (0,9%, 10 OP)
Symptomatic occlusion of vessel
2 (0,3%, konserv.) 2 (0,08%, 2 OP)
total 8 (1,4%) 47 (2%)
* Transfusions or prolonging hospitalisation
The Radial Access in General: necessity of energy and
dedication
Radial Failure Rate
Meta analysis
Radial failure = 1,9 %
If OCTOPLUS Study is excluded(patients > 80 years, RF 10,6%, FF 9,3%)
P.Agostini et al- JACC 2004; 44:349-56
Octoplus-Complications
The Salzburg Experience:
Octogenerians n=340
Radial (n=85) femoral (n=255)
age 83,06 2,26 83,02 2,93
Gender m:f 47:38 (55,3% f) 154:101 (60,4% f)
No signif. CHD 15 (17,6%) 50 (19,6%)
3 VD ± LM 30 (35,3%) 77 (30,2%)
PCI-rate 54% 40,45%
Acute/Urgent PCI
15 (17,6%) 50 (19,6%)
CABG 4 (4,7%) 13 (5%)
The Salzburg Experience:Octogenerians periprocedural data
radial (n=85) femoral (n=255)
Only diagnostic (n) 39 146
Time on the tablemedian (min/max)
35min (15 – 130) 26min (8-105)
Fluoroscopy time 3,3min (1-17) 2min (1-26)
Contrast 116,6ml ± 64,8 119ml (± 53,8)
PCI (n) 46 (54,1%, 8 akut) 109 (42,7%, 17 akut)
Time on the tablemedian (min/max)
55min (26-138) 51min (14-196)
Fluoroscopy time 12min (1-36) 9min (2-55)
Contrast 244ml ± 99,3 231,6ml ± 84
Multivessel- or LM-PCI 21 (24,7%) 43 (16,8%)
Shift of access-concept 3 (3,5%) 6 (2,3%)
Complications* 3 (3,5%) 8 (3,1%)
* Access site hematoma and vessel-problems
The Salzburg Experience:
Octogenerians n=340
Radial (n=85) femoral (n=255)
age 83,06 2,26 83,02 2,93
Gender m:f 47:38 (55,3% f) 154:101 (60,4% f)
No signif. CHD 15 (17,6%) 50 (19,6%)
3 VD ± LM 30 (35,3%) 77 (30,2%)
PCI-rate 54% 40,45%
Acute/Urgent PCI 15 (17,6%) 50 (19,6%)
CABG 4 (4,7%) 13 (5%)
The Salzburg Experience:Octogenerians periprocedural data
radial (n=85) femoral (n=255)
Only diagnostic (n) 39 146
Time on the tablemedian (min/max)
35min (15 – 130) 26min (8-105)
Fluoroscopy time 3,3min (1-17) 2min (1-26)
Contrast 116,6ml ± 64,8 119ml (± 53,8)
PCI (n) 46 (54,1%, 8 akut) 109 (42,7%, 17 akut)
Time on the tablemedian (min/max)
55min (26-138) 51min (14-196)
Fluoroscopy time 12min (1-36) 9min (2-55)
Contrast 244ml ± 99,3 231,6ml ± 84
Multivessel- or LM-PCI 21 (24,7%) 43 (16,8%)
Shift of access-concept 3 (3,5%) 6 (2,3%)
Complications* 3 (3,5%) 8 (3,1%)
* Access site hematoma and vessel-problems