Modified CHA2DS2-VASc score predicts in-hospital mortality and procedural complications in acute coronary syndrome treated with percutaneous coronary intervention

Background: Current risk prediction models in acute coronary syndrome (ACS) patients undergoing PCI are mathematically complex. This study was undertaken to assess the accuracy of a modified CHA2DS2-VASc score, comprised of easily accessible clinical factors in predicting adverse events. Methods: The National Inpatient Sample (NIS) was queried for ACS patients who underwent PCI between 2010 and 2014. We developed a modified CHA2DS2-VASc score for risk prediction in ACS patients. Multivariate mixed effect logistic regression was utilized to study the adjusted risk for adverse outcomes based on the score. The primary outcome evaluated was in-hospital mortality. Secondary outcomes assessed were stroke, respiratory failure, acute kidney injury, all-cause bleeding, pacemaker insertion, vascular complications, length of stay and cost. Results: There were 252,443 patients admitted with ACS included. Mean age was 62 +/- 12 years. The mean CH3A2DS-VASc score was 1.6 +/- 1.6. The in-hospital mortality rate was 2.5%. CH3A2DS-VASc score was highly correlated with increased rate of mortality and all secondary outcomes. ROC curve analysis for association of CH3A2DS-VASc score with mortality demonstrates that area under the curve (AUC) = 0.83 (95%C: 0.82-0.84). Stepwise increases in CH3A2DS-VASc score correlated with incremental risk, and total score was an independent predictor of mortality (adjusted OR: 1.99 (95%CI: 1.96-2.03) p \u3c 0.001) and all secondary outcomes. Conclusion: This study supports the applicability of the CH3A2DS-VASc score as an accurate risk prediction model for ACS patients undergoing PCI and could supplant more complicated models for quality assurance

Radiation Dose Reduction during Radial Cardiac Catheterization: Evaluation of a Dedicated Radial Angiography Absorption Shielding Drape

Objectives. Radiation scatter protection shield drapes have been designed with the goal of decreasing radiation dose to the operators during transfemoral catheterization. We sought to investigate the impact on operator radiation exposure of various shielding drapes specifically designed for the radial approach. Background. Radial access for cardiac catheterization has increased due to improved patient comfort and decreased bleeding complications. There are concerns for increased radiation exposure to patients and operators. Methods. Radiation doses to a simulated operator were measured with a RadCal Dosimeter in the cardiac catheterization laboratory. The mock patient was a 97.5 kg fission product phantom. Three lead-free drape designs were studied. The drapes were placed just proximal to the right wrist and extended medially to phantom’s trunk. Simulated diagnostic coronary angiography included 6 minutes of fluoroscopy time and 32 seconds of cineangiography time at 4 standard angulated views (8 s each), both 15 frames/s. ANOVA with Bonferroni correction was used for statistical analysis. Results. All drape designs led to substantial reductions in operator radiation exposure compared to control (P&lt;0.0001). The greatest decrease in radiation exposure (72%) was with the L-shaped design. Conclusions. Dedicated radial shielding drapes decrease radiation exposure to the operator by up to 72% during simulated cardiac catheterization.</jats:p

Abstract 203: Evaluation of Acute Radial Artery Injury Following Transradial Percutaneous Coronary Intervention by Optical Coherence Tomography

Background: Recent evidence has shown a reduced bleeding risk and resultant decreased morbidity and mortality when the transradial approach is utilized over the transfemoral approach for percutaneous coronary intervention (PCI). However, transradial catheterization may introduce acute and/or chronic injury to the radial artery limiting its use for future procedures and as a bypass conduit. Our goal was to utilize optical coherence tomography (OCT) to evaluate the incidence of acute radial artery injury in patients following transradial PCI. Methods: In this observational study OCT (C7 Dragonfly catheter, St. Jude Medical Systems, St. Paul, MN) was used to evaluate the radial artery of 25 patients at the University of Illinois and Jesse Brown Veterans Affairs Medical Centers in Chicago, IL following transradial PCI. Specific injuries assessed for included radial artery dissection and thrombus formation. Diameter and cross sectional area of the artery were taken proximally and distally. Measurements were taken independently by two separate readers to account for inter-reader variability. Results: The radial artery was assessed in 25 patients following transradial PCI. The mean BMI of our patient population was 27.8 kg/m2. A 5Fr sheath was used in 24% (n=6) cases and a 6Fr sheath was utilized for the remaining 19 cases. In 8 cases the sheath was upsized from a 5 to 6 F. The average length of artery scanned was 39.4mm with a mean proximal cross sectional area of 7.56 mm2 and distal area of 7.08 mm2. An average of 4.4 catheter exchanges were made per case. A small intimal tear was noted in the radial artery of one patient. No other dissections or thrombi were noted. Conclusion: Based on our initial observation, the incidence of acute radial artery injury following transradial PCI is very low (1/25) and overall transradial PCI is a safe modality. When compared with prior studies we believe the factors that decreased the incidence of acute radial artery injury in our population were related to larger arterial cross sectional area, higher mean BMI, and ultimately a lower sheath size to artery diameter ratio. </jats:p