The Trans Radial Intervention and Patient Subsets (II)

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