Epidemiological, Clinical and Coronary Angiography Aspects of Acute Coronary Syndrome in the Cardiology Department of the Hospital Mother-Child “Le Luxembourg”Mali

Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training. Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome. Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako. Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome. Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%. Sex-ratio was 2.10. Mean age of patients was 58.5 ± 11.39 years. ST elevation acute coronary syndrome was the most common indication with 63.92% of cases. High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases. Coronary angiography was pathological in 91.70% of cases (n = 548). Patients with lesions of anterior interventricular artery were 73.73% of cases. Tritruncal lesions accounted for 40.63% of cases. Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome. Anterior interventricular artery is most often the culprit lesion for our patients.

Coronary Artery Patterns in Diabetic Patients Undergoing Diagnostic Coronary Angiography-Data from a Major Cardiac Center in Yemen

Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.

Effects of Continuous Precision Nursing Model on Knowledge, Attitudes, and Practices (KAP) Behavior and Cardiac Function in Patients after Percutaneous Coronary Angiography and Stent Implantation

Objective:To explore the impact of a continuous precision nursing model on patients’Knowledge,Attitudes,and Practices(KAP)and cardiac function during the nursing process of patients undergoing percutaneous coronary angiography and stent implantation.Methods:Ninety patients who underwent percutaneous coronary angiography and stent implantation in our hospital from April 2022 to April 2023 were selected and randomly divided into the control group(45 cases),in which routine nursing support was carried out during the treatment process,and the observation group(45 cases),in which continuous precision nursing model was carried out during the treatment process.Comparisons were made between the two groups of patients on their KAP,cardiac function,and quality of life during recovery.Results:There was no difference in the left ventricular ejection fraction(LVEF),cardiac output(CO),and cardiac index(CI)levels before intervention.After the intervention,the levels of cardiac function in the observation group were higher than those of the control group(P<0.05).There was no difference in the Exercise of Self-Care Agency(ESCA)self-care ability scale scores before the intervention.After the intervention,the observation group had higher ESCA scores than the control group(P<0.05).Conclusion:Implementation of a continuous precision nursing model in the care of patients undergoing percutaneous coronary angiography and stent implantation improved the patient’s cardiac function,and KAP,and promoted recovery.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Contrast-induced ischemic colitis following coronary angiography:A case report

BACKGROUND Ischemic colitis(IC)is common,rising in incidence and associated with high mortality.Its presentation,disease behavior and severity vary widely,and there is significant heterogeneity in therapeutic strategies and prognosis.The common causes of IC include thromboembolism,hemodynamic insufficiency,iatrogenic factors and drug-induced.However,contrast-induced IC,especially isolated right colon ischemia is rarely reported.CASE SUMMARY A 52-year-old man was admitted to the hospital due to intermittent chest distress accompanied by palpitation.Coronary angiography was performed using 60 mL of the iodinated contrast agent iohexol(Omnipaque 300),and revealed moderate stenosis of the left anterior descending artery and right coronary artery.At 3 h post-procedure,he complained of epigastric pain without fever,diarrhea and vomiting.Vital signs remained normal.An iodixanol-enhanced abdominal computed tomography(CT)scan revealed thickening,edema of the ascending and right transverse colonic wall and inflammatory exudate,without thrombus in mesenteric arteries and veins.Following 4 days of treatment with antibiotic and supportive management,the patient had a quick and excellent recovery with disappearance of abdominal pain,normalization of leucocyte count and a significant decrease in C reactive protein.There was no recurrence of abdominal pain during the patient's two-year follow-up.CONCLUSION This case emphasizes that contrast-induced IC should be considered in the differential diagnosis of unexplained abdominal pain after a cardiovascular interventional procedure with the administration of contrast media.Timely imaging evaluation by CT and early diagnosis help to improve the prognosis of IC.

Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease

BACKGROUND There is evolving role of computed tomography coronary angiography(CTCA)in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease(KD).Despite this,there is lack of data on radiation dose in this group of children undergoing CTCA.AIM To audit the radiation dose of CTCA in children with KD.METHODS Study(December 2013-February 2018)was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering.The dose length product(DLP in milligray-centimeters-mGy.cm)was recorded.Effective radiation dose(millisieverts-mSv)was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection.Radiation dose was compared across the groups(0-1,1-5,5-10,and>10 years).RESULTS Eighty-five children(71 boys,14 girls)with KD underwent CTCA.The median age was 5 years(range,2 mo-11 years).Median DLP and effective dose was 21 mGy.cm,interquartile ranges(IQR)=15(13,28)and 0.83 mSv,IQR=0.33(0.68,1.01)respectively.Mean DLP increased significantly across the age groups.Mean effective dose in infants(0.63 mSv)was significantly lower than the other age groups(1-5 years 0.85 mSv,5-10 years 1.04 mSv,and>10 years 1.38 mSv)(P<0.05).There was no significant difference in the effective dose between the other groups of children.All the CTCA studies were of diagnostic quality.No child required a repeat examination.CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD.Thus,CTCA has the potential to be an important adjunctive imaging modality in children with KD.

Prevalence and Predictive Factors of Severe Coronary Lesions in Algerian Patients Undergoing Coronary Angiography

Background: The severity of coronary lesions in patients with coronary artery disease (CAD) has important prognostic and therapeutic consequences. Clinical symptoms not always reflect the disease severity and this study aimed to evaluate coronary lesions in the Algerian population where these data are scarce. Methods: It was a prospective cross-sectional study conducted in consecutive patients with an age ≥20 years who underwent clinically-indicated coronary angiography in our center. The objective of the study was to determine the prevalence of severe coronary lesions assessed with the Gensini score. The predictive factors of severity were evaluated in a multivariate analysis. Results: A total of 507 patients were included (male, 79.7%;mean age, 58.8 years). Coronary angiography was prescribed most frequently for ST-segment elevation myocardial infarction (STMI) (46.9%) and non-STMI (38.1%). The prevalence of severe coronary lesions was 69.6% (95% CI 65.5 - 73.5). In multivariate analysis, the independent predictive factors of severe coronary lesions were male sex (odds ratio [OR] 2.00;p = 0.0141), diabetes (OR 1.92;p = 0.0070), left ventricular dysfunction (OR 1.81;p = 0.0059), age (OR 1.72;p = 0.0297) and no lipid-lowering treatment (OR, 0.47;p = 0.0388). Conclusions: Severe coronary lesions were present in two out three patients in this cohort of Algerian patients undergoing coronary angiography. Independent predictive factors of severe coronary lesions were male sex, diabetes, age, left ventricular dysfunction and no lipid-lowering treatment. It is important to identify these at-risk patients, as they should be explored at an asymptomatic stage before a cardiovascular event and receive prompt treatment with angioplasty or surgery.

Feasibility analysis of coronary angiography by transradial approach with 4F catheter

Objective:To assess the feasibility of coronary angiography by transradial approach with 4F catheter.Methods:The procedural details,picture quality,local complication were recorded for coronary by transradial approach with 4F catheter in 138 patients.Results:The success rate of angiography was 97.7%;fluoroscopy time was(5.05±3.23)minutes,total procedural time was(20.51±3.37)minutes;the incidence of dislodgement,excessive engagement of either coronary artery was 7.8%,9.4%,repectively;the angiographic scores for left anterior descending,circumflex and right coronary arteries were(2.87±0.40),(2.88±0.39),(2.90±0.35),respectively.The spasm complication occurred 4.3% in radial artery and 1.5% in coronary artery.There were no occlusion of radial artery during follow up.Conclusion:4F catheter could be the first chosen in some selecting patients for its nice maneuverability,fine images and fewer vascular complications.

The Systemic Inflammation on Transradial vs Transfemoral Approach for Coronary Angiography in Patients with Chronic Coronary Syndrome <br/>—Does Transradial Coronary Angiography Trigger More Inflammation?

Background: Most of the institutions accept the Transradial Access (TRA) as the first approach for patients undergoing Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Several studies clearly revealed endothelial injury of coronary arteries triggers inflammatory response. In this study, we aimed to evaluate inflammatory respond to CAG and to compare the inflammatory response of TRA and Transfemoral Access (TFA). Methods: In this single-center prospective study 140 consecutive patients presenting with (Chronical Coronary Syndrome) CCS and underwent transradial or transfemoral CAG between December 2017 and December 2018 were included. After exclusions, left 92 patients were divided into two equal groups as TRA and TFA. The primary endpoints were 2nd hour Tumor Necrosis Factor alpha (TNFα), 48th hour high-sensitivity C-Reactive Protein (hs-CRP), complication rates, amount of contrast medium, procedure time and fluoroscopy time. Results: Basal characteristics of TRA and TFA groups were similar. A comparison of variables demonstrated that there was no statistical significance in increase in inflammatory markers (TNFα, hs-CRP), complication rates, amount of contrast media and procedure time. In contrast, TRA was associated longer fluoroscopy time and higher X-ray dosage, although statistically insignificant. CAG caused a similar increase in hs-CRP in both groups, insignificantly. Conclusion: In contrast to previous studies reporting a higher inflammatory response with TRA, this study demonstrates that inflammatory response caused by CAG is unrelated to access site and similar in TRA and TFA. Longer fluoroscopy time, higher X-ray dosage and longer procedure time in the TRA group indicate the importance of carefully selecting the angiographic route especially in patients with chronic heart failure, chronic renal impairment and malignancy risk. Also, these parameters place importance for physicians own health and woman planning pregnancy.

Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography

Objective To investigate the performance of dual-source computed tomography （DSCT） using high-pitch spiral fliPS） mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography （ICA）, while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate （HR） on image quality （P 〉 0.05）, while HR variability had a slight impact on that （P 〈 0.05）. Sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） of DSCT in detection of in-stent restenosis （ISR） based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant differ- ence on sensitivity, specificity, PPV and NPV between diameter 〉 3.0 mm group （93.3%, 97.9%, 87.5%, and 98.9%） and diameter 〈 3.0 mm group （80%, 93.3%, 80.0%, and 93.3%） （P 〈 0.05）, and that between stent number 〉 3 group （82.3%, 77.8%, 66.7%, and 60%） with 〈 3 group （97.3%, 80%, 96.5%, and 75%）. The effective dose of DSCT （1.4 ± 0.5 mSv） is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv （P 〈 0.01）]. Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR 〈 65 beats/rain.

Feasibility and Diagnostic Accuracy for Assessment of Coronary Artery Stenosis of Prospectively Electrocardiogram-gated High-pitch Spiral Acquisition Mode Dual-source CT Coronary Angiography in Patients with Relatively Higher Heart Rates: in Comparison wit

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.

CORONARY ANGIOGRAPHY WITH DUAL SOURCE COMPUTED TOMOGRAPHY:INITIAL EXPERIENCE

Objective To explore the scan technique and image quality of coronary angiography with dual source computed tomography(CT) without oral metoprolol preparation.Methods Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients.Calcium scoring with plain scan images as well as multi-planar reconstruction(MPR),maximum intensity projection(MIP),and volume rendering technique(VRT) reconstruction with enhanced scan images were performed in all cases.The scan technique and post-reconstruction experience was summarized.The image quality was classified as 1 to 4 points,and coronary segments classified according to the American Heart Association standards were evaluated.Results The average calcium score of the 600 cases was 213.6±298.7(0-3 216.5).The average heart rate of the enhanced scan was 82.1±16.2(47-139) bpm.The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method,two or more phases supplemented method,and electrocardiogram editing method.Altogether 8 457 coronary segments were evaluated,among which 97.2% were evaluated as point 1,1.7% point 2,0.5% point 3,and 0.6% point 4.The coronary segments in 261 cases were completely normal,while 360 segments were diagnosed with <50% stenosis and 625 segments with ≥50% stenosis.Conclusions Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation.Heart rate is not a major source of the artifact,coronary segments can be well shown with single or multiple-phase reconstruction method.

Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram:A comparison of shockable and non-shockable initial rhythms

AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.

Plaque imaging with CT coronary angiography:Effect of intra-vascular attenuation on plaque type classification

AIM: To assess the attenuation of non-calcified atherosclerotic coronary artery plaques with computed tomography coronary angiography (CTCA). METHODS: Four hundred consecutive patients underwent CTCA (Group 1: 200 patients, Sensation 64 Cardiac, Siemens; Group 2: 200 patients, VCT GE Healthcare, with either Iomeprol 400 or Iodixanol 320, respectively) for suspected coronary artery disease (CAD). CTCA was performed using standard protocols. Image quality (score 0-3), plaque (within the accessible non-calcified component of each non-calcified/mixed plaque) and coronary lumen attenuation were measured. Data were compared on a per-segment/per-plaque basis. Plaques were classified as fibrous vs lipid rich based on different attenuation thresholds. A P < 0.05 was considered significant. RESULTS: In 468 atherosclerotic plaques in Group 1 and 644 in Group 2, average image quality was 2.96 ± 0.19 in Group 1 and 2.93 ± 0.25 in Group 2 (P ≥ 0.05). Coronary lumen attenuation was 367 ± 85 Hounsfield units (HU) in Group 1 and 327 ± 73 HU in Group 2 (P < 0.05); non-calcified plaque attenuation was 48 ± 23 HU in Group 1 and 39 ± 21 HU in Group 2 (P < 0.05). Overall signal to noise ratio was 15.6 ± 4.7 in Group 1 and 21.2 ± 7.7 in Group 2 (P < 0.01). CONCLUSION: Higher intra-vascular attenuation modifies significantly the attenuation of non-calcified coronary plaques. This results in a more difficult characterization between lipid rich vs fibrous type.

Intravenous Contrast Material Administration at High-pitch Dual-source CT Coronary Angiography: Bolus-tracking Technique with Shortened Time of Respiratory Instruction Versus Test Bolus Technique

Objective To investigate the feasibility of acquiring the similar homogeneous enhancement using bolus-tracking techniques with shortened respiratory time in prospectively electrocardiogram-gated high-pitch spiral acquisition mode (Flash mode) coronary computed tomography angiography (CCTA) compared with test bolus technique. Methods One hundred and eighty-four consecutive patients with mean heart rate ≤65 beats per minute undergoing CCTA were prospectively included in this study. The patients were randomly divided into two groups. Patients in the group A (n=92) instructed to shorten respiratory time received CCTA using bolus-tracking technique with high-pitch spiral acquisition mode (Flash mode), while those in the group B (n=92) underwent CCTA with test bolus technique. The attenuation in the ascending aorta, image noise, contrast-to-noise ratio and radiation doses of the two groups were assessed. Results There were no significant differences in the mean attenuation values in the ascending aorta (483.18±59.07 HU vs. 498.7±83.51 HU, P=0.183), image noise (21.4±4.5 HU vs. 20.9±4.3 HU, P=0.414), contrast-to-noise ratio (12.1±4.2 vs. 13.8±5.1, P=0.31) between the groups A and B. There were no significant differences in the radiation dose of dynamic monitoring scans (0.056±0.026 mSv vs. 0.062±0.018 mSv, P=0.068) and radiation dose of angiography (0.94±0.07 mSv vs. 0.96±0.15 mSv,P=0.926) between the two groups, while 15 mL less contrast material volume was administered in the group A than the group B. Conclusion Bolus-tracking technique with shortened time of respiratory in Flash mode of dual-source CT yields the similar homogeneous enhancement with less contrast material in comparison to the test bolus technique.

Application of the interventional limb raising management strategy(ILRMS) at radial vascular access sites in coronary angiography and percutaneous coronary intervention:A randomized trial

Purpose:To compare the effectiveness of the interventional limb raising management strategy(ILRMS)to elastic bandage compression at radial vascular access sites following coronary angiographies(CAGs)and percutaneous coronary interventions(PCIs).Methods:Patients with ischemic coronary heart disease whose condition was stable over three months were enrolled in this clinical study(n=590;aged 25e80).All participants had just undergone CAG and PCI.Patients were randomized into either the ILRMS group(n=360)or standard post-intervention care with an elastic bandage(n=230).Overall comfort and wrist pain was assessed and the degree of index finger swelling and oxygen saturation was measured on the affected arm.All variables were measured prior to postintervention treatment and again at six hours after CAG and PCI.Results:We found that patients receiving ILRMS had significantly lower wrist pain scores and swelling around the index finger compared to the elastic bandage group(p<0.05).Oxygen saturation of the index finger was not statistically significant(p>0.05).We also found that 19.57%of the elastic bandage patients were comfortable,while ILRMS patients were significantly more comfortable(93.06%;p<0.05).Conclusions:We find that ILRMS alleviates swelling and pain of the wrist more effectively than current practices and improves the degree of overall comfort of patients who undergo CAG and PCI.

Polymorphisms in the genes for coagulation factor II,V,VII in patients undergoing coronary angiography

Objective: To determine whether polymorphisms in the genes for coagulation factor II,V, VII could predispose an individual to increase risk for coronary artery disease (CAD) and/or myocardial infarction (MI) in Chinese. Methods: We screened coagulation factor II(G20210A),V(G1691A),VII (R353Q and HVR4) genotype in 374 patients undergoing coronary angiography by polymerase chain reaction and restriction fragment length polymorphism (PCR RFLP) assay. Results: The R353Q and HVR4 genotype of the factor VII distribution was in accordance with Hardy Weinberg equilibrium. The frequencies of FVII genotype or allele did not show statistically significant differences between CAD group and controls or between male and female. The frequencies of the Q allele and (RQ+QQ) genotype were significantly higher among the CAD patients without myocardial infarction (MI) history than among those with MI history ( P <0.05). However, HVR4 polymorphism was not significantly different within groups. We only find one normal control of factorII(G20210A) mutation. No coagulation factor V(G1691A) mutation was found in the CAD patients and controls. Conclusion: The factor II(G20210A),V(G1691A) mutation is absent and may not be a major genetic factor for CAD and/or MI; the Q allele of the R353Q polymorphism of the factor VII gene may be a protective genetic factor against myocardial infarction in Chinese.

Safety and efficacy of transradial coronary angiography and intervention in patients older than 80 years： from the Korean Transradial Intervention Prospective Registry

Background Radial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younger patients. This study was conducted to investigate the feasibility and safety oftransradial coronary angiography or intervention in the elderly. Methods A total of 6132 patients from Korean Transradial Intervention Prospective Registry at 20 centers were analyzed. Patients were divided into the non-elderly group （n = 5667） and the elderly （_〉 80 years） group （n = 465）. Using propensity score matching, the elderly group （n = 465） was compared with one-to-one matched the non-elderly group （n = 465）. Results After propensity score matching, mean age was 64.3 ＋ 10.3 years in the non-elderly group and 83.5 -4- 3.3 years in the elderly group. There was no difference of procedural characteristics, procedural and fluoroscopic times. Access site cross-over rate was not different between the non-elderly group and elderly group （7.5% vs. 6.2%, P = 0.074）. Bleeding compli- cations occurred similarly in two groups （2.6% of the non-elderly group vs. 1.9% of the elderly group, P -~ 0.660）. Access site complications were 1.9% of the non-elderly group and 0.9% of the elderly group （P = 0.263）. Both of in hospital death and cardiovascular death for one year were also similar between two groups. Conclusions Transradial angiography or intervention was safe and feasible in elderly patients. Complication rates and clinical outcomes in elderly patients were comparable with those in non-elderly patients.

The feasibility of left radial artery approach for coronary angiography

Objective：To study the feasibility of the left radial approach for coronary angiography. Methods：195 patients diagnosed with coronary atherosclerotic heart disease were randomly divided for coronary angiography（CAG） into a left radial artery approach group（98 cases） and a right radial artery approach group（97 cases） from Jan 2006 to Dec 2006. Selective coronary angiographies were performed with 5F TIG catheters. The time of puncturing, duration under X-ray fluoroscopy and of the operation, successful rates of puncturing and coronary angiography were recorded. Results：There was no difference in the time of puncturing（2.25 ± 1.58 min vs 2.19 ± 1.62 min）, duration under X-ray fluoroscopy（3.12 ± 1.53 min vs 3.21 ± 1.49 min） and the duration of the operation（12.87 ± 2.52 min vs 12.98 ± 2.85 rain）, nor in the success rates of puncturing（95.91% vs 95.87%） and coronary angiography（94.90% vs 94.85%）. Conclusion： Coronary angiography can be accomplished via the left radial artery approach, indicating that this is a worthwhile clinical approach.

Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease

Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.