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Trans-Radial approach in Overweight Patients

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55 diapositives · 909 Views · Sep 12, 2012

Trans-Radial approach in Overweight Patients. Hakim Ben Amer, MD On behalf the TROP study group. Predicting vascular complications in percutaneous coronary interventions. 18,137 PCI pts in northern New England (1997-1999); vascular complication* 2.98%

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  1. Trans-Radial approach in Overweight Patients Hakim Ben Amer, MD On behalf the TROP study group

  2. Predicting vascular complications in percutaneous coronary interventions 18,137 PCI pts in northern New England (1997-1999); vascular complication* 2.98% Variables associated with increased risk in the multivariate analysis Age >or=70 OR 2.7 Female gender OR 2.4 Body surface area <1.6 m OR 1.9 History of congestive heart failure OR 1.4 Chronic obstructive pulmonary disease OR 1.5 Renal failure OR 1.9 Lower extremity vascular disease OR 1.4 Bleeding disorder OR 1.68 Emergent priority OR 2.3 Myocardial infarction OR 1.7 Shock OR 1.86 >or=1 type B2 lesions OR 1.32 type C lesions OR 1.7 3-vessel PCI OR 1.5 Thienopyridines OR 1.4 Glycoprotein IIb/IIIa inhibitors OR 1.9 *Vascular complications: access-site injury requiring treatment or bleeding requiring transfusion Piper WD Am Heart J. 2003 Jun;145(6):1022-9

  3. Complications following diagnostic coronary angiography: Predicting factors 7,412 consecutive diagnostic cardiac catheterizations between 1990 and 2000 Ammann CCVI 2003;59:13-18

  4. Impact of Access Site Hematoma With Transfusion in Patients Undergoing Percutaneous Coronary Intervention 6613 PCI (98-00)(NHLBI): hematoma w transfusion 1.8% (97% femoral) Predictors: Older age, Lower BMI, Female, renal disease, HTN, AMI, 3-VD, GPIIb/IIa -, Postprocedure heparin Independent predictors: Older age, female, thrombotic lesion, 3-VD, renal disease, emergent PCI, prior aspirin Procedural death: 10.3% w HWT 1.2% w/o HWT p <0.001 death/MI: 18.1% 3.55% <0.001 HWT is a predictor of death/MI (OR = 3.49; 95% CI: 1.98-6.14) J. Slater Am J Cardiol 2003 (suppl) 92: 18L

  5. Clinical Significance of Bleeding Complications From Blankenship Am Heart J 1999; 138: S287-S296

  6. Radial / Femoral Approach meta-analysis: Entry site complications Agostini P JACC

  7. TransRadial ApproachIn OverWeight Patients • Multicentric European Registry, • Coronary angiography (CA) or angioplasty (PCI) • Centres where there is at least one operator • with a wide experience in the transradial approach • for CA and PCI. • We include in the registry all the overweight • patients with BMI  35, undergoing CA and/or PCI • whatever the vascular approach chosen by the operator. • The primary end point is the occurrence of complications delaying the hospital discharge. TROP Study Group

  8. TROP Centers • Bergamo (Italy) • Brighton (England) • CHU Caen, (France) • HEP la Roseraie, (France) • Clinic Barcelona, (Spain) • Hôpital Bichat, Paris (France) • ICPS, Massy (France) • ICPS, Quincy (France) • Meixoeiro, (Spain) • Riga, (Latvia) • Szeged, (Hungary) • Val-de-Grâce (France) • Valle de Hebron, (Spain)

  9. N = 346 TROP Study Group

  10. Clinical Datas Mean Age 61.2 +/- 10.9 years (30/83) Sexe (Male) 52.9 % Mean Weight 108 +/- 15 Kg (79/155) Mean Height 1.67 +/- 0.1 M (1.45/1.90) Mean BMI 38.7 +/- 3.4 Kg/m2 (35/56) Renal Insuf7.8% TROP Study Group

  11. Clinical Datas % TROP Study Group

  12. Clinical Datas P = .0006 TROP Study Group

  13. Clinical Datas % TROP Study Group

  14. Clinical Datas % TROP Study Group

  15. Vascular Access Transradial approach IT: 249/346 (71.9%) Transradial approach AC: 243/346 (70.2%) Reasons for using Femoral access: 97/346 (28.1%) - Physician choice (76): 78.4% - Dialysis (1): 1% - Need for 7F catheters (5): 5.2% - Abnormal Allen test (1): 1% - CABG (double Mam) (4): 4.1% - No or to small radial (4): 4.1% - Other (ring, prior rad failure…) (6): 6.2% IT: Intention To Treat AC: After Cross over TROP Study Group

  16. Vascular Access Cross over: 17 (4.9%) - Radial to femoral: 9 (3.6%) - Radial to radial: 4 (1.6%) - Femoral to radial: 3 (3.1%) - Radial to Ulnar 1 (0.4%) TROP Study Group

  17. Vascular Access: Size N TROP Study Group

  18. INDICATIONS % TROP Study Group

  19. Clinic Presentation % TROP Study Group

  20. Documented Ischemia % TROP Study Group

  21. Vascular Access Radial difficulties: 249 patients - Failure: 10 (4%) - No difficulty 210 (84.3%) - Catheterism diff. 10 (4%) - Spasm 6 (2.8%) - Loops 10 (4%) - Others 2 (0.8%) - TOTAL 29 (11.6%) TROP Study Group

  22. CAD extension % TROP Study Group

  23. PCI (N = 124 pts) • - Transradial access: 78/124 (62.9%) • Femoral access: 46/124 (38.1%) • - PCI success/Vessel: 163/169 (96.5%) • Clinical Total Success: 118 (95.2%) • QMI: 4 (3.2%) • MACE: 1 (3.2%) • Emergent CABG: 0 (0%) • Death: 0 (0%) TROP Study Group

  24. Fem vs Rad access TROP Study Group

  25. Fem vs Rad access TROP Study Group

  26. Fem vs Rad access TROP Study Group

  27. Fem vs Rad access TROP Study Group * With transfusion §: with 8 Closing Device

  28. Impact of Weight for in Hospital Outcome after PCI RM, Minuella Am J cardiol 2004;93:1229-32

  29. Conclusion 1 • Obesity is a risk factor for CAD (Hypertension, Dyslipidemia, Diabetes) • Obesity is more frequent in female gender • Obesity is a factor of complication in diagnostic angiography and coronary intervention

  30. Conclusion 2 • Preliminary analysis of this study • Radial approach in obese patients reduces the rate of vascular complications • Subgroup analysis (pending) is necessary to better define patients at higher risk, interest of closure devices for femoral procedures… • Potential other advantage of radial approach: prevention of infectious complication

  31. Bleeding Complications F.V Aguirre et al, Circulation 1995;91:2882-90

  32. Bleeding complications

  33. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients Distribution of patients who underwent cardiac catheterization procedures by BMI N Cox, Am J Cardiol 2004;94:1174–1177

  34. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients N Cox, Am J Cardiol 2004;94:1174–1177

  35. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients N Cox, Am J Cardiol 2004;94:1174–1177

  36. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients Vascular complications by BMI. The patients with the smallest BMIs experienced the highest rate of vascular complications N Cox, Am J Cardiol 2004;94:1174–1177

  37. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients Overall vascular complication rate in nonobese and obese (BMI >30.0) patient subgroups stratified by vascular access approach N Cox, Am J Cardiol 2004;94:1174–1177

  38. Comparison of the Risk of Vascular Complications Associated With Femoral and Radial Access Coronary Catheterization Procedures in Obese Versus Nonobese Patients N Cox, Am J Cardiol 2004;94:1174–1177

  39. Low-Normal or Excessive Body Mass Index: Newly Identified and Powerful Risk Factors for Death and Other ComplicationsWith Percutaneous Coronary Intervention Major Cardiac Outcomes and Complications Stephen G. Ellis, Am J Cardiol 1996;78:642-64

  40. Low-Normal or ExcessiveBody Mass Index: Newly Identified and Powerful Risk Factors for Death and Other Complications With Percutaneous Coronary Intervention Peripheral Vascular Complications Stephen G. Ellis, Am J Cardiol 1996;78:642-64

  41. Low-Normal or ExcessiveBody Mass Index: Newly Identified and Powerful Risk Factors for Death and Other Complications With Percutaneous Coronary Intervention Independent Correlates of Death With and Without BMI Stephen G. Ellis, Am J Cardiol 1996;78:642-64

  42. Low-Normal or ExcessiveBody Mass Index: Newly Identified and Powerful Risk Factors for Death and Other Complications With Percutaneous Coronary Intervention Causes of Death Stephen G. Ellis, Am J Cardiol 1996;78:642-64

  43. Low-Normal or ExcessiveBody Mass Index: Newly Identified and Powerful Risk Factors for Death and Other ComplicationsWith Percutaneous Coronary Intervention Stephen G. Ellis, Am J Cardiol 1996;78:642-64

  44. Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox) H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

  45. Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox) H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

  46. Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox) H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

  47. Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox) H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

  48. Impact of BMI on Short- and Long-Term FU in Patients Undergoing Coronary Revascularization: Insights From BARI Procedural Characteristics of Study Patients According to BMI H. Gurm J Am Coll Cardiol 2002;39:834–40

  49. Impact of BMI on Short- and Long-Term FU in Patients Undergoing Coronary Revascularization: Insights From BARI Incidence and Odds Ratios of In-Hospital Events According to BMI: PTCA Group H. Gurm J Am Coll Cardiol 2002;39:834–40