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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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trans radial approach in overweight patients

Trans-Radial approach in Overweight Patients

Hakim Ben Amer, MD

On behalf the TROP study group

predicting vascular complications in percutaneous coronary interventions
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

slide3

Complications following diagnostic coronary angiography: Predicting factors

7,412 consecutive diagnostic cardiac catheterizations between 1990 and 2000

Ammann CCVI 2003;59:13-18

slide4
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

clinical significance of bleeding complications
Clinical Significance of Bleeding Complications

From Blankenship Am Heart J 1999; 138: S287-S296

t rans r adial approach in o verweight p atients
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

trop centers
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)
slide9

N = 346

TROP Study Group

clinical datas
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

slide11

Clinical Datas

%

TROP Study Group

slide12

Clinical Datas

P = .0006

TROP Study Group

slide13

Clinical Datas

%

TROP Study Group

slide14

Clinical Datas

%

TROP Study Group

vascular access
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

slide16

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

slide17

Vascular Access: Size

N

TROP Study Group

slide18

INDICATIONS

%

TROP Study Group

slide19

Clinic Presentation

%

TROP Study Group

slide20

Documented Ischemia

%

TROP Study Group

slide21

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

cad extension
CAD extension

%

TROP Study Group

pci n 124 pts
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

fem vs rad access
Fem vs Rad access

TROP Study Group

slide25

Fem vs Rad access

TROP Study Group

slide26

Fem vs Rad access

TROP Study Group

slide27

Fem vs Rad access

TROP Study Group

* With transfusion

§: with 8 Closing Device

impact of weight for in hospital outcome after pci
Impact of Weight for in Hospital Outcome after PCI

RM, Minuella Am J cardiol 2004;93:1229-32

conclusion 1
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
conclusion 2
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
bleeding complications
Bleeding Complications

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

slide34

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

slide35

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

slide36

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

slide37

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

slide38

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

slide39

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

slide40

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

slide41

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

slide42

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

slide43

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

slide44

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

impact of body mass index on outcome after percutaneous coronary intervention the obesity paradox
Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

impact of body mass index on outcome after percutaneous coronary intervention the obesity paradox46
Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

impact of body mass index on outcome after percutaneous coronary intervention the obesity paradox47
Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

impact of body mass index on outcome after percutaneous coronary intervention the obesity paradox48
Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

H Gurm, P. Topol Am J Cardiol 2002; 90: 42-45

slide49
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

slide50
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

slide51
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: CABG Group

H. Gurm J Am Coll Cardiol 2002;39:834–40

slide52
Impact of BMI on Short- and Long-Term FU in Patients Undergoing Coronary Revascularization: Insights From BARI

Incidence and OR of Long-Term Mortality According to BMI: PTCA Group (n=2,090)

H. Gurm J Am Coll Cardiol 2002;39:834–40

slide53
Impact of BMI on Short- and Long-Term FU in Patients Undergoing Coronary Revascularization: Insights From BARI

Incidence and OR of In-Hospital Events According to BMI: CABG Group

H. Gurm J Am Coll Cardiol 2002;39:834–40

obesity a risk for cabg surgery
Obesity a risk for CABG surgery

N.J.O. Birkmeyer Circulation 1998;97:1689-94

slide55

Obesity a risk for CABG surgery

CVA Cerebrovascular Accident

SWI Sternal Wound infection

N.J.O. Birkmeyer Circulation 1998;97:1689-94

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