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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

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Trans radial approach in overweight patients l.jpg

Trans-Radial approach in Overweight Patients

Hakim Ben Amer, MD

On behalf the TROP study group


Predicting vascular complications in percutaneous coronary interventions l.jpg

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


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Complications following diagnostic coronary angiography: Predicting factors

7,412 consecutive diagnostic cardiac catheterizations between 1990 and 2000

Ammann CCVI 2003;59:13-18


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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


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Clinical Significance of Bleeding Complications

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


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Radial / Femoral Approach meta-analysis: Entry site complications

Agostini P JACC


T rans r adial approach in o verweight p atients l.jpg

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 l.jpg

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)


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N = 346

TROP Study Group


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Clinical Datas

Mean Age 61.2 +/- 10.9 years (30/83)

Sexe (Male)52.9 %

Mean Weight108 +/- 15 Kg(79/155)

Mean Height1.67 +/- 0.1 M(1.45/1.90)

Mean BMI38.7 +/- 3.4 Kg/m2(35/56)

Renal Insuf7.8%

TROP Study Group


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Clinical Datas

%

TROP Study Group


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Clinical Datas

P = .0006

TROP Study Group


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Clinical Datas

%

TROP Study Group


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Clinical Datas

%

TROP Study Group


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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


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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 Ulnar1 (0.4%)

TROP Study Group


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Vascular Access: Size

N

TROP Study Group


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INDICATIONS

%

TROP Study Group


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Clinic Presentation

%

TROP Study Group


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Documented Ischemia

%

TROP Study Group


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Vascular Access

Radial difficulties: 249 patients

- Failure: 10 (4%)

- No difficulty210 (84.3%)

- Catheterism diff.10 (4%)

- Spasm6 (2.8%)

- Loops10 (4%)

- Others2 (0.8%)

- TOTAL29 (11.6%)

TROP Study Group


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CAD extension

%

TROP Study Group


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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


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Fem vs Rad access

TROP Study Group


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Fem vs Rad access

TROP Study Group


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Fem vs Rad access

TROP Study Group


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Fem vs Rad access

TROP Study Group

* With transfusion

§: with 8 Closing Device


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Impact of Weight for in Hospital Outcome after PCI

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


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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


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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


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Bleeding Complications

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


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Bleeding complications


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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


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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 l.jpg

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


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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


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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


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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 l.jpg

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


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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


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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


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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 l.jpg

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


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Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

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


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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 l.jpg

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 l.jpg

Impact of Body Mass Index on Outcome AfterPercutaneous Coronary Intervention (The Obesity Paradox)

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


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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


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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


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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


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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 l.jpg

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


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Obesity a risk for CABG surgery

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


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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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