Interventional cardiologist perceptions about PCI without surgical backup-Results of an international survey.

Background: Percutaneous coronary intervention (PCI) without surgical backup is becoming increasingly common in the United States. Additionally, a recent SCAI expert consensus document has liberalized recommendations for performing PCI without cardiac surgery on site (SOS).

Aims: The current study sought to understand practice patterns and operator preferences with regard to performing PCI without SOS.

The association between implementation of multidisciplinary rounds and clinical outcomes.

Background: Multidisciplinary rounds (MDR) consisting of social workers, dietitians, pharmacists, physical therapists, nurses, and physicians have been implemented at many healthcare institutions to address the complex components of inpatient care. However, little is known on the association of MDR on clinical outcomes across cardiovascular pathologies. This study aimed to investigate the impact of MDR on cardiovascular patients.

Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population.

Purpose: Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL).

Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis.

Background: Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial.

Methods: PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality.

Stent selection among patients with chronic kidney disease: Results from the NCDR CathPCI Registry.

Objectives: This study sought to define contemporary rates of drug eluting stent (DES) usage in patients with chronic kidney disease (CKD).

Background: Among patients with CKD undergoing percutaneous coronary interventions (PCIs), outcomes are superior for those who receive DES compared to those who receive bare metal stents (BMSs). However, perceived barriers may limit the use of DES in this population.

SCAI expert consensus statement update on best practices for transradial angiography and intervention.

Transradial angiography and intervention continues to become increasingly common as an access site for coronary procedures. Since the first "Best Practices" paper in 2013, ongoing trials have shed further light onto the safest and most efficient methods to perform these procedures. Specifically, this document comments on the use of ultrasound to facilitate radial access, the role of ulnar artery access, the utility of non-invasive testing of collateral flow, strategies to prevent radial artery occlusion, radial access for primary PCI and topics that require further study.

Acupuncture to Improve Symptoms for Stable Angina: Protocol for a Randomized Controlled Trial.

Background: Acupuncture has demonstrated physiologic analgesic effects in Chinese patients with stable angina. One proposed mechanism of action for these analgesic effects is the downregulation of M1 macrophages, interleukin 1 beta, interleukin-6, interleukin-18, and tumor necrosis factor alpha.

Objective: This study aims to test a 10-session, 5-week acupuncture treatment protocol as a complementary therapy for symptoms of stable angina for American patients, who vary from Chinese patients in health care systems and other salient variables.

Contemporary transradial access practices: Results of the second international survey.

Objectives: To gain insight into current practice of transradial angiography and intervention in the United States and around the world.

Background: Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators.

Image noise reduction technology reduces radiation in a radial-first cardiac catheterization laboratory.

Background: Transradial coronary angiography (TRA) has been associated with increased radiation doses. We hypothesized that contemporary image noise reduction technology would reduce radiation doses in the cardiac catheterization laboratory in a typical clinical setting.

Methods And Results: We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200).

Compared to femoral venous access, upper extremity right heart catheterization reduces time to ambulation: A single center experience.

Objectives: To determine ambulation times after right heart catheterization (RHC) via upper extremity access compared to femoral venous access.

Background: Transradial coronary angiography has been associated with shorter times to ambulation. We hypothesized that RHC from the upper extremity would be similarly associated with shorter ambulation times when compared to traditional femoral access.

Complications of Transradial Cardiac Catheterization and Management.

The transradial approach for coronary angiography has become an increasingly used alternative to the conventional transfemoral approach. Decreased access site complications and bleeding, reduced hospital stays and health care costs, and increased patient satisfaction contribute to the attractiveness of this approach. However, operators must be familiar with the distinct complications associated with the transradial approach.

Radiation safety and vascular access: attitudes among cardiologists worldwide.

Objectives: To determine opinions and perceptions of interventional cardiologists on the topic of radiation and vascular access choice.

Background: Transradial approach for cardiac catheterization has been increasing in popularity worldwide. There is evidence that transradial access (TRA) may be associated with increasing radiation doses compared to transfemoral access (TFA).

Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories.

Background/purpose: Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why.

Methods/material: We conducted a national survey in February 2013 to assess perceptions of TRI vs.

Patient access and 1-year outcomes of percutaneous coronary intervention facilities with and without on-site cardiothoracic surgery: insights from the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program.

Background: The safety of percutaneous coronary intervention (PCI) at medical facilities without on-site cardiothoracic (CT) surgery has been established in clinical trials. However, the comparative effectiveness of this strategy in real-world practice, including impact on patient access and outcomes, is uncertain. The Veterans Affairs (VA) health care system has used this strategy, with strict quality oversight, since 2005, and can provide insight into this question.

Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998-2008.

Background: With conflicting evidence regarding the usefulness of intraaortic balloon pump (IABP), reports of IABP use in the United States have been inconsistent. Our objective was to examine trends in IABP usage in percutaneous coronary intervention (PCI) in the United States and to evaluate the association of IABP use with mortality.

Methods: This is a retrospective, observational study using patient data obtained from the Nationwide Inpatient Sample database from 1998 to 2008.

Temporal trends in percutaneous coronary intervention--associated acute cerebrovascular accident (from the 1998 to 2008 Nationwide Inpatient Sample Database).

Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome and coronary artery disease is associated with high rates of morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was used to identify 1,552,602 PCIs performed for acute coronary syndrome and coronary artery disease. We assessed temporal trends in the incidence, predictors, and prognostic impact of CVA in a broad range of patients undergoing PCI.

Techniques and best practices for optical coherence tomography: a practical manual for interventional cardiologists.

Optical coherence tomography (OCT) is a novel intracoronary imaging modality that utilizes near-infrared light to provide information regarding lesion length and severity, vessel lumen diameter, plaque morphology, as well as the opportunity for stent procedure guidance and follow-up. While analogous to intravascular ultrasound (IVUS), the specific imaging properties, including significantly higher resolution, and technical specifications of OCT offer the ability for intracoronary diagnostic and interventional procedure guidance roles that require a thorough understanding of the technology. We provide coronary interventionalist's a user's guide to OCT, focusing on techniques and approaches to optimize imaging, with a focus on efficiency, safety and strategies for effective imaging.

Myocardial infarction due to intracoronary embolization of percutaneous coronary intervention packaging.

Intracoronary device loss is occasionally encountered and removal is commonly performed at the time of the procedure. We report a case of removal of a retained coronary balloon protective plastic tubing inadvertently left in the coronary artery for a month and associated with myocardial infarction. Optical coherence tomography was used to visualize the foreign body prior to removal with a snare.

A review of radiation exposures associated with radial cardiac catheterisation.

Transradial (TR) cardiac catheterisation is thought to be associated with an increased exposure to radiation compared with the traditional transfemoral (TF) access. This paper provides a review of current literature describing these reported associations. Although several studies have reported an increase in radiation exposure to both operator and patient with TR compared with TF access, others have reported findings suggesting no significant difference, even reporting decreased exposure with TR access.

Unintentional extraction of an endothelialized bare metal stent.

The extraction of a previously endothelialized stent has been rarely reported in the literature. We report a case of a patient with unstable angina due to in-stent restenosis. During percutaneous coronary intervention, a stent was inadvertently dislodged in the ostium of the right coronary artery.