Transradial access for coronary angiography and angioplasty: a novel approach.

Coronary angiography and angioplasty are usually performed via transfemoral access. Though this route provides an easier vascular access, it is associated with a small but potentially serious incidence of vascular complications at the puncture site that may result in significant groin haematoma, blood transfusion or require surgical repair. A useful alternative approach is through the transradial access. This route has a very low rate of vascular complications and also allows early mobilisation of patients. We performed an analysis of our experience with transradial angiography and angioplasty, demonstrating this to be a safe and effective technique suitable for most patients.

Gender differences in outcome after an acute myocardial infarction in Singapore.

OBJECTIVES: To characterise gender and age-related differences in presentation and outcome after an acute myocardial infarction (AMI). DESIGN: Data were derived retrospectively from the Singapore Myocardial Infarction Registry from 1988 through 1997. This database comprised all AMI cases for ages between 20 and 64 years (group A). For approximately three months a year, data were also collected for all AMI cases above the age of 64 years (group B). There were 13,048 and 4,425 cases in groups A and B respectively. RESULTS: In age - standardised AMI rates, males outnumbered females by a factor of 4.0 and 1.7 for groups A and B respectively.The median age of presentation was higher in females for both age groups being 58 years versus 54 years for group A and 75 years versus 72 years for group B. Younger females had worse survival at 28 days and were more likely to have prior ischaemic heart disease and require resuscitation. They were also more likely to have atypical symptoms. Previous myocardial infarction was not different between the sexes in both groups. Among the older age group, there was no gender difference in prior ischaemic heart disease, 28-day survival and requirement for resuscitation. CONCLUSION: Women who have AMI tend to be older than men. Gender differences are age-specific. Women who are 64 years and below have more atypical symptoms, prior ischaemic heart disease and worse prognosis than men after AMI. These differences are not seen in those over the age of 64.

Prevention of restenosis after percutaneous coronary intervention: the continuing challenge.

Percutaneous coronary intervention with angioplasty and stenting is well established in the treatment of coronary artery disease. However, the many advances in technique and equipment over the last couple of decades have yet to significantly reduce the incidence of restenosis. This Achilles' heel has necessitated frequent re-interventions and also introduced a new iatrogenic disease of in-stent restenosis. Brachytherapy and coated stents may be the answer to this difficult problem. Many papers have been published in the last few years on these two new modalities of treatment, and we review the evidence available so far. Early results show that brachytherapy significantly reduce the incidence of restenosis when used in restenotic lesions, and coated stents significantly reduce restenosis in de novo lesions. This early promise of brachytherapy and coated stents, if confirmed in longer-term studies, will represent a breakthrough in the battle against restenosis and may dramatically change the practice of interventional cardiology in the near future.