ABSTRACT
INTRODUCTION: Radial access for diagnostic coronary angiography (CAG) has gained traction in recent years over the femoral artery approach, but difference in image quality has not been extensively studied. This study aims to compare image quality and diagnostic value in radial vs femoral access in patients undergoing invasive CAG. METHODS: This is a retrospective study of 200 patients (100 radial and 100 femoral) undergoing CAG at an experienced center from 2014 to 2015. The primary endpoint was angiographic image quality, and secondary endpoints were proportion of non-diagnostic images and patient radiation dose. Image quality was assessed by four experienced angiographers using a quantitative scale. Mean differences in scores were compared as well as proportion of non-diagnostic images produced. RESULTS: Radial access produced images that were significantly poorer than femoral access when viewing the left coronary artery (2.65 ± 0.04 vs 2.79 ± 0.03; P<.01). This difference remained significant after adjusting for age, gender, and catheter size (P=.04). There was no significant difference in image quality between the radial and femoral group when viewing the right coronary artery (2.91 ± 0.03 vs 2.84 ± 0.04; P=.11). There was a higher proportion of non-diagnostic images produced by radial access than femoral (3.23% vs 2.02%; P<.01) and radial access resulted in higher patient radiation doses (832.81 ± 49.59 mGy vs 645.69 ± 35.46 mGy; P<.01). CONCLUSION: Radial access produces poorer angiographic image quality and exposes patients to greater radiation compared to femoral access in contemporary practice. An awareness of these limitations is important when selecting mode of access in patients undergoing diagnostic CAG.
Subject(s)
Catheterization, Peripheral/methods , Coronary Angiography/standards , Coronary Artery Disease/diagnosis , Coronary Vessels/diagnostic imaging , Vascular Access Devices , Aged , Coronary Angiography/methods , Female , Femoral Artery , Follow-Up Studies , Humans , Male , Middle Aged , Radial Artery , Reproducibility of Results , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVE: Blood transfusion has been associated with adverse outcomes in certain conditions. This study investigates the prevalence and outcomes of red blood cell (RBC) transfusion in patients with acute pulmonary embolism (PE). METHODS: Retrospective study of consecutive patients from 2000 to 2012 admitted to a tertiary hospital with a primary diagnosis of acute PE. Transfusion status during the hospital admission was ascertained. Mortality was tracked from a state-wide death database and analysed using multivariable modelling. RESULTS: A total of 73 patients (5% of all patients admitted with PE) received RBC transfusion during their admission. These patients were significantly older, had more co-morbidities, worse haemodynamics, higher simplified pulmonary embolism severity index scores, and lower plasma sodium and haemoglobin (Hb) levels at admission. Unadjusted mortality for the transfused group was significantly higher at 30-day (19% vs 4%, P < 0.001) and 6-month (40% vs 10%, P < 0.001) follow-up. Multivariable modelling showed RBC transfusion to be a significant independent predictor of mortality at 30-day (odds ratio 3.06, 95% CI: 1.17-8.01, P = 0.02) and 6-month (hazard ratio (HR) 1.97, 95% CI: 1.12-3.46, P = 0.02). Sensitivity analysis confirmed that transfused patients had higher mortality than non-transfused patients in the subgroup of patients with Hb <100 g/L. CONCLUSION: RBC transfusion in patients hospitalized with acute PE is rare and appears to be associated with increased risk of short- and long-term mortality, independent of Hb level on admission. This finding underscores the need for future randomized controlled studies on the impact of RBC transfusion in the management of patients admitted with acute PE. [Correction added on 4 May 2018, after first online publication: the word 'serum' was changed to 'plasma' throughout the article where appropriate.].
