TransRadial versus transUlnar artery approach for elective invasive percutaneous coronary interventions: a randomized trial on the feasibility and safety with ultrasonographic outcome - RAUL study.

INTRODUCTION: Transradial access (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) is superior to transfemoral access (TFA). Transulnar access (TUA) is an alternative to TRA. AIM: To compare the efficacy and safety of TRA vs. TUA in patients scheduled for CAG or PCI. MATERIAL AND METHODS: This was a prospective, single-center, randomized study conducted between 2013 and 2016. Two hundred patients referred for the first elective CAG were included in the study. Eligible patients were then randomly assigned to the TRA or TUA group. Before and after the invasive procedure, all patients underwent ultrasonographic measurements of the right upper limb arteries. RESULTS: The primary endpoint was efficacy, defined as a successful CAG without a crossover of vascular access. The secondary endpoint was safety, assessed as the number of vascular complications. Successful coronary angiography via the access site was 95% vs. 75% in the TRA vs. TUA groups, respectively (p < 0.001). It depended on the anatomy of UA and the operator experience. No differences were observed in early and late follow-up complications. CONCLUSIONS: TRA was superior to TUA with regard to efficacy. TUA occurred a safe approach for CAG and PCI and could be used as an alternative method of forearm access.

Remote Ischemic Preconditioning in Renal Protection During Elective Percutaneous Coronary Intervention.

Remote ischemic preconditioning (RIPC) exerts protection in remote organs. The purpose of this study was to investigate the potential of RIPC to prevent contrast induced nephropathy. One hundred and twenty four patients were randomized to elective percutaneous coronary intervention with or without RIPC. RIPC was performed using three cycles of 5-min inflation to 200 mmHg of a standard upper arm blood pressure cuff. The time between the last inflation cycle and the coronary intervention was less than 2 h. The primary endpoint was the incidence of contrast-induced nephropathy based on the standard criteria of the serum creatinine (SC) and cystatin C (CC) levels. The rates of major cardiac and cerebral adverse events (MACCE) during 1 year follow-up were evaluated. We found that contrast-induced nephropathy assessed by SC occurred in 4.9% (3/61) patients with RIPC and in 12.1% (7/58) patients without it (p = 0.20). Nephropathy assessed by CC occurred in 1.7% (1/58) patients with RIPC and 3.5% (2/57) patients without it (p = 0.62). There was no coincidence between the diagnosis of contrast-induced nephropathy based on SC and CC (McNemar test 0.012, κ = 0.28); SC was a more sensitive marker of nephropathy than CC (ten and three cases, respectively). The MACCE rate during the year of follow-up tended to be lower with the ischemic preconditioning than without it, four vs. six cases, respectively. We conclude that RIPC prior to percutaneous coronary intervention has no major influence on the development of contrast-induced nephropathy and does not improve the one-year outcome.

Antazoline-insights into drug-induced electrocardiographic and hemodynamic effects: Results of the ELEPHANT II substudy.

BACKGROUND: Antazoline is an old antihistaminic and new antiarrhythmic agent with unknown mechanisms of action which recently has been shown to effectively terminate atrial fibrillation. The aim of study was to examine the effects of antazoline on hemodynamic and ECG parameters. METHODS: Antazoline was given intravenously in three 100 mg boluses to 10 healthy volunteers (four males, mean age 40 + 11 years). Hemodynamic and ECG parameters were measured using impedance cardiography [systolic (sBP), diastolic (dBP), mean (mBP) blood pressure, stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR) and heart rate (HR), P wave, PR interval, QRS complex, QT and corrected QT (QTcF) interval]. Plasma concentration of antazoline was also measured. RESULTS: Antazoline caused significant prolongation of P wave, QRS as well as QT and QTcF (101 ± 10 vs 110 ± 16 ms, p < .05, and 101 ± 12 vs 107 ± 12 ms, p < .05, 399 ± 27 vs 444 ± 23 ms, p < .05, and 403 ± 21 vs 448 ± 27 ms, p < .05, respectively). Also, a significant decrease in SV was noted (94.9 ± 21.8 vs 82.4 ± 19.6 ml, p < .05). A significant correlation between changes in plasma drug concentration and changes in CO, HR, and dBP was found. CONCLUSIONS: Antazoline impairs slightly hemodynamics, significantly reducing SV. Significant prolongation of P wave and QRS duration corresponds to drug-induced prolongation of conduction, whereas QT prolongation represents drug-induced prolongation of repolarization.