Intima-media thickness and ankle-brachial index are correlated with the extent of coronary artery disease measured by the SYNTAX score.

INTRODUCTION: The extent of peripheral artery disease (PAD) measured by the ankle-brachial index (ABI) and intima-media thickness (IMT) is correlated with the complexity of coronary artery disease (CAD) in stable angina patients. However, data regarding patients with acute coronary syndromes are still lacking. AIM: To compare coronary complexity measured by the SYNTAX score in patients with and without PAD presenting with myocardial infarction (MI). MATERIAL AND METHODS: Both ABI and IMT were measured in 101 consecutive patients who underwent primary diagnostic due to MI. Patients were divided into three tertile groups depending on the SYNTAX score (0-4; 5-11; 12 and more points). RESULTS: Mean ABI in the general population was 0.9 ±0.26, mean IMT was 0.8 ±0.3 mm and mean SYNTAX score was 7.8 ±5.4 points. We found significant correlations between ABI and SYNTAX score (p = 0.01), IMT and SYNTAX score (p < 0.001), and IMT and ABI (p < 0.001). The highest mean values of IMT (p < 0.001) and lowest mean values of ABI (p = 0.015) were found in patients in the highest SYNTAX score group. When analyzing receiver operating characteristics (ROC) curves, IMT had greater specificity and sensitivity than ABI. CONCLUSIONS: Both IMT and ABI are correlated with SYNTAX score (positively for IMT and negatively for ABI values). In our study, IMT was a better predictor of SYNTAX score than ABI. Our study suggests that the higher rate of cardiovascular events in patients with PAD presenting with MI may be partially explained by greater coronary lesion complexity.

Comparison of patient comfort after coronary angiography by standard arterial access approaches.

BACKGROUND: Radial access during coronary angiography has become an increasingly popular alternative to femoral access. The procedural outcomes and complications of these two approaches have been thoroughly evaluated; however, no studies have focused exclusively on the postprocedural quality of life of patients. AIM: To determine and compare both methods from the patient's point of view. METHODS: Data were gathered from 165 consecutive patients scheduled for elective coronary angiography (from October 2011 to June 2012). The choice of the access site was left at operator's discretion. Femoral and radial groups consisted of 91 and 74 patients, respectively. Quality of life was assessed by the Short Form of the McGill Questionnaire and a self-designed questionnaire (Questionnaire II) consisting of eight questions evaluating the procedure-specific aspects of recovery time. After three months from index hospitalisation post-discharge interviews were conducted using a modified version of Questionnaire II with an additional two questions. RESULTS: Patients from the transfemoral approach group characterised their pain (according to McGill Questionnaire) more often as aching (mean value ± SD: 0.84 ± 1.2 vs. 0.21 ± 0.6; p = 0.003), heavy (0.29 vs. 0.027; p = 0.02), and exhausting (0.22 ± 0.7 vs. 0.07 ± 0.2; p = 0.037). Moreover, in Questionnaire II they indicated tenderness of the puncture site (0.42 ± 0.8 vs. 0.23 ± 0.07; p = 0.00004) more frequently. CONCLUSIONS: The quality of life of patients who underwent coronary angiography from radial access was remarkably better in terms of pain characteristic and overall discomfort.

Comparison of radiation dose exposure in patients undergoing percutaneous coronary intervention vs. peripheral intervention.

INTRODUCTION: Most endovascular techniques are associated with patient and personal exposure to radiation during the procedure. Ionising radiation can cause deterministic effects, such as skin injury, as well as stochastic effects, which increase the long-term risk of malignancy. Endovascular operators need to be aware of radiation danger and take all necessary steps to minimise the risk to patients and staff. Some procedures, especially percutaneous peripheral artery revascularisation, are associated with increased radiation dose due to time-consuming operations. There is limited data comparing radiation dose during percutaneous coronary intervention (PCI) with percutaneous transluminal angioplasty (PTA) of peripheral arteries. AIM: To compare the radiation dose in percutaneous coronary vs. peripheral interventions in one centre with a uniform system of protection methods. MATERIAL AND METHODS: A total of 352 patients were included in the study. This included 217 patients undergoing PCI (single and multiple stenting) and 135 patients undergoing PTA (in lower extremities, carotid artery, renal artery, and subclavian artery). Radiation dose, fluoroscopy time, and total procedural time were reviewed. Cumulative radiation dose was measured in gray (Gy) units. RESULTS: The total procedural time was significantly higher in PTA (PCI vs. PTA: 60 (45-85) min vs. 75 (50-100) min), p < 0.001. The radiation dose for PCI procedures was significantly higher in comparison to PTA (PCI vs. PTA: 1.36 (0.83-2.23) Gy vs. 0.27 (0.13-0.46) Gy), p < 0.001. There was no significant difference in the fluoroscopy time (PCI vs. PTA: 12.9 (8.2-21.5) min vs. 14.4 (8.0-22.6) min), p = 0.6. The analysis of correlation between radiation dose and fluoroscopy time in PCI and PTA interventions separately shows a strong correlation in PCI group (r = 0.785). However, a weak correlation was found in PTA group (r = 0.317). CONCLUSIONS: The radiation dose was significantly higher during PCI in comparison to PTA procedures despite comparable fluoroscopy time and longer total procedure time in PTA. Fluoroscopy time is a reliable parameter to control the radiation dose exposure in coronary procedures. The increasing complexity of endovascular interventions has resulted in the increase of radiation dose exposure during PCI procedures.

Primary percutaneous coronary intervention during on- vs off-hours in patients with ST-elevation myocardial infarction. Results from EUROTRANSFER Registry.

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is regarded as the treatment of choice for ST elevation myocardial infarction (STEMI) patients. It has been emphasised that only experienced centres with round-the-clock cathlab facilities should perform PPCI. Some investigators have doubted whether PPCI performed during 'off-hours' is as effective and safe as that performed during regular hours. Papers supporting both possibilities have been published. AIM: To investigate whether off-hours PPCI is associated with impaired immediate and long-term outcomes based on a contemporary European registry study. METHODS: Consecutive data on STEMI patients referred for PPCI in hospital STEMI networks between November 2005 and January 2007 was gathered. Patients were divided into two groups: PPCI performed during 'on-hours' and PPCI performed during 'off-hours (including Saturdays and Sundays)'. RESULTS: Data from a total of 1,650 patients were collected in the EUROTRANSFER Registry. There were 1,005 patients in the off-hours group (61%) and 645 (39%) patients in the on-hours group. Patients in both groups did not differ in baseline demographics. Thrombolysis before admission to cathlab was more frequently administered to patients off-hours (4.1% vs 2.3%, p = 0.041). The PPCI complications were rare and occurred in similar frequency in the studied groups. Time from chest pain onset to diagnosis of STEMI was shorter in the off-hours group (173 ± 210 vs 183 ± 187, p = 0.007). In-hospital mortality was 3.4% in the on-hours group and 4.3% in the off-hours group (NS). CONCLUSIONS: The PPCI performed in high-volume, experienced invasive cardiology centres in Europe during off-hours is associated with a comparable outcome and safety profile as PPCI performed during regular working hours.