Radial artery spasms - angiographic morphology, risk factors and management.

Introduction: Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. Aim: To observe factors contributing to a symptomatic radial artery spasm. Material and methods: In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. Results: The overall incidence of the radial artery spasm was high - 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, p = 0.02), failure of the first puncture attempt (OR = 3.12, p = 0.014) and use of non-hydrophilic sheath (OR = 9.56, p = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm (p = 0.022). No spasms were observed after hydrophilic sheath application (n = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Conclusions: Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.

Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management.

Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.

Experience with Optical Coherence Tomography Enhanced by a Novel Software (Ultreon™ 1.0 Software)-The First One Hundred Cases.

Introduction: Optical coherence tomography (OCT) intravascular imaging including the latest version Ultreon™ 1.0 Software (Abbott Vascular, Santa Clara, CA, USA), not only improve patients prognosis, but also facilitates improved percutaneous coronary intervention (PCI). Objectives: The aim of the study was to compare procedure related decision making, procedural indices, clinical outcomes according to the extent of stent expansion and assess risk factors of underexpansion in patients treated with PCI using OCT. Methods: The study comprised 100 patients, which were divided in groups according to the extent of stent expansion: <90 (29 patients) and ≥90% (71 patients). Comparison of OCT parameters, selected clinical and procedural characteristics was performed between groups. We assessed clinical outcomes during the follow-up: major adverse cardiovascular events and risk factors of stent underexpansion. Results: Patients from the stent underexpansion group were treated more often in the past with percutaneous peripheral interventions (p=0.02), no other significant differences being noted in general characteristics, procedural characteristics or clinical outcomes comparing both groups. Significant predictors of stent underexpansion assessed by simple linear univariable analysis included: hypercholesterolemia, obstructive bronchial diseases and treatment with inhalators, family history of cardiovascular disease, PCI of other than the left main coronary artery, stent and drug-eluting stent implantation, PCI without drug-eluting balloon, paclitaxel antimitotic agent, greater maximal stent diameter and lower mean Euroscore II value. Univariable logistic regression analysis revealed a correlation between stent underexpansion and greater creatinine serum concentration before [OR: 0.97, 95%CI: 0.95-0.99, p=0.01] and after PCI [OR: 0.98, 95%CI: 0.96-0.99, p=0.02]. Conclusions: Based on the presented analysis, the degree of stent expansion is not related to the selected procedural, OCT imaging indices and clinical outcomes. Logistic regression analysis confirmed such a relationship for creatinine level.

Procedure-Related Differences and Clinical Outcomes in Patients Treated with Percutaneous Coronary Intervention Assisted by Optical Coherence Tomography between New and Earlier Generation Software (Ultreon™ 1.0 Software vs. AptiVue™ Software).

(1) Introduction: Optical coherence tomography (OCT) intravascular imaging facilitates percutaneous coronary intervention (PCI). Software for OCT is being constantly improved, including the latest version Ultreon™ 1.0 Software (U) (Abbott Vascular, Santa Clara, CA, USA). In the current analysis, we aim to compare processing results, procedural indices as well as clinical outcomes in patients treated via PCI. This was conducted using earlier generation OCT imaging software versions (non-U) and the newest available one on the market (U). (2) Methods: The study comprised 95 subsequent and not selected patients (55 processed with U and 40 non-U). The non-U processings were transferred for evaluation by U software, while the comparison of OCT parameters, selected clinical and procedural indices was performed between groups. We further assessed clinical outcomes during the follow-up period, i.e., major adverse cardiovascular events (MACE) and predictors of stent expansion. (3) Results: We did not detect any differences in general features between either of the assessed groups at baseline. Non-U software was more often used for bare-metal stenting (p = 0.004), while PCIs in the U group demanded a greater number of stents (p = 0.03). The distal reference of external elastic lamina (EEL) diameter was greater in the non-U group (p = 0.02) with no concurrent differences in minimal (p = 0.27) and maximal (p = 0.31) stent diameter. It was also observed that MACE was more frequently observed in the non-U group (p = 0.01). Neither univariable (estimate: 0.407, 95%CI: (-3.182) - 3.998, p = 0.82) nor multivariable (estimate: 2.29, 95%CI: (-4.207) - 8.788, p = 0.5) analyses demonstrated a relationship between the type of software and stent expansion. (4) Conclusions: Improvement in the software for image acquisition and processing of OCT is not related to stent expansion. The EEL diameter is preferably used to select the distal stent diameter in newer software.

Sex-related differences and rotational atherectomy: Analysis of 5 177 percutaneous coronary interventions based on a large national registry from 2014 to 2020.

BACKGROUND: Patients undergoing percutaneous coronary interventions (PCI) with rotational atherectomy (RA) have massively calcified coronary arteries and their prognosis differs between sexes. AIMS: The aim of the study was to evaluate the trends in the percentage of sexes in the subsequent years, to compare demographic characteristics between men and women, and to identify factors associated with the risk of periprocedural complications and death. METHODS: We analyzed data on 751 113 patients treated with PCI between 2014 and 2020 from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI). We extracted data on 5 177 (0.7%) patients treated with RA of whom 3 552 (68.6%) were men. To determine risk factors of periprocedural complications and death, a multivariable analysis was performed. RESULTS: The proportion of PCIs involving RA increased between 2014 and 2020 (P <0.001). Almost twice as many RA procedures were performed on men (68.55%), and that proportion did not change in the following years. The female patients were older (75.2 [8.3] vs. 70.5 [9.2] years; P <0.001). When considering periprocedural complications, their overall rate (3.45% vs. 2.31%; P = 0.01) and death rate (0.68% vs. 0.17%; P = 0.006) were greater among women. Also, via multivariable analysis, female sex was found to be a risk factor for greater periprocedural mortality (P = 0.02) and overall complication rate (P = 0.007). CONCLUSIONS: The majority of patients treated with RA are men and sex-related distribution was stable during the analyzed period. Female sex is a risk factor for greater periprocedural complications and mortality in patients treated with RA.

Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions: a contemporary survey among Polish dentists.

BACKGROUND: The number of dental patients requiring periodic or lifelong antiplatelet or anticoagulanttherapy is constantly growing. AIMS: We aimed to determine the level of knowledge on antiplatelet and anticoagulant therapy among Polish dentists. METHODS: self­designed online questionnaire was distributed among dentists to evaluate their knowledge on the use of antiplatelet and anticoagulant drugs in clinical dental practice. RESULTS: The study included 352 dentists. Patients requiring vitamin K antagonists were referred for a cardiac consultation by 64.52%, 57.29%, and 58.55% of dentists with <5, 5-15, and >15 years of experience,respectively (P = 0.003). A similar trend was observed for non-vitamin K antagonist oral anticoagulants among nonsurgical dentists. However, an equal percentage of surgical dentists (39.7%) performedextraction with and without consultation, and they were more likely to perform extraction withoutconsultation than nonsurgical dentists (39.7% vs 27.8%; P = 0.01). Most surgical and nonsurgical dentistspreferred to consult a cardiologist about dual antiplatelet therapy before an invasive procedure (56.9%and 73.81%, respectively; P = 0.03). Extractions in patients on aspirin were accepted by 75.81%, 70.83%, and 49.34% of dentists with <5, 5-15, and >15 years of experience, respectively (P = 0.004), and by 79.31%of surgical and 57.14% of nonsurgical dentists (P = 0.003). CONCLUSIONS: Knowledge on antiplatelet and anticoagulant therapy in patients undergoing dental procedures is unsatisfactory among Polish dentists. Both therapies were discontinued before extractionsmore frequently than recommended in the guidelines, while extractions in patients on aspirin were common.

Prevention of infective endocarditis during dental extractions among Polish dentists - a contemporary nationwide survey.

INTRODUCTION: Infective endocarditis (IE) is a potentially life-threatening condition. According to current ESC (European Society of Cardiology) guidelines, the use of antibiotic prophylaxis should only be reserved for specific dental procedures with interruption of consistency of the oral mucosa such as extractions and should be reserved for patients with the highest risk of developing IE. The aim of this study was to assess the knowledge of need for IE prophylaxis in de ned clinical settings among Polish dentists. MATERIAL AND METHODS: A specially self-designed internet questionnaire was created concerning the topic of infective endocarditis prophylaxis in specific clinical scenarios for patients undergoing dental extractions during outpatient visits. The survey was made available to the dentists via internet and was active in March 2018. RESULTS: there were 352 Polish dentists who completed the survey. Antibiotic prophylaxis for IE during dental extractions was used in 93% of cases with prior IE, 89% with artificial heart valve, 69% with biological valve, 28% with pacemaker, 54% with coronary stent, 73% with cyanotic heart defect, 58% with diabetes mellitus, 20% after prior myocardial infarction and 54% with heart valve disease. There was a significant relationship between the time of working as a physician (>15 years) and more outdated or improper IE prophylaxis (p = 0.04). CONCLUSIONS: the management of patients for infective endocarditis prophylaxis undergoing dental extractions is suboptimal. Antibiotic therapy is overused in some clinical scenarios and on the other hand underutilized in those recommended by the current ESC guidelines.