Routine preprocedural radial artery angiography in STEMI patients is associated with lower rate of access site bleeding complications and reduced overall procedural time and TRA crossover rate.
BACKGROUND:Diabetes is diagnosed in 10-20% of patients with acute coronary syndrome (ACS) not known to be diabetics. Elevated blood glucose is an independent risk factor for cardiac events, regardless of presence of diabetes.AIM:Evaluating the prevalence of new-diagnosed DM among patients with ACS, and assessing the relationship between stress glycaemia and new diagnosed DM with in-hospital cardiac events.METHODS:Prospective observational study, in patients with ACS, in whom we analyzed parameters of glycemic metabolism, clinical data, and in-hospital cardiac events. We comparatively analyzed patients according to the HgbA1C and known DM in five groups: non-DM (< 5.6%), new pre-DM (5.6-6.5%), new DM (≥ 6.5%), controlled (<7%) and uncontrolled (≥7%) known DM.RESULTS:150 patients, (93 male and 57 female) were included. Impaired glucose metabolism was detected in 44.5% of patients, 7.9% of whom were newly-diagnosed DM. The highest levels of stress glycaemia were found in new and uncontrolled known DM. The in-hospital event rate was 20.7%, the mortality rate 7.3%, being the highest in new diagnosed and uncontrolled known DM patients.CONCLUSIONS:The prevalence of unknown DM was high among patients with ACS. Stress glycaemia and failure to achieve glycemic controlee, were an independent predictors of in-hospital cardiac events.
Objective: To assess the incidence of arterial anomalies of the radial artery in the Macedonian population registered during transradial access (TRA) angiography procedures in a large series of patients. Background: Transradial angiography (TRA) is now the recommended access for percutaneous coronary intervention, but technically is a more challenging approach for angiography procedures mostly due to the anatomic anomalies on the radial artery, which may influence the success rate of transradial angiographic procedures. Methods: All consecutive 19292 patients from our Center, in the period from March 2011 until December 2014 were examined. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type and incidence of vascular anatomy variants and access site complications were analyzed. Results: Anatomical variants were present in 1625 (8.8%) patients. The most frequent was high-bifurcating radial artery origin from the axillary and brachial arteries in 1017 (5.5%) patients, 227 (1.2%) had extreme radial artery tortuosity, 176 (0.95%) had a full radial loop, 32 (0.17%) with hypoplastic radial artery and 173 (0.9%) had tortuous brachial, subclavian and axillary arteries. Radial artery spasm was very common in patients with present radial artery anomalies. Conclusion: Radial artery anomalies are very common in the general population. Knowing the anatomy of the radial artery helps the interventional cardiologist in successfully planning and performing this procedure. Radial artery angiography is strongly encouraged in every patient before the begining of the transradial angiography procedures.
The aim of this report is to describe invasive cardiology procedural practice in Macedonia during the period from 2010 to 2015. Details of all consecutive 39,899 patients who underwent cardiovascular, peripheral or structural heart procedures during the period from 2010 until 2015 were examined. Clinical and procedure characteristics, access site, procedural success and complications were analysed. The number of coronary angiographies increased from 5,540 in 2010 to 8,550 in 2015. Transfemoral access (TFA) was present in 4% of coronary angiographies in 2010 and had decreased to 1% in 2015. The number of primary percutaneous coronary interventions (PCI) for acute ST-segment elevation myocardial infarction increased from 763 to 1,175 and both chronic total occlusion and left main coronary artery interventions also increased over time. In 2015, the drug-eluting stent penetration rate was 65%. Structural heart interventions, including transcatheter aortic valve implantations (TAVI) were introduced in 2014 and 23 TAVI cases have since been performed. Transradial access was performed in 38,455 (96%) of all patients. Wrist access adoption in the majority of cardiovascular interventions is possible in all PCI centres in Europe if an appropriate national strategy is developed.
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