Propofol was associated with a statistically significant improvement in comfort and sedation score when compared to midazolam and meperidine.
Background: Currently coronary perforations are rare but can potentially have catastrophic complications. Aim: The aim of this study is to evaluate the incidence, predictors, clinical outcomes, prognosis and management of coronary perforations at a tertiary centre. Materials and methods:The clinical, angiographic, procedural and in-hospital outcomes of patients with or without coronary perforations were compared. Results and discussion: 25 patients (0.9%) had coronary perforations among a total of 2650 consecutive patients who underwent coronary interventions between Oct 1, 2014 and Sept 30, 2015 at our institution. The study group comprising of 25 patients were compared with the control group comprising of 2625 patients who did not develop perforation. Systemic hypertension and dyslipidemia were commoner in study group Coronary perforation was commonest in females <50 years. The clinical profile revealed a strong association with PCI in the background of NSTEMI. Coronary perforation occurred mostly in distal small calibre vessels. In the CTO subgroup blunt end compared to tapering end and long segment CTO compared to short segment had strong positive predictive value for perforation.2 patients had tamponade physiology.10 cases were managed with prolonged balloon inflation. Gelfoam was used in 4 (16%) cases, Coil embolization in 1 (4%) while covered stent was used in 5 (20%) cases. There were two deaths (8%) both occurring in Grade III perforation. At 6 months follow up, 1 died due to non cardiac causes and 5 underwent PCI to non target vessels Conclusion: Coronary perforation is a rare event with an overall incidence of 0.9%.Females<50 years, history of hypertension, dyslipidemia, clinical background of NSTEMI, CTO interventions, interventions in distal small sized vessels, use of stiff guide wires with higher tip load and a higher Balloon to artery ratio were all predictors for coronary perforation. Coronary perforation is mostly managed conservatively with high success rates. Selected cases require heparin reversal, use of covered stents, gelfoams and coils. The 6 month outcome is good. Introduction: Over the last several years, the superior safety profile associated with the radial, rather than the classical femoral approach, in patients subjected to invasive coronary procedures has been proven. Nonetheless, in approximately 10% of cardiac catheterizations performed with a radial access, it is necessary to complete the procedure through another vascular approach. In such cases, the best alternative is currently unknown. Methods: Out of the 21573 procedures undergone in our lab between 2010-2015, we reviewed the 16438 (76.2%) patients that underwent radial access. In 459 (2.8%) of these cases, the radial vascular approach failed. The alternative access used was either the brachial -45 patients (9.8%)-or the femoral artery -414 30-days complications patients (90.2%)-. The main objective pursued was to compare the complications between both accesses in a span of 30 days. Results: Regarding the clinical characte...
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