Primary and Secondary Vascular Access Site Complications Associated With Percutaneous Coronary Intervention

Kopin, David; Seth, Milan; Sukul, Devraj; Dixon, Simon; Aronow, Herbert D.; Lee, Daniel; Tucciarone, Michael; Pielsticker, Elizabeth; Gurm, Hitinder S.

doi:10.1016/j.jcin.2019.05.051

Cited by 28 publications

(18 citation statements)

References 34 publications

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“…Vascular access site complications are common, and they occur in up to 1.4% of PCIs ( 1 ). AVF is a known but rare complication of vascular access, occurring in up to 0.86% of cardiac catheterizations through a femoral approach and in <0.03% through a radial approach ( 2 , 3 ).…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure

et al. 2021

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Iatrogenic complications may manifest in a variety of ways. We present the case of an 86-year-old woman who underwent a percutaneous coronary intervention with a drug-eluting stent for non–ST-segment elevation myocardial infarction followed by leadless pacemaker placement through a femoral approach. Her post-procedure course was complicated by new onset high-output heart failure secondary to iatrogenic arteriovenous fistula formation, requiring covered stent placement. ( Level of Difficulty: Advanced. )

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure

et al. 2021

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“…Transradial access (TRA) in AMI is associated with significant reductions in mortality, major bleeding, and vascular complications, when compared to transfemoral access (TFA) 6 . As TRA utilization continues to rise nationwide, it is now advocated as the default access site for coronary angiography and intervention 6,7 . The clinical benefits of TRA in AMI‐CS are less certain; however, these patients have either been underrepresented or excluded from randomized trials 8 .…”

Section: Introductionmentioning

confidence: 99%

Transradial access in acute myocardial infarction complicated by cardiogenic shock: Stratified analysis by shock severity

Tehrani

Damluji

Sherwood

et al. 2020

Cathet Cardio Intervent

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Background Transradial access (TRA) is associated with improved survival and reduced vascular complications in acute myocardial infarction (AMI). Limited data exist regarding TRA utilization and outcomes for AMI complicated by cardiogenic shock (CS). We sought to assess the safety, feasibility, and clinical outcomes of TRA in AMI‐CS. Methods One‐hundred and fifty‐three patients with AMI‐CS were stratified into tertiles of disease severity using the CardShock score. The primary endpoint was successful percutaneous coronary intervention (PCI), defined as Thrombolysis in Myocardial Infarction III flow with survival to 30 days. Results Mean age was 66 years, 72% were men, and 47% had diabetes. TRA was the preferred access site in patients with low and intermediate disease severity. Overall, 50 (32%) patients experienced major adverse cardiac and cerebrovascular events; most events (78%) occurred in patients undergoing transfemoral access (TFA) in the intermediate‐high tertiles of CS severity. Of the 41 (27%) total bleeding events, 32% occurred at the coronary angiography access site, of which 92% were in the TFA group. The use of ultrasound (US) guidance for TFA resulted in reduced coronary access‐site bleeding (8.5 vs. 33.0%, p = .01). In a hierarchical logistic regression model, utilizing TRA did not result in lower odds of successful PCI (Odds ratio [OR]: 1.36; 95% confidence interval [CI]: 0.54–3.40). Conclusion This study suggests that TRA is feasible across the entire spectrum of AMI‐CS and is associated with reduced coronary access‐site bleeding. In addition, US‐guided TFA is associated with reductions in access‐site bleeding and vascular complications. Concerted efforts should be made to incorporate vascular access protocols into existing CS algorithms in dedicated shock care centers.

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“…The inception date of the pandemic cohort was chosen based on the date when the first COVID-19 case was diagnosed in Michigan ( March 11, 2020). Details of the BMC2 registry have been previously described [19][20][21]. Data, collected by on-site registered nurse coordinators, included demographic and clinical characteristics, procedural details, and in-hospital outcomes of patients undergoing PCI procedures.…”

Section: Study Populationmentioning

confidence: 99%

Trends and outcomes of percutaneous coronary intervention during the COVID-19 pandemic in Michigan

et al. 2022

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Background The COVID-19 pandemic has severely impacted healthcare delivery and patient outcomes globally. Aims We aimed to evaluate the influence of the COVID-19 pandemic on the temporal trends and outcomes of patients undergoing percutaneous coronary intervention (PCI) in Michigan. Methods We compared all patients undergoing PCI in the BMC2 Registry between March and December 2020 (“pandemic cohort”) with those undergoing PCI between March and December 2019 (“pre-pandemic cohort”). A risk-adjusted analysis of in-hospital outcomes was performed between the pre-pandemic and pandemic cohort. A subgroup analysis was performed comparing COVID-19 positive vs. negative patients during the pandemic. Results There was a 15.2% reduction in overall PCI volume from the pre-pandemic (n = 25,737) to the pandemic cohort (n = 21,822), which was more pronounced for stable angina and non-ST-elevation acute coronary syndromes (ACS) presentations, and between February and May 2020. Patients in the two cohorts had similar clinical and procedural characteristics. Monthly mortality rates for primary PCI were generally higher in the pandemic period. There were no significant system delays in care between the cohorts. Risk-adjusted mortality was higher in the pandemic cohort (aOR 1.26, 95% CI 1.07–1.47, p = 0.005), a finding that was only partially explained by worse outcomes in COVID-19 patients and was more pronounced in subjects with ACS. During the pandemic, COVID-19 positive patients suffered higher risk-adjusted mortality (aOR 5.69, 95% CI 2.54–12.74, p<0.001) compared with COVID negative patients. Conclusions During the COVID-19 pandemic, we observed a reduction in PCI volumes and higher risk-adjusted mortality. COVID-19 positive patients experienced significantly worse outcomes.

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Primary and Secondary Vascular Access Site Complications Associated With Percutaneous Coronary Intervention

Cited by 28 publications

References 34 publications

Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure

Iatrogenic Arteriovenous Fistula Following Femoral Access Precipitating High-Output Heart Failure

Transradial access in acute myocardial infarction complicated by cardiogenic shock: Stratified analysis by shock severity

Trends and outcomes of percutaneous coronary intervention during the COVID-19 pandemic in Michigan

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