SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection

Klein, Lloyd W.; Goldstein, James A.; Haines, David E.; Chambers, Charles E.; Mehran, Roxana; Kort, Smadar; Valentine, C. Michael; Cox, David A.

doi:10.1016/j.jacc.2020.02.015

Cited by 22 publications

(21 citation statements)

References 46 publications

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“…In per-patient analysis, Oikonomou et al found that increased PCAT RCA was predictive of MI in patients with stable CAD [ 7 ]. Likewise, Lin et al found that per-patient PCAT attenuation was associated with AMI and was distinctly higher in these patients compared to stable CAD or control patients [ 10 ]. Studies evaluating per-lesion analysis demonstrated increased attenuation around culprit lesions in ACS [ 12 , 23 ] and MI [ 6 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pericoronary adipose tissue (PCAT) attenuation is a novel marker of coronary inflammation on coronary CTA, capturing changes in adipocyte size and lipid accumulation caused by inflammatory mediators from the vascular wall [ 6 ]. Measurement of PCAT around the proximal RCA represents a standardised and prognostically validated per-patient metric [ 7 , 8 , 9 , 10 ]. PCAT attenuation can also be quantified around identifiable coronary lesions as a dynamic marker of coronary inflammation [ 6 , 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

Yuvaraj

Lin

Nerlekar

et al. 2021

Cells

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Background: High-risk plaques (HRP) detected on coronary computed tomography angiography (CTA) confer an increased risk of acute coronary syndrome (ACS). Pericoronary adipose tissue attenuation (PCAT) is a novel biomarker of coronary inflammation. This study aimed to evaluate the association of PCAT with HRP and subsequent ACS development in patients with stable coronary artery disease (CAD). Methods: Patients with stable CAD who underwent coronary CTA from 2011 to 2016 and had available outcome data were included. We studied 41 patients with HRP propensity matched to 41 controls without HRP (60 ± 10 years, 67% males). PCAT was assessed using semi-automated software on a per-patient basis in the proximal right coronary artery (PCATRCA) and a per-lesion basis (PCATLesion) around HRP in cases and the highest-grade stenosis lesions in controls. Results: PCATRCA and PCATLesion were higher in HRP patients than controls (PCATRCA: −80.7 ± 6.50 HU vs. −84.2 ± 8.09 HU, p = 0.03; PCATLesion: −79.6 ± 7.86 HU vs. −84.2 ± 10.3 HU, p = 0.04), and were also higher in men (PCATRCA: −80.5 ± 7.03 HU vs. −86.1 ± 7.08 HU, p < 0.001; PCATLesion: −79.6 ± 9.06 HU vs. −85.2 ± 7.96 HU, p = 0.02). Median time to ACS was 1.9 years, within a median follow-up of 5.3 years. PCATRCA alone was higher in HRP patients who subsequently presented with ACS (−76.8 ± 5.69 HU vs. −82.0 ± 6.32 HU, p = 0.03). In time-dependent analysis, ACS was associated with HRP and PCATRCA. Conclusions: PCAT attenuation is increased in stable CAD patients with HRP and is associated with subsequent ACS development. Further investigation is required to determine the clinical implications of these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

Yuvaraj

Lin

Nerlekar

et al. 2021

Cells

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“…PCAT attenuation studies have shown that coronary inflammatory changes may occur incrementally with the burden of CAD and coronary events. Lin et al [ 71 ] found that patients with AMI had distinctly increased PCAT attenuation per-patient in the proximal RCA compared to matched patients with stable CAD and controls without CAD. In adjusted analysis, PCAT attenuation was found to be predicted by stable CAD and MI, and increased PCAT attenuation predicted the presence of AMI, independent of total plaque burden.…”

Section: Coronary Computed Tomography Angiography (Cta) Assessment Of Eat and Pericoronary Adipose Tissue (Pcat) As A Marker Of Coronary mentioning

confidence: 99%

“…As discussed, PCAT attenuation has been assessed previously using a range of methodologies [ 63 , 64 , 65 , 66 , 67 , 68 , 69 ], and this has been to a large extent accounted for via the use of validated per-patient and per-lesion forms of assessment. However, there is some heterogeneity as to the degree to which plaque within the RCA may affect the per-patient assessment of PCAT in this vessel [ 71 , 72 ]. Moreover, the present definition of PCAT (adipose tissue within a distance equivalent to the vessel diameter) includes an inherently larger volume of adipose tissue in the RCA than in its counterpart vessels.…”

Section: Coronary Computed Tomography Angiography (Cta) Assessment Of Eat and Pericoronary Adipose Tissue (Pcat) As A Marker Of Coronary mentioning

confidence: 99%

The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation

Yuvaraj

Cheng

Lin

et al. 2021

Cells

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A large body of evidence arising from recent randomized clinical trials demonstrate the association of vascular inflammatory mediators with coronary artery disease (CAD). Vascular inflammation localized in the coronary arteries leads to an increased risk of CAD-related events, and produces unique biological alterations to local cardiac adipose tissue depots. Coronary computed tomography angiography (CTA) provides a means of mapping inflammatory changes to both epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) as independent markers of coronary risk. Radiodensity or attenuation of PCAT on coronary CTA, notably, provides indirect quantification of coronary inflammation and is emerging as a promising non-invasive imaging implement. An increasing number of observational studies have shown robust associations between PCAT attenuation and major coronary events, including acute coronary syndrome, and ‘vulnerable’ atherosclerotic plaque phenotypes that are associated with an increased risk of the said events. This review outlines the biological characteristics of both EAT and PCAT and provides an overview of the current literature on PCAT attenuation as a surrogate marker of coronary inflammation.

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“…Radiation exposure is a constant worry in the catheterization laboratory [43]. Advances in technology have lowered radiation exposure including improved shielding.…”

Section: Areas Of Researchmentioning

confidence: 99%

Radial Artery Access

Panetta¹,

Chahine²

2021

Interventional Treatment for Structural Heart Disease

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Radial artery access for angiography has matured over the past two decades and is now the preferred point of access for most patients. Lower bleeding rates in clinical randomized trials have translated into lower mortality prompting change in the guidelines. Advances in technique with use of ultrasound for access to properly size the sheath, proper dosing of anticoagulation and new techniques for sheath removal have dramatically lowered radial artery occlusion rates. Radial artery spasm has improved with vasodilators and proper sedation. Advances in support boards and sheath extension have opened up left radial access. Advances in lower profile sheaths and sheathless systems allow larger catheters in smaller arteries. Advances in longer balloons and sheaths have opened up radial access for peripheral interventions. Areas of clinical research include use of ulnar artery compared to radial, left versus right radial access, use of radial artery for a surgical conduit after angiography, radiation exposure and advantage of radial approach in the elderly.

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SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory: Shifting the Paradigm for Healthcare Workers' Protection

Cited by 22 publications

References 46 publications

Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

Pericoronary Adipose Tissue Attenuation Is Associated with High-Risk Plaque and Subsequent Acute Coronary Syndrome in Patients with Stable Coronary Artery Disease

The Emerging Role of CT-Based Imaging in Adipose Tissue and Coronary Inflammation

Radial Artery Access

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