Upper Extremity Function after Transradial Percutaneous Coronary Intervention Short-Term Interim Results of the ARCUS Study

Abstract

Aims: To examine the short-term effects of transradial percutaneous coronary interventions on the upper extremities function. Method and results:This is an interim analysis of the Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) study. Out of 191 patients evaluated at 2 weeks after they had undergone a transradial percutaneous coronary intervention, 120 (62.8 % ) had manifestations of upper extremity dysfunction on the side of the intervention. The main abnormalities were a decrease in sensibility, a ≥ 15 % increase in the Disabilities of the Hand and Shoulder questionnaire score and a ≥ 2 cm increase in hand and forearm volumes. Radial artery occlusions occurred in 12 patients in the upper extremity dysfunction versus 1 patient in the no upper extremity dysfunction group (p = 0.03). Patients with upper extremity dysfunction were significantly more likely to have a family history of heart disease (50 % vs. 26.8 % ; p = 0.002). In addition, there was a trend (p = 0.07) toward a greater proportion of previous smokers in the group with upper extremity dysfunction than in the other group. Conclusions: Upper extremity dysfunction after transradial percutaneous coronary intervention is a medical concern. However, our original score may be overly sensitive and overestimate the rate of upper extremity dysfunction. Further analyses are needed, as well as perhaps a modification of the primary endpoint.

Arteriografía coronaria con acceso radial en la enfermedad coronaria aguda y su relación con la fuerza de agarre y la permeabilidad de la arteria radial (CARHANG)

“…Studies such as ARCUS and HANGAR are the most relevant in measuring the loss of handgrip strength; however, both studies were performed in populations undergoing coronary arteriography, not necessarily with ACS diagnosis, unlike our study. 14,21 An interim ARCUS report, with a sample of 191 patients, showed upper limb dysfunction. However, the methodology used in this study differs from ours since they are based on questionnaire-type scales.…”

“…However, the methodology used in this study differs from ours since they are based on questionnaire-type scales. 21 On the other hand, when measuring the handgrip strength with a dynamometer, no loss of this was demonstrated, since they used percentages instead of absolute values of the scales proposed by the ASTH. Contrary to what we did in our study, absolute values were used and showed a decrease of handgrip strength in the general population and the same way in the distribution by gender.…”

“…Moreover, the scales available for evaluating upper limb dysfunction have little sensitivity and are highly dependent on subjective standards, making it challenging to apply them in other studies. 21,22 Additionally, even though there are tools such as the hydraulic dynamometer to standardized guidelines for an objective measurement of handgrip strength loss, 22,23 the definitions are inconclusive about a clinically significant loss of strength is. The scales used for strength classification are not satisfactory for different patients (including category or specification by gender, age, and profession) in the clinical setting after coronary arteriography with radial access.…”

“…The scales used for strength classification are not satisfactory for different patients (including category or specification by gender, age, and profession) in the clinical setting after coronary arteriography with radial access. 21,22 After a literature review, we decided to use the disability criteria for IADL, 19 which was initially used to assess handgrip strength loss in patients with sarcopenia. Based on these criteria, we found that the loss of handgrip strength in the analyzed patients translates into a compromise to perform daily living activities in both men and women, representing an essential adverse event since it negatively impacts performance and the fine motor capacity of the upper limb.…”

Upper Extremity Function following Transradial Percutaneous Coronary Intervention: Results of the ARCUS Trial

“…Interim analysis revealed that the questionnaires, especially the DASH questionnaire, and the rigorous cut-off points of the strength measurements yielded false positive results for both extremities [15]. us, the questionnaires were excluded and the cut-off values for those measurements were modified to percentage instead of absolute change (Table 1) [15]. e modified primary endpoint was applied for the final analysis.…”