Repeated transradial catheterization: feasibility, efficacy, and safety.

Transradial access is an alternative to the transfemoral approach in coronary interventions. It results in less access-site bleeding, shorter hospital stays, lower costs, and less pain for the patient. However, some authors have suggested that the transradial approach might lead to radial artery occlusion, which precludes repeated same-artery catheterizations. Using data from our center, we evaluated the feasibility, safety, and efficacy of repeated transradial catheterization. We reviewed the 3,006 transradial catheterizations performed at our center from 2006 through 2009. Patients who had undergone at least one repeated transradial catheterization were identified, their cases monitored through 2012, and their baseline characteristics and other factors, including procedural sequelae, were analyzed. Seventy-nine patients underwent repeated right radial artery catheterizations, for a total of 92 repeated procedures. Repeated access to the right radial artery was not achieved in 4 attempts (failure rate, 4.3%), because of poor pulses or the operator's inability to advance the wire. No major sequelae were noted. The average times between the 1st to 2nd, 2nd to 3rd, and 3rd to 4th catheterizations were 406, 595, and 401 days, respectively. Our procedural success rate of 95.7% in performing repeated transradial catheterizations with no major sequelae provides support for the efficacy and safety of such procedures.

A simple risk score for prediction of mortality in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS).

AIMS: To develop an easily applicable prognostic model that can predict mortality risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS). METHODS AND RESULTS: A retrospective analysis of 630 consecutive patients undergoing PCI for NSTEACS at our institution between January 1999 and December 2000 (development phase). Multivariate logistic regression analysis to identify independent predictors of mortality. Development of a 'weighted' and an 'unweighted' risk prediction model, each including the following 8 parameters: age > 65 years, age >75 years, left ventricular systolic function (LVEF) <50%, renal impairment (serum creatinine > 200 mmol/L), multi-vessel (3 vessel) disease, peripheral vascular disease, diabetes mellitus and female gender. Validation of the predictive model on the following 500 patients that underwent PCI over a 20 month period (validation phase). Prognostic models tested for their ability to predict mortality. The derived model was applied to the validation group and the area under receiver operating characteristic curves (ROC) was used to estimate the predictive ability of the prognostic models. The area under the ROC curve on the validation phase was 0.835, signifying a good ability to predict 30 day mortality following PCI. CONCLUSION: We have derived a simple easily applicable predictive model based on readily available information that can predict mortality following PCI for NSTEACS.