Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK).

BACKGROUND: In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. METHODS: The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. RESULTS: From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). CONCLUSION: Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

Social anxiety is associated with heart rate but not gaze behavior in a real social interaction.

BACKGROUND AND OBJECTIVES: Much of our current understanding of social anxiety rests on the use of highly restricted laboratory experiments. Latest technological developments now allow the investigation of eye movements and physiological measures during real social interactions. Considering the wealth of conflicting findings on gaze behavior in social anxiety, the current study aimed at elucidating the modulation of gaze patterns in a naturalistic setting. METHODS: We introduced 71 participants with differing social anxiety symptoms to a waiting room situation while recording heart rate, electrodermal activity and eye movements using mobile technology. RESULTS: We observed fewer fixations on the head of the confederate in the initial waiting phase of the experiment. These head fixations increased when the confederate was involved in a phone call and subsequently initiated an actual conversation. Contrary to gaze-avoidance models of social anxiety, we did not observe any correlations between social anxiety and visual attention but an elevated heart rate in participants with high social anxiety. LIMITATIONS: Although social anxiety varied considerably in the current sample and reached clinically relevant levels in one third of participants, formal clinical diagnoses were not available. CONCLUSIONS: The current findings suggest that gaze avoidance might only occur in specific situations or very high levels of social anxiety. Fear of eye contact could at times represent a subjectively experienced rather than an objectively measurable feature of the disorder. The observation of elevated heart rate throughout the entire experiment indicates that physiological hyperactivity might constitute a cardinal feature of social anxiety.

[4th report of German Association of Cardiologists in private practice (BNK) on quality assurance in cardiac catheterization and coronary intervention 1999-2002]. / 4. Bericht des Bundesverbandes Niederglassener Kardiologen zur Qualitätssicherung in der diagnostischen und therapeutischen Invasivkardiologie 1999-2002.

The Society of German Cardiologists in private practice (BNK) reports about its project on quality assurance in invasive cardiology (QuIK). Results of a computerized data collection and analysis of cardiac catheterizations and interventions in the years 1999-2002 are presented. These results are compared with other registries. The QuIK-project is done voluntarily by 70% of the society's cardiologists who perform invasive methods. A total of 225,562 diagnostic and 64,895 interventional procedures are documented over the 4 years. Patient characteristics and procedural data kept unchanged. Complication rates were low (< 2%), MACE < 0.5%. There was a rising number of patients referred with acute myocardial infarction. Less time was used to complete procedures from 1 year to another. Two out of three of the centers underwent a monitoring/auditing process in 2002. The desirable post-interventional follow-up after discharge in all cases appears to be impossible to fulfill under the given economical circumstances.