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BACKGROUND: The distal transradial access (dTRA) has become an attractive and alternative access to the conventional transradial access (TRA) for cardiovascular interventional diagnosis and/or treatment. There was a lack of randomized clinical trials to evaluate the effect of the dTRA on the long-term radial artery occlusion (RAO). METHODS: This was a prospective, randomized controlled study. The primary endpoint was the incidence of long-term RAO at 3 months after discharge. The secondary endpoints included the successful puncture rate, puncture time, and other access-related complications. RESULTS: The incidence of long-term RAO was 0.8% (3/361) for dTRA and 3.3% (12/365) for TRA (risk ratio = 0.25, 95% confidence interval = 0.07-0.88, P = 0.02). The incidence of RAO at 24 h was significantly lower in the dTRA group than in the TRA group (2.5% vs. 6.7%, P < 0.01). The puncture success rate (96.0% vs. 98.5%, P = 0.03) and single puncture attempt (70.9% vs. 83.9%, P < 0.01) were significantly lower in the dTRA group than in the TRA group. However, the number of puncture attempts and puncture time were higher in the dTRA group. The dTRA group had a lower incidence of bleeding than the TRA group (1.5% vs. 6.0%, P < 0.01). There was no difference in the success rate of the procedure, total fluoroscopy time, or incidence of other access-related complications between the two groups. In the per-protocol analysis, the incidence of mEASY type ≥ II haematoma was significantly lower in the dTRA group, which was consistent with that in the as-treated analysis. CONCLUSIONS: The dTRA significantly reduced the incidence of long-term RAO, bleeding or haematoma. TRIAL REGISTRATION: ClinicalTrials.gov identifer: NCT05253820.
Subject(s)
Arterial Occlusive Diseases , Percutaneous Coronary Intervention , Humans , Radial Artery/surgery , Prospective Studies , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/epidemiology , Hemorrhage , Hematoma/etiology , Hematoma/complications , Coronary Angiography/adverse effects , Coronary Angiography/methods , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Treatment OutcomeABSTRACT
INTRODUCTION: One of the important advantages of the distal transradial access (dTRA) is the significant reduction in the incidence of radial artery occlusion (RAO). There are few reports on the influencing factors for distal radial artery occlusion (dRAO) after cardiovascular interventions via the dTRA. METHODS: This retrospective analysis included the clinical data of patients who underwent a cardiovascular intervention via the dTRA. The dRAO was evaluated by ultrasound within 24 hours after the procedure. Multivariate logistic analysis was used to explore the influencing factors for dRAO. RESULTS: The incidence of dRAO was 3.5% (28/805) at 24 hours follow-up after the procedure. In the comparison between the 2 groups, the preoperative distal radial artery (DRA) internal diameter in the dRAO group was significantly smaller than that in the non-dRAO group (p=0.001). The prevalence of DRA inner diameter/sheath outer diameter <1 was significantly higher in the dRAO group than in the non-dRAO group (p=0.013). The number of puncture attempts was significantly greater in the dRAO group than in the non-dRAO group (p=0.007). Multivariate logistic analysis showed that DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO (OR=4.827, 95% CI=1.087-21.441, p=0.039). CONCLUSIONS: The incidence of dRAO 24 hours after cardiovascular intervention via the dTRA was 3.5%, and a DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of dRAO. CLINICAL IMPACT: The incidence of distal radial artery occlusion after cardiovascular intervention was 3.5%. The distal radial artery inner diameter/sheath outer diameter <1 was an independent risk factor for distal radial artery occlusion. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of distal radial artery occlusion. The number of puncture attempts and compression time were not related to distal radial artery occlusion.
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BACKGROUND: Distal transradial access (dTRA) has been suggested to have great advantages over cTRA. However, there is a lack of preliminary data on dTRA in patients undergoing emergency coronary angiography (CAG) or percutaneous coronary intervention (PCI). To explore the feasibility and safety of distal transradial access in patients with acute chest pain. METHODS: A total of 1269 patients complaining of acute chest pain in our emergency department from January 2020 to February 2022 were retrospectively included. The patients who met the inclusion criteria were divided into the conventional transradial access (cTRA) group (n = 238) and the dTRA group (n = 158). Propensity score matching was used to minimize the baseline differences. RESULTS: The cannulation success rate in the dTRA group was significantly lower than that in the cTRA group (87.41% vs. 94.81%, p < 0.05). No significant differences in the puncture time and total procedure time were noted between the two groups (p > 0.05). Compared with the cTRA group, the hemostasis duration was significantly shorter [4(4, 4) h vs. 10(8, 10) h, p < 0.001) and the incidence of minor bleeding (BARC Type I and II) was significantly lower in the dTRA group than that in the cTRA group (0.85% vs. 5.48%, p = 0.045). Asymptomatic radial artery occlusion was observed in six patients (5.83%) in the cTRA group and one patient (1.14%) in the dTRA group (p = 0.126). The subgroup analysis of ST-elevation myocardial infarction (STEMI) showed no significant differences in the puncture time, D-to-B time or total procedure time between the two groups. CONCLUSIONS: The dTRA for emergency CAG or PCI has an acceptable success rate and puncture time, a shorter hemostasis time, and a downward trend in RAO rate compared to the cTRA. The dTRA did not increase the D-to-B time in emergency coronary interventions in STEMI patients. On the contrary, a low incidence of RAO by the dTRA created an opportunity for future coronary interventions in non-culprit vessels in the same access. TRIAL REGISTRATION: Retrospectively registered in Chinese Clinical Trial Registry (registry number: ChiCTR2200061104, date of registration: June 15, 2022).
Subject(s)
Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Cohort Studies , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Propensity Score , Feasibility Studies , Chest Pain/diagnostic imaging , Chest Pain/epidemiology , Radial Artery/diagnostic imaging , Radial Artery/surgery , Treatment OutcomeABSTRACT
The study aimed to investigate the efficacy and safety of coronary intervention via distal transradial access (dTRA) in patients with low body mass index (BMI). A total of 67 patients with low BMI who underwent coronary intervention, comprising 29 patients via dTRA and 38 patients via conventional transradial access (cTRA), were retrospectively included. There was no significant difference in the puncture success rate between the two groups (dTRA 96.6%, cTRA 97.4%, P=0.846). Compared with the cTRA group, the success rate of one-needle puncture in the dTRA group was lower (51.7% vs. 81.6%, P=0.020). The compression haemostasis time in the dTRA group was shorter than that in the cTRA group (P < 0.001). However, the incidence of radial artery occlusion was lower in the dTRA group than in the cTRA group (4.0% vs. 33.3%, P=0.007). In conclusion, coronary intervention via dTRA was safe and effective in patients with low BMI.
Subject(s)
Body Mass Index , Percutaneous Coronary Intervention , Arterial Occlusive Diseases/epidemiology , Humans , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Punctures , Radial Artery , Retrospective StudiesABSTRACT
PURPOSE: Radial artery occlusion (RAO) is one of the common complications after coronary intervention via the conventional radial artery approach. The purpose of the study was to explore the safety and feasibility of retrograde recanalization of the occluded radial artery via a distal radial artery (DRA) approach. METHODS: Combined with the practice of our centre and a literature review, we summarized the procedure of retrograde recanalization of RAO, success rate, and complications. RESULTS: A total of 14 of 15 patients with 15 pieces of occluded radial arteries were successfully recanalized via the DRA in our centre. In the 15 occluded vessels, 11 vessels (73.3%) had total occlusion and 4 vessels (26.7%) had functional occlusion. Four of 15 occluded vessels were acute occlusions. Two acute RAOs were only treated with aspiration via sheath, 11 RAOs with balloon angioplasty, and 2 RAOs with both, respectively. In 6 patients, cardiac catheterization was carried out via the DRA after recanalizing the RAO. A total of 10 studies reporting the results of recanalization of RAO via the DRA were systematically retrieved in the present study. In 3 case series, the number of cases was more than 5, and the success rate of recanalization was more than 85.7%. Two studies reported complications, including dissection in one case, hematoma in 2 cases, and pain in the forearm during angioplasty. CONCLUSIONS: Recanalization of the occluded radial artery via the DRA was safe and effective. When repeat cardiac catheterization was required, recanalization of the RAO and subsequent coronary angiography or intervention through the ipsilateral radial artery approach was feasible.
Subject(s)
Arterial Occlusive Diseases , Radial Artery , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , Cardiac Catheterization/adverse effects , Cardiac Catheterization/methods , Coronary Angiography/adverse effects , Coronary Angiography/methods , Humans , Radial Artery/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: This study investigated the safety and efficacy of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via distal transradial artery access (d-TRA). METHODS: For this single-centre prospective cohort study, a total of 1066 patients who underwent CAG or PCI procedures from September 2019 to November 2020 were included. Patients were divided into two groups: the d-TRA group (346) and the conventional transradial artery access (c-TRA) group (720) based on access site. A total of 342 pairs of patients were successfully matched using propensity score matching (PSM) for subsequent analysis. RESULTS: No significant differences in puncture success rate, procedural method, procedural time, sheath size, contrast dosage or fluoroscopy time were noted between the two groups. The puncture time in the d-TRA group was longer than that in the c-TRA group (P < 0.01), and the procedure success rate was lower than that in the c-TRA group (90.94% vs. 96.49%, P = 0.01). The haemostasis time in the d-TRA group was shorter than that in the c-TRA group (P < 0.01), and the visual analogue scale (VAS) was lower than that in the c-TRA group (P < 0.01). In addition, the prevalence of bleeding and haematoma in the d-TRA group was lower than that in the c-TRA group (1.75% vs. 7.31%, P < 0.01; 0.58% vs. 3.22%, P = 0.01, respectively). No significant difference in the incidence of numbness was noted between the two groups. No other complications were found in two groups. CONCLUSION: d-TRA is as safe and effective as c-TRA for CAG and PCI. It has the advantages of improved comfort and fewer complications. Trail registration Chinese Clinical Trial Registry, ChiCTR1900026519.
Subject(s)
Catheterization, Peripheral , Coronary Angiography , Percutaneous Coronary Intervention , Catheterization, Peripheral/methods , Coronary Angiography/adverse effects , Coronary Angiography/methods , Femoral Artery , Humans , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Propensity Score , Prospective Studies , Radial Artery/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: Radial artery occlusion is a common complication after coronary angiography and percutaneous coronary intervention via the transradial access. In recent years, coronary angiography and percutaneous coronary intervention via the distal transradial access has gradually emerged, but recanalization of the occluded radial artery through the distal transradial access has rarely been reported. CASE PRESENTATION: A 67-year-old female with arterial hypertension and diabetes mellitus was admitted to the hospital due to chest pain for three hours. She was diagnosed with acute myocardial infarction. After admission, the patient successfully underwent emergency coronary angiography and percutaneous coronary intervention through the right transradial access. Radial artery occlusion was found after the operation, and recanalization was successfully performed through the right distal transradial access before discharge. Immediately after the operation and one month later, vascular ultrasonography showed that the antegrade flow was normal. CONCLUSIONS: This report presents a case of radial artery occlusion after emergency coronary angiography and percutaneous coronary intervention in which recanalization was successfully performed through the right distal transradial access. This case demonstrates that recanalization of a radial artery occlusion via the distal transradial access is safe and feasible.
Subject(s)
Angioplasty, Balloon , Arterial Occlusive Diseases/therapy , Catheterization, Peripheral/adverse effects , Radial Artery , Aged , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/physiopathology , Coronary Angiography , Female , Humans , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/therapy , Percutaneous Coronary Intervention , Punctures , Radial Artery/diagnostic imaging , Radial Artery/physiopathology , Treatment Outcome , Vascular PatencyABSTRACT
BACKGROUND: Dyslipidaemia plays an important role in coronary atherosclerotic disease (CAD). The relationship between the atherogenic index of plasma (AIP) and CAD in elderly individuals was explored in this study. METHODS: Elderly individuals (age ≥ 65 years) who underwent coronary angiography from January 2016 to October 2020 were consecutively enrolled in the study. RESULTS: A total of 1313 individuals, including 354 controls (non-CAD) and 959 CAD patients, were enrolled. In univariate analysis of all populations, the adjusted AIP (aAIP) in the CAD group was 1.13 (0.96, 1.3), which was significantly higher than that in the controls [1.07 (0.89, 1.26)]. However, in subgroup analyses, this phenomenon was only present in males. In addition, further study showed that aAIP was positively related to CAD severity. In binary logistic regression analyses, after adjusting for sex, age, smoking status, primary hypertension (PH), type 2 diabetes mellitus (T2DM), heart rate (HR), white blood cell (WBC) and platelet (PLT), AIP remained independently related to CAD in elderly individuals and was superior to traditional and other nontraditional lipid indices. Subgroup analyses showed that AIP independently influenced CAD risk in males. Ultimately, sensitivity analyses were performed excluding all coronary emergencies, and the final results were similar. CONCLUSIONS: AIP was positively related to the risk and severity of CAD in elderly individuals and was superior to traditional and other nontraditional lipid profiles. However, this association only exists in elderly males.
Subject(s)
Coronary Artery Disease/blood , Dyslipidemias/blood , Aged , Case-Control Studies , Coronary Artery Disease/etiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/complications , Dyslipidemias/complications , Female , Humans , Logistic Models , Male , Patient Acuity , Risk Factors , Sex Factors , Smoking/adverse effectsABSTRACT
BACKGROUND: Transradial access (TRA) has been considered as the default choice in cardiac catheterization. Although infrequent, vascular complications of this approach remain. Recently, the distal transradial approach (dTRA) in cardiac catheterization was reported by interventionalists. METHODS: We retrieved the relevant literatures and reviewed the safety and feasibility of this novel approach in cardiac catheterization. RESULTS: The dTRA for cardiac intervention has superior safety and satisfaction. As a novel approach for cardiac catheterization, access related complications should also be considered by operators, such as RAO, radial spasm, bleeding and haematoma, and injury of the superficial branch of the radial nerve. CONCLUSIONS: The dTRA in cardiovascular angiography and intervention was safe and feasible.
Subject(s)
Cardiac Catheterization , Catheterization, Peripheral , Coronary Angiography , Percutaneous Coronary Intervention , Radial Artery , Cardiac Catheterization/adverse effects , Catheterization, Peripheral/adverse effects , Coronary Angiography/adverse effects , Humans , Patient Safety , Percutaneous Coronary Intervention/adverse effects , Punctures , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Endothelial lipase (EL) plays an important role in the regulation of lipid metabolism by reducing the high density lipoprotein cholesterol (HDL-C) levels and inducing the macrophages to take up native low density lipoprotein cholesterol (LDL-C). Our purpose was to investigate the impact of EL genetic polymorphisms on the lipid-lowering effects of rosuvastatin in Chinese coronary artery disease (CAD) patients. METHODS: One hundred twenty-one unrelated CAD patients, who underwent the treatment with rosuvastatin (10mg/day) for four to eight weeks, were enrolled in this study. Before and after treatment, serum lipids levels were measured. Genotypes of EL 2037T/C and 2237 G/A polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: Patients with EL 2037C allele (CC + CT) had significantly lower LDL-C levels than those with TT genotype (CC + CT: 2.60 ± 0.74 mmol/l; TT: 2.90 ± 0.87 mmol/l; P = 0.047), before rosuvastatin treatment. No significant differences between baseline lipid levels and the EL 2237G/A genotypes were observed. After treatment with rosuvastatin, total cholesterol (TC), high triglyceride (TG) and LDL-C levels decreased from baseline, on average, by 23.09 % (4.59 ± 0.96 mmol/l to 3.47 ± 0.83 mmol/l), 6.36 % (2.01 ± 1.18 mmol/l to 1.68 ± 1.16 mmol/l), 32.48 % (2.77 ± 0.83 mmol/l to 1.79 ± 0.62 mmol/l), respectively (all P < 0.05) in all patients. While changes in HDL-C levels did not reach statistical significance. No significant effects of EL 2037T/C or 2237G/A polymorphism were observed on lipid-lowering effects of rosuvastatin. CONCLUSIONS: EL 2037T/C and 2237 G/A polymorphisms might not affect the lipid-owing effects of rosuvastatin in Chinese CAD patients.
Subject(s)
Coronary Artery Disease/drug therapy , Coronary Artery Disease/genetics , Lipase/genetics , Rosuvastatin Calcium/administration & dosage , Adult , Aged , Aged, 80 and over , Asian People , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Artery Disease/blood , Coronary Artery Disease/pathology , Female , Genotype , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Male , Middle Aged , Polymorphism, Genetic , Triglycerides/bloodABSTRACT
Epidemiologic studies have been performed to explore the relationship between MCP-1 polymorphism and ischemic heart disease (IHD) and ischemic stroke (IS). But, the results are not consistent. Because of the poor effect of each individual study, we've performed a systematic review and a meta-analysis. A comprehensive search was carried out from PubMed, Embase, Foreign Medical Journal Service (FMJS), China National Knowledge Infrastructure and Wanfang Data. Odds ratios (OR) with 95% confidence interval (CI) were used to evaluate the strength of associations between the MCP-1 A-2518G polymorphism (rs1024611) and IHD and IS susceptibilities. The pooled OR was calculated by the allelic model (G vs A), the additive model (GG vs AA), the dominant model (GG+GA vs AA) and the recessive model (GG vs AA+GA), respectively. The homogeneity among studies was checked using Cochrane Q statistic. The stability of results was checked by one-way sensitivity analysis. The publication bias between studies was examined by Begg's funnel plots and Egger's test. 28 eligible case-control studies met all the criteria and were involved in the present meta-analysis, including a total of 8,901 cases and 12,623 controls. Overall, the MCP-1 A-2518G polymorphism was significantly associated with the IHD susceptibility. The pooled OR was 1.27 (95% CI 1.09-1.48, P = 0.002) in the dominant model, 1.20 (95% CI 1.07-1.35, P = 0.001) in the allelic model, 1.25 (95% CI 1.05-1.50, P = 0.015) in the recessive model and 1.39 (95% CI 1.10-1.75, P = 0.005) in the additive model. At the same time, the MCP-1 A-2518G polymorphism was significantly associated with the IS susceptibility. The pooled OR was 1.72 (95% CI 1.12-2.65, P = 0.013) in the dominant model, 1.39 (95% CI 1.12-1.74, P = 0.003) in the allelic model, 1.59 (95% CI 1.30-1.93, P = 0.000) in the recessive model, and 2.33 (95% CI 1.76-3.08, P = 0.000) in the additive model, respectively. No significant publication bias was found in the present meta-analysis. The results of the present meta-analysis suggest that MCP-1 gene A-2518G polymorphism may be associated with the IHD and IS susceptibilities. But the positive result exists in relatively small sample size subgroup.
Subject(s)
Chemokine CCL2/genetics , Myocardial Ischemia/genetics , Polymorphism, Single Nucleotide , Stroke/genetics , Aged , Genetic Predisposition to Disease , Humans , Middle Aged , Odds Ratio , Publication BiasABSTRACT
BACKGROUND: Studies had investigated the associations between proprotein convertase subtilisin/kexin type 9 (PCSK9) E670G polymorphism and coronary artery disease (CAD) and lipid levels, but the results were controversial. Thus, we performed this meta-analysis to investigate the association between PCSK9 E670G polymorphism and lipid levels and the susceptibility to CAD. METHODS: All relevant articles according to the inclusion criteria were retrieved and included in the present meta-analysis. Odds ratios (ORs) with 95 % confidence interval (CI) were used to analyze the strength of the association between PCSK9 E670G polymorphism and the susceptibility to CAD. At the same time, the pooled standardized mean difference (SMD) with 95 % CI was used for the meta-analysis of PCSK9 E670G polymorphism and lipid levels. The publication bias was examined by using Begg's funnel plots and Egger's test. RESULTS: A total of seventeen studies met the inclusion criteria. For CAD association, the pooled effects indicated that the G allele carriers had higher risk of CAD than non-carriers in dominant genetic model (OR:1.601, 95 % CI: 1.314-1.951, P < 0.001), as well as in allelic genetic model (OR: 1.546, 95 % CI: 1.301-1.838, P < 0.001). When the subgroup analysis stratified by ethnicity and HWE was performed, the positive result existed in most of the subgroups. For lipid levels association, the pooled effects indicated that the G allele carriers had higher TC and LDL-C levels than the non-carriers (for TC, SMD: 0.126, 95 % CI: 0.023-0.229, P = 0.016; for LDL-C, SMD: 0.170, 95 % CI: 0.053-0.287, P = 0.004, respectively). There was no difference in the levels of TG and HDL-C between the G carriers and the non-carriers in the whole population (SMD: 0.031, 95 % CI: -0.048-0.110, P = 0.440; SMD: -0.123, 95 % CI: -0.251-0.006, P = 0.061, respectively). When the studies were stratified by ethnicity and type of study, the G carriers had higher TC levels than the non-carriers (SMD: 0.126, 95 % CI: 0.014-0.238, P = 0.027) in the non-Asian subgroup. The similar results existed in cohort subgroup. The association between PCSK9 E670G polymorphism and LDL-C levels was significant in all subgroups. Meanwhile, the G carriers had higher TG levels than the non-carriers (SMD: 0.113, 95 % CI: 0.012-0.214, P = 0.028) in the case-control subgroup. AG + GG genotypes had lower HDL-C levels than AA genotype in Asian subgroup (SMD: -0.224, 95 % CI: -0.423- -0.025, P = 0.027) and in case-control subgroup (SMD: -0.257, 95 % CI: -0.467--0.048, P = 0.016). CONCLUSIONS: The present meta-analysis concluded that PCSK9 E670G polymorphism was associated with CAD risk and lipid levels.
Subject(s)
Coronary Artery Disease/genetics , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide , Proprotein Convertases/genetics , Serine Endopeptidases/genetics , Alleles , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Artery Disease/blood , Coronary Artery Disease/ethnology , Coronary Artery Disease/pathology , Gene Expression , Gene Frequency , Genotype , Heterozygote , Humans , Models, Genetic , Odds Ratio , Proprotein Convertase 9 , Proprotein Convertases/blood , Racial Groups , Risk Factors , Serine Endopeptidases/blood , Triglycerides/bloodABSTRACT
BACKGROUND: Studies had investigated the relationships between endothelial lipase (EL) 584C/T polymorphism and high density lipoprotein cholesterol (HDL-C) level and coronary heart disease (CHD), but the results were controversial. To investigate a more authentic associations between EL 584C/T polymorphism and HDL-C level, and the risk of CHD, we performed this meta-analysis. METHODS: We searched electric databases for all articles on the associations between EL 584C/T polymorphism and HDL-C level, and CHD risk. Odds ratios (ORs) with 95% confidence interval (CI) were used to evaluate the strength of the association between the EL 584C/T polymorphism and the CHD susceptibility. The pooled standardized mean difference (SMD) with 95% CI was used for the meta-analysis of EL 584C/T polymorphism and HDL-C level. Begg's funnel plots and Egger's test were used to examine the publication bias. RESULTS: For CHD association, the pooled OR was 0.829 (95% CI: 0.701-0.980, P = 0.028) for the dominant model and 0.882 (95% CI: 0.779-0.999, P = 0.049) for the allelic model. By meta-regression analysis, we found that only total sample size could influence the initial heterogeneity. When the subgroup analysis was carried out, we found that the protective effect only existed in the subgroups of relatively small sample size. Sensitivity analyses indicated that Tang's study influenced the overall results significantly. We calculated the pooled ORs again after excluding Tang's study and found the association between EL 584C/T polymorphism and the risk of CHD was not significant for any genetic model. For HDL-C level association, the carriers of 584 T allele had a higher HDL-C level than the non-carriers. The pooled SMD was 0.399 (95% CI: 0.094-0.704, P = 0.010). When the studies were stratified by ethnicity and total sample size, the positive effects existed in the Caucasians and in subgroups of larger sample size. No significant publication bias was found in the present meta-analysis. CONCLUSIONS: The results of the present meta-analysis suggest that the carriers of EL 584 T allele have a higher HDL-C level in Caucasian populations. Whereas, it might not be a protective factor for CHD.
Subject(s)
Coronary Disease/genetics , Lipase/genetics , Polymorphism, Genetic/genetics , Genetic Predisposition to Disease/genetics , HumansABSTRACT
BACKGROUND: Distal transradial access (dTRA) has recently emerged as a new vascular access alternative for coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). However, published data on long-term mortality and major adverse cardiac events after PCI via dTRA are inconclusive. The aim of this study was to compare the long-term prognoses of PCI via dTRA and conventional transradial access (cTRA) for acute coronary syndrome (ACS) after 1-3 years of follow-up. METHODS: Patients who were diagnosed with ACS and underwent PCI between January 1, 2020 and December 31, 2021, were retrospectively enrolled. The patients were divided into two groups at a 1:1 ratio, subjected to propensity score matching (PSM), and then followed for 1-3 years after PCI. Cox proportional hazards regression was used to evaluate the relationship between the two access sites and clinical outcomes. RESULTS: Among the 550 patients in the dTRA and cTRA groups, 11 (4.0%) and 19 (6.9%) died during the observation period, respectively. dTRA and cTRA had similar risks of all-cause mortality [hazard ratio (HR) = 0.688; 95% CI = 0.323-1.463; P = 0.331] and major adverse cardiac events (MACEs, HR = 0.806, 95% CI = 0.515-1.263; P = 0.347) after PCI. The risk of cardiovascular mortality (HR = 0.330, 95% CI = 0.107-1.105; P = 0.053), TLR-MACEs (HR = 0.587, 95% CI = 0.339-1.109; P = 0.058), and unplanned revascularization (HR = 0.860, 95% CI = 0.483-1.529; P = 0.606) were not significantly different between the two groups. CONCLUSIONS: PCI via dTRA has the same long-term prognoses as PCI via cTRA in ACS patients, and the compression time and bleeding rate are lower than those in patients undergoing PCI via cTRA.
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BACKGROUND: Assessing the size of the distal radial artery (DRA) in anatomic snuffbox (AS) before coronary intervention is extremely important in the selection of suitable patients, improving the success rate of puncture and reducing the complications. OBJECTIVE: To evaluate the diameter of the DRA in AS and its influencing factors in Chinese patients scheduled for coronary intervention. METHODS: Ultrasound was used to detect the inner diameter of vessels. A total of 1182 patients were involved in the study. RESULTS: In all patients, the mean inner diameters of the DRA, conventional radial artery (CRA) and ulnar artery (UA) were 2.00 ± 0.43 mm, 2.38 ± 0.51 mm and 1.99 ± 0.47 mm, respectively. The proportion of DRA diameter ⩾2.0 mm was 53% (in all patients), 64% (in males), 36% (in females), respectively. The DRA/CRA ratios were 0.85 ± 0.13 in all patients, 0.86 ± 0.13 in males and 0.84 ± 0.13 in females. The diameter of the DRA was strongly positively correlated with the diameter of the CRA (r = 0.750, p < 0.05), and weakly correlated with the body mass index (r = 0.303, p < 0.05) and the diameter of the UA (r = 0.304, p < 0.05). Multivariate regression analysis showed that female sex, age ⩾60 years, body mass index <24 kg/m2, previous CRA/DRA access and history of coronary artery disease were independent predictors of the DRA diameter <2.0 mm. CONCLUSION: Measurement of the diameter of the DRA by ultrasonography may offer important information prior to coronary catheterization.
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BACKGROUND: There is a lack of randomized clinical trials on whether the 6-French (Fr) Glidesheath Slender (GSS; Terumo, Tokyo, Japan) is superior to the 6-Fr conventional radial sheath (CS) with respect to the early-term incidence of distal radial artery occlusion (dRAO) in patients who have undergone coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via distal transradial access. METHODS: This was a prospective, single-centre trial of patients who were randomized to undergo CAG and/or PCI with either a 6-Fr GSS or a 6-Fr CS. The primary end point was the incidence of dRAO at 24 hours postoperatively, evaluated using Doppler ultrasound. RESULTS: A total of 620 patients were included in the study. The baseline patient and procedural characteristics were similar among the 2 groups. For the primary end point, the incidence of dRAO at 24 hours after the procedure was 1.0% (3/314) in the GSS group and 3.6% (11/306) in the CS group (risk ratio, 0.266; 95% confidence interval, 0.075-0.943; P = 0.027) according to the intention to treat analysis. For the secondary end points, the incidence of proximal radial artery occlusion was 0.3% (1/314) in the GSS group and 2.3% (7/306) in the CS group (P = 0.029). Other secondary end points, including the puncture success rate, procedural outcomes, other puncture-related outcomes, and access-related complications were not significantly different in the 2 groups. CONCLUSIONS: The use of a thin-walled and hydrophilic coating sheath can reduce the incidence of early-term dRAO in patients who undergo CAG and/or PCI via the distal transradial access. CLINICAL TRIAL REGISTRATION: NCT05501925.
ABSTRACT
Numerous studies have shown a relationship between cholesteryl ester transfer protein (CETP) polymorphism in the synthesis of high-density lipoprotein cholesterol (HDL-C) and the coronary artery disease (CAD) susceptibility, but the results have remained inconsistent. In addition, there was no study exploring the relationship between CETP polymorphisms and atherogenic index of plasma (AIP) levels.We conducted a case-control study to evaluate the relationship between CETP rs708272 polymorphism and CAD risk and lipid levels in Chinese Han population. 556 CAD patients and 414 controls undergoing coronary angiography were consecutively enrolled in the hospital-based study. Polymerase chain reaction-ligase detection reaction (PCR-LDR) method was used to detect the different genotypes at rs708272.No significant association between CETP rs708272 polymorphism and CAD risk was observed in different genetic models. In the whole population, participants with TT genotype had higher HDL-C levels (1.17â±â0.31âmmol/L vs 1.09â±â0.29âmmol/L, Pâ=â.001) and lower AIP levels (0.08â±â0.35 vs 0.16â±â0.31, Pâ=â.004) compared to those with CC genotype, after adjusting for age, gender, smoking, essential hypertension (EH), and DM. The T allele carriers had higher HDL-C levels than the T allele non-carriers (1.13â±â0.29âmmol/L vs 1.09â±â0.29âmmol/L, Pâ=â.023). Furthermore, subgroup analyses based on gender were carried out. In males, the results showed that participants with TT genotype had significant higher HDL-C levels and lower AIP levels compared with CC genotype (Pâ<.05). In addition, males with CT+TT genotypes had higher HDL-C levels and lower AIP levels than those with CC genotypes (HDL-C: CT+TT 1.11â±â0.31vs CC 1.06â±â0.30âmmol/L, Pâ=â.041; AIP: CT+TT 0.12â±â0.32vs CC 0.16â±â0.31, Pâ=â.034, respectively). However, there were no significant associations between lipid levels and CETP rs708272 polymorphism in females, after adjusting for confounders.CETP rs708272 polymorphism has a gender-specific effect on lipid and AIP levels but not on the risk of CAD.
Subject(s)
Cholesterol Ester Transfer Proteins/genetics , Coronary Artery Disease/genetics , Lipids/blood , Polymorphism, Genetic , Sex Characteristics , Aged , Asian People/genetics , Atherosclerosis/blood , Atherosclerosis/genetics , Case-Control Studies , Female , Gene Frequency , Humans , Male , Middle AgedABSTRACT
Dyslipidemia is one of the most important factors for coronary artery disease (CAD). The atherogenic index of plasma (AIP), a new comprehensive lipid index, might be a strong marker for predicting the risk of CAD.A hospital-based case-control study including 2936 CAD patients and 2451 controls was conducted in a Chinese population. Traditional lipid parameters were detected, and nontraditional lipid comprehensive indexes were calculated.Compared with controls, CAD patients had higher levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C). By contrast, the level of high-density lipoprotein cholesterol (HDL-C) was lower in CAD patients. The values of nontraditional lipid profiles, including non-HDL-C, TC/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C (atherogenic index, AI), TC*TG*LDL/HDL-C (lipoprotein combine index, LCI), and lg (TG/HDL-C) (AIP), were all significantly higher in the cases than in the controls. The results of Pearson correlation analyses indicated that AIP was positively and significantly correlated with TC (râ=â0.125, Pâ<â.001), TG (râ=â0.810, Pâ<â.001), LDL-C (râ=â0.035, Pâ<â.001), non-HDL-C (râ=â0.322, Pâ<â.001), TC/HDL-C (râ=â0.669, Pâ<â.001), LDL-C/HDL-C (râ=â0.447, Pâ<â.001), AI (râ=â0.669, Pâ<â.001), and LCI (râ=â0.688, Pâ<â.001) and was negatively correlated with age (râ=â-0.122, Pâ<â.001) and HDL-C (râ=â-0.632, Pâ<â.001). In the univariate logistic regression analysis, AIP was the lipid parameter that was most strongly associated with CAD, with an unadjusted odds ratio of 1.782 (95% confidence interval: 1.490-2.131, Pâ<â.001), for an increase of 1-SD. Multivariate logistic regression analyses revealed that AIP was an independent risk factor for CAD.AIP might be a strong and independent predictor for CAD in the Chinese Han population.
Subject(s)
Coronary Artery Disease/blood , Lipids/blood , Asian People , Biomarkers/blood , Case-Control Studies , China , Coronary Angiography , Coronary Artery Disease/ethnology , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Peroxisome proliferator-activated receptor gamma (PPARG) plays an important role in the pathogenesis and maintenance of essential hypertension (EH). It has been suggested that polymorphisms of PPARG are associated with the risk of EH. However, findings to date remain controversial. To elucidate the associations between the PPARG Pro12Ala and C161T polymorphisms and EH risk, a meta-analysis was carried out. METHODS: A comprehensive literature search of PubMed, Embase, CNKI (Chinese National Knowledge Infrastructure), VIP and Wanfang databases was conducted. The pooled odds ratios (ORs) and 95% confidence interval (CI) were calculated to estimate the size of the effect using the random-effects model. At the same time, the pooled standardized mean difference (SMD) with 95% CI was used for the meta-analysis of the PPARG Pro12Ala polymorphism and blood pressure. RESULTS: Finally, Fifteen papers (seventeen studies) including 4,151 cases and 4,997 controls to evaluate the association of the PPARGPro12Ala polymorphism and EH risk, were included in this study. Overall, the results suggested that Ala allele was associated with the decreased EH risk (for allelic model, OR = 0.757, 95%CI: 0.624-0.918, P = 0.005; for dominant model, OR = 0.771, 95%CI: 0.627-0.946, P = 0.013). The subgroup analysis stratified by ethnicity showed that the significant association between the PPARG Pro12Ala polymorphism and EH was only detected in the Asian subgroup. There was no difference in blood pressure values between Ala carriers and non-carriers. For the C161T polymorphism, only 5 studies comprising 1,118 cases and 1,357 controls met the inclusion criteria. The overall results showed that the PPARG C161T polymorphism was not associated with the risk of EH. But in the subgroup analysis, we found that the PPARG C161T polymorphism significantly associated with the risk of EH in the Asian subgroup (for allelic model, OR = 0.719, 95% CI: 0.537-0.963, P = 0.027; for dominant model, OR = 0.653, 95% CI: 0.439-0.972, P = 0.036). CONCLUSION: Our meta-analysis suggested that the PPARG polymorphisms might be associated with the risk of EH.