Existentially Oriented Group Intervention for Patients With Heart Failure: Intervention Development and Preliminary Assessment.

BACKGROUND: Patients with heart failure (HF) cope with a chronic, life-threatening, particularly disabling medical condition. Their well-being is considered to be at a greater risk than that of patients with any other cardiovascular disease, and their psychological distress is associated with a worse prognosis. These patients are often preoccupied with existential concerns such as fear of death, loneliness, and a loss of sense of meaning. However, there is a dearth of literature regarding psychological interventions that address these issues among this population. AIMS: We, the authors of the current pilot study, present the development and initial implementation of a novel protocol: "existentially oriented group intervention for patients with heart failure." Our aims were to test the intervention's feasibility, as well as to explore patients' subjective experience of it. METHODS: The intervention (consisting of seven 1-hour weekly sessions) was applied to 2 consecutive groups. Twelve patients coping with HF levels III and IV-according to the New York Heart Association classification-from a hospital-based HF clinic participated. The Narrative Evaluation of Intervention Interview was applied. RESULTS: Although high dropout levels were detected, the patients who fully participated in the program reported on satisfaction and progress in the following 4 domains: personal growth, social support, self-worth, and mastery. CONCLUSIONS: On the basis of our preliminary findings, the "existentially oriented group intervention for patients with heart failure" is recommended to be further tested among patients coping with HF.

Statin Therapy: Diabetes Mellitus Risk and Cardiovascular Benefit in Primary Prevention.

BACKGROUND: The salutary effects of statin therapy in patients with cardiovascular disease (CVD) are well established. Although generally considered safe, statin therapy has been reported to contribute to induction of diabetes mellitus (DM). OBJECTIVES: To assess the risk-benefit of statin therapy, prescribed for the prevention of CVD, in the development of DM. METHODS: In a population-based real-life study, the incidence of DM and CVD were assessed retrospectively among 265,414 subjects aged 40-70 years, 17.9% of whom were treated with statins. Outcomes were evaluated according to retrospectively determined baseline 10 year cardiovascular (CV) mortality risks as defined by the European Systematic COronary Risk Evaluation, statin dose-intensity regimen, and level of drug adherence. RESULTS: From 2010 to 2014, 5157 (1.9%) new cases of CVD and 11,637 (4.4%) of DM were observed. Low-intensity statin therapy with over 50% adherence was associated with increased DM incidence in patients at low or intermediate baseline CV risk, but not in patients at high CV risk. In patients at low CV risk, no CV protective benefit was obtained. The number needed to harm (NNH; incident DM) for low-intensity dose regimens with above 50% adherence was 40. In patients at intermediate and high CV risk, the number needed to treat was 125 and 29; NNH was 50 and 200, respectively. CONCLUSIONS: Prescribing low-dose statins for primary prevention of CVD is beneficial in patients at high risk and may be detrimental in patients at low CV risk. In patients with intermediate CV risk, our data support current recommendations of individualizing treatment decisions.

Personality Makes a Difference: Attachment Orientation Moderates Theory of Planned Behavior Prediction of Cardiac Medication Adherence.

OBJECTIVE: To achieve a comprehensive understanding of patients' adherence to medication following acute coronary syndrome (ACS), we assessed the possible moderating role played by attachment orientation on the effects of attitudes, subjective norms, and perceived behavioral control (PBC), as derived from the Theory of Planned Behavior (TPB; Ajzen, 1991), on intention and reported adherence. METHOD: A prospective longitudinal design was employed. During hospitalization, ACS male patients (N = 106) completed a set of self-report questionnaires including sociodemographic variables, attachment orientation, and measures of TPB constructs. Six months post-discharge, 90 participants completed a questionnaire measuring adherence to medication. RESULTS: Attachment orientations moderated some of the predictions of the TPB model. PBC predicted intention and reported adherence, but these associations were found to be significant only among individuals with lower, as opposed to higher, attachment anxiety. The association between attitudes and intention was stronger among individuals with higher, as opposed to lower, attachment anxiety. Only among individuals with higher attachment avoidance, subjective norms were negatively associated with intention to take medication. CONCLUSIONS: Cognitive variables appear to explain both adherence intention and behavior, but differently, depending on individuals' attachment orientations. Integrating personality and cognitive models may prove effective in understanding patients' health behaviors.

Multidisciplinary rehabilitation program in recently hospitalized patients with heart failure and preserved ejection fraction: rationale and design of a randomized controlled trial.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) comprises a large portion of heart failure patients and portends poor prognosis with similar outcome to heart failure with reduced ejection fraction (HFrEF). Thus far, no medical therapy has been shown to improve clinical outcome in this common condition. TRIAL DESIGN: The study is a randomized-controlled, multicenter clinical trial aimed to determine whether early posthospitalization comprehensive cardiac rehabilitation (CR) including exercise training (ET) in recently hospitalized HFpEF patients reduces the composite end point of all-cause mortality and hospitalizations in comparison with usual care (UC). After undergoing baseline evaluation, patients are randomized to either UC or to ambulatory comprehensive CR program. Patients in the CR arm will participate in a 6-month biweekly ET program according to a predefined protocol, in addition to a complementary home exercise prescribed by a specialist in CR. Exercise training will include endurance and low-intensity resistance training. Patients in the UC arm will be followed up at the outpatient clinic, with management according to current heart failure guidelines. Physician follow-up visits will be conducted at 3, 6, and 12 months for assessment of adherence to therapy and ET, functional status, quality of life, and clinical events. Secondary end points will include quality-of-life questionnaire, economic end points, blood pressure, and hemoglobin A1C levels. CONCLUSIONS: Cardiac rehabilitation and ET are relatively inexpensive and accessible and can be beneficial in HFpEF patients. Our trial is designed to evaluate the impact of early posthospitalization comprehensive rehabilitation program on clinical end points of mortality, hospitalization, and quality of life in HFpEF patients.

Relationship between the intensity of heparin anticoagulation and clinical outcomes in patients receiving glycoprotein IIb/IIIa inhibitors during primary percutaneous coronary intervention in acute myocardial infarction.

OBJECTIVES: We sought to determine the impact of the activated clotting time (ACT) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with unfractionated heparin (UFH) and a glycoprotein IIb/IIIa inhibitor (GPI). BACKGROUND: UFH+GPI is commonly used during primary PCI for STEMI. UFH anticoagulation is titrated with ACT. METHODS: Patients randomized to UFH+GPI in HORIZONS-AMI who underwent primary PCI are included (N = 1,624). Initial UFH bolus was 60 IU kg(-1) (target ACT: 200-250 sec). Patients were divided into three tertiles of peak ACT (cutoffs 240 and 298 sec). The 30-day rates of major and minor bleeding, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE; MACE or major bleeding) were determined. RESULTS: Mortality at 30 days occurred in 2.2, 3.3, and 3.5% of patients in the low to high ACT tertiles, respectively (P(trend) = 0.22). Nor was the peak ACT significantly related to major bleeding, MACE or NACE. However, minor bleeding was increased in the highest ACT tertile (14.7% vs. 14.2% vs. 19.4%, P(trend) = 0.04). By multivariable analysis peak ACT was not significantly related to major bleeding, mortality, MACE, and NACE but was a significant independent predictor of minor bleeding (odds ratio = 1.027 [1.013, 1.042], P < 0.001, for each 10 sec increase in ACT). CONCLUSIONS: In patients undergoing primary PCI for STEMI treated with UFH+GPI, the peak procedural ACT achieved does not have a substantial effect on major bleeding, mortality, or MACE, although lower peak ACT is associated with less minor bleeding.

Illness cognition as a predictor of exercise habits and participation in cardiac prevention and rehabilitation programs after acute coronary syndrome.

BACKGROUND: Despite well-established medical recommendations, many cardiac patients do not exercise regularly either independently or through formal cardiac prevention and rehabilitation programs (CPRP). This non-adherence is even more pronounced among minority ethnic groups. Illness cognition (IC), i.e. the way people perceive the situation they encounter, has been recognized as a crucial determinant of health-promoting behavior. Few studies have applied a cognitive perspective to explain the disparity in exercising and CPRP attendance between cardiac patients from different ethnic backgrounds. Based on the Health Belief Model (HBM) and the Common Sense Model (CSM), the objective was to assess the association of IC with exercising and with participation in CPRP among Jewish/majority and Arab/minority patients hospitalized with acute coronary syndrome. METHODS: Patients (N = 420) were interviewed during hospitalization (January-2009 until August- 2010) about IC, with 6-month follow-up interviews about exercise habits and participation in CPRP. Determinants that predict active lifestyle and participation in CPRP were assessed using backward stepwise logistic regression. RESULTS: Perceived susceptibility to heart disease and sense and personal control were independently associated with exercising 6 months after the acute event (OR = 0.58, 95% CI: 0.42-0.80 and OR = 1.09, 95% CI: 1.02-1.17, per unit on a 5-point scale). Perceived benefits of regular exercise and a sense of personal control were independently associated with participation in CPRP (OR = 1.56, 95% CI: 1.12-2.16 and OR = 1.08, 95% CI: 1.01-1.15, per unit on a 5-point scale). None of the IC variables assessed could explain the large differences in health promoting behaviors between the majority and minority ethnic groups. CONCLUSIONS: IC should be taken into account in future interventions to promote physical activity and participation in CPRP for both ethnic groups. Yet, because IC failed to explain the gap between Arab and Jewish patients in those behaviors, other explanatory pathways such as psychological state or cultural views should be considered as potential areas for further research.

Deep convolution neural network for screening carotid calcification in dental panoramic radiographs.

Ischemic stroke, a leading global cause of death and disability, is commonly caused by carotid arteries atherosclerosis. Carotid artery calcification (CAC) is a well-known marker of atherosclerosis. Such calcifications are classically detected by ultrasound screening. In recent years it was shown that these calcifications can also be inferred from routine panoramic dental radiographs. In this work, we focused on panoramic dental radiographs taken from 500 patients, manually labelling each of the patients' sides (each radiograph was treated as two sides), which were used to develop an artificial intelligence (AI)-based algorithm to automatically detect carotid calcifications. The algorithm uses deep learning convolutional neural networks (CNN), with transfer learning (TL) approach that achieved true labels for each corner, and reached a sensitivity (recall) of 0.82 and a specificity of 0.97 for individual arteries, and a recall of 0.87 and specificity of 0.97 for individual patients. Applying and integrating the algorithm in healthcare units and dental clinics has the potential of reducing stroke events and their mortality and morbidity consequences.

Preliminary evidence for the construct and concurrent validity of the DS14 in Hebrew.

BACKGROUND: Type D personality is a risk indicator in cardiac patients. While both the validity and reliability of the Type D scale (DS14) have been confirmed in Western Europe, less attention has been paid to the subject in other nations. PURPOSE: The purpose of this study was to examine the validity of the Hebrew version of the DS14 among a sample of cardiac patients in Israel. METHOD: Male patients (N = 94) hospitalized for a first acute coronary syndrome (ACS) completed the DS14 1 month after their ACS. The Brief Symptoms Inventory (BSI) scales for depression and anxiety and the Buss-Durkee Hostility Inventory-Dutch for measuring covert and overt aggressions were administered during the initial hospitalization (baseline). The BSI was administered again at the 6-month follow-up. At follow-up, patients were also asked about their participation in a formal cardiac rehabilitation program. RESULTS: The two-factor structure of the DS14 was confirmed and the DS14 subscales were internally consistent (Cronbach's α = 0.79/0.80). Type D cardiac patients had a significantly higher mean score on anxiety, depression, and covert aggression at baseline compared to non-Type D patients. At the 6-month follow-up, Type D was associated with more anxiety, more depression, and less attendance at a formal cardiac rehabilitation program. The prevalence of Type D in the current sample (5.3%) was found to be significantly lower than elsewhere in Europe. CONCLUSION: Preliminary evidence suggests that it is possible to use the Hebrew version of the DS14 among Hebrew-speaking cardiac patients in future studies. However, the prevalence of the Type D personality in Israel should be further assessed.

Hair cortisol and the risk for acute myocardial infarction in adult men.

Acute stress is increasingly recognized as a precipitant of acute myocardial infarction (AMI). However, the role of chronic stress in developing AMI is less clear. We have developed a method to measure cortisol in hair, which allows longitudinal assessment of cortisol levels prior to an acute event. We aimed to evaluate the hypothesis that chronic stress, as assessed by hair cortisol content, is associated with the development of AMI. A prospective case-control study included 56 patients admitted to hospital with AMI and 56 control patients, admitted to internal medicine wards for other indications. An enzyme immunoassay technique was used to measure cortisol in the most proximal 3 cm of hair, considered to represent the most recent 3 months of exposure. Median hair cortisol contents (range) were 295.3 (105.4-809.3)ng/g in AMI patients and 224.9 (76.58-949.9)ng/g in controls (p = 0.006, Mann-Whitney U-test). After controlling for other risk factors for AMI using multiple logistic regression, log-transformed hair cortisol content remained the strongest predictor (OR 17.4, 95% CI 2.15-140.5; p = 0.007). We demonstrated elevated hair cortisol concentrations in patients with AMI. This suggests that chronic stress, as assessed by increased hair cortisol in the 3 months prior to the event, may be a contributing factor for AMI.

Primary angioplasty in patients following coronary artery bypass surgery: trends in application and outcome. Results from the acute coronary syndrome Israeli Survey (ACSIS) 2000-2008.

OBJECTIVES: We aimed to study the trends in management and outcome of post CABG patients presenting with acute MI. BACKGROUND: Primary angioplasty is the treatment of choice in patients with acute myocardial infarction. Saphenous vein grafts used for CABG are large-diameter conduits that tend to accumulate a large mass of thrombus when they are the culprit artery for acute myocardial infarction (MI). We hypothesized that performing PCI in these patients is more complex and possibly results in worse outcome compared to non-CABG patients. METHODS: Data for patients with STEMI was obtained from five acute coronary syndromes Israeli biennial Surveys (ACSIS) during 2000-2008. Baseline characteristics, management and outcome of post-CABG patients were compared to non-post CABG patients during 2006-2008 surveys. RESULTS: A total of 9,781 patients were included. About 1,002 (10.2%) were post-CABG. Reperfusion therapy for post-CABG patients (34-48%) was consistently lower compared to non-CABG patients (57-65%). Angiographic outcome in patients with STEMI who underwent primary PCI (17 post-CABG, mean age 66.6 ± 9.1 and 821 non-CABG, age 60.1 ± 12.9) was successful (TIMI flow 3) in 86 and 88%, respectively. Thirty-day mortality was 5.9 and 5.1% (P = 0.89) and MACE rates were 17.6 and 12.5%, respectively (P = 0.54). CONCLUSIONS: Use of primary PCI in post-CABG patients was lower than in non-CABG patients but increased steadily and to a similar extent in both groups. Angiographic and clinical outcome was similar despite assumingly larger thrombus burden in post CABG patients. Therefore, primary angioplasty is appropriate also in post-CABG patients presenting with STEMI.

Six- and twelve-month clinical outcomes after implantation of prokinetic BMS in patients with acute coronary syndrome.

AIMS: To evaluate the Prokinetic bare metal stent implanted in patients presenting with acute coronary syndrome (ACS). METHODS: We retrospectively studied ACS patients who underwent percutaneous coronary intervention (PCI) with a Prokinetic stent implantation. Excluded were patients presenting with cardiogenic shock, undergoing PCI to left main coronary artery (LM), or having implantation of additional stents other than Prokinetic. Six and 12 months clinical follow-up was obtained by phone. RESULTS: A total of 140 Prokinetic stents were implanted in 117 patients (age 64+/-13.0 years, 78% men). Thirty two percent of the patients had unstable angina, 36% had non ST-elevation myocardial infarction (NSTEMI) and 33% had ST-elevation myocardial infarction (STEMI). Forty two percent of lesions were categorized as B2 and 21% as C type. Procedural success was achieved in 99.1% of lesions. Clinical success was achieved in 97.4% of patients. Major adverse cardiac events (MACE) rate was 8.5% and 11.1% at 6 and 12 months follow-up, respectively. The incidence of cardiac death, MI and TLR was 2.6%, 3.4% and 2.6%, respectively at 6 months, and 4.3%, 4.3%, 2.6% respectively at 12 months. CONCLUSIONS: Clinical outcomes at 6 and 12 months after Prokinetic stent implantation are excellent and may be attributable to its unique combination of composition, design and coating.

Mean platelet volume on admission correlates with impaired response to thrombolysis in patients with ST-elevation myocardial infarction.

Mean platelets volume (MPV) has been shown to correlate with impaired reperfusion and increased mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary precutaneous coronary intervention (PCI). We aimed to study whether the same association exists in STEMI patients treated with thrombolysis. Included in the study were STEMI patients receiving thrombolysis. Thrombolysis failure was defined as a need for rescue precutaneous coronary intervention (PCI), in-hospital mortality, unplanned PCI during hospitalization or complete occlusion of the culprit coronary artery in a follow-up angiography. MPV levels were compared between patients with failed or successful thrombolysis. Of the 122 patients, 30 had failed thrombolysis while the other 92 fulfilled the criteria for successful treatment. There were no significant differences in demographic or clinical baseline characteristics of the two groups. Mean MPV was significantly higher in patients with failed thrombolysis compared to patients with successful treatment (9.2 +/- 1.1fl and 8.7 +/- 1.0fl respectively, p = 0.019 in multivariate analysis). The prevalence of thrombolysis failure was significantly higher in patients with MPV > 8.6 fl compared to those with MPV

Behavior and knowledge trajectories among adult offspring of patients with an acute cardiac event: A call for a turning point in cardiac prevention.

INTRODUCTION: Early detection is critical in the prevention of cardiovascular disease (CVD). An at-risk population for cardiac disease-and conveniently approachable in terms of timing-is cardiac patients' offspring, at the moment when the parent is hospitalized for his or her own cardiac event. Based on the theoretical underpinning of life turning points, defined as perceived life course-changing events, we suggest that adult children would view the parent's cardiac event as a significant life turning point and that this understanding would motivate them to learn about CVD and to change their lifestyles accordingly. The current study's main goal was therefore to assess the baseline level and change over time in the adult offspring's knowledge of cardiac risk factors and cardiac health-promoting behaviors. METHOD: In a prospective design, 69 Israeli adult offspring of individuals newly diagnosed with an acute coronary event were approached and interviewed at 3 time points (on average 17 days, 55 days, and 125 days after the parent's hospitalization). RESULTS: Contrary to our assumption, no significant change over time was detected among the adult children with regard to body mass index, physical activity, eating behaviors, or smoking. In fact, over time, they seemed to know less about CVD risk factors than they did originally. CONCLUSION: Adult children of cardiac patients seem to be reluctant to spontaneously engage in health-promoting behaviors. The option of approaching them, in a primary preventive act, as early as during a parent's hospitalization should be further investigated. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

[The new universal definition of myocardial infarction].

Given the considerable advances in recent years in myocardial infarction diagnosis and management, the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), together with the World Heart Federation [WHF] recently published an expert consensus document to establish a universal definition for myocardial infarction. The consensus document recognizes five separate myocardial infarction categories based on the differences in pathophysiology, and whether percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery is involved. The new consensus document expands the criteria for defining myocardial infarction by adding new ECG criteria and imaging modalities, and also includes patients who present with sudden death. The Israel Heart Society has adopted the new universal definition and recommends its use by clinicians, researchers and epidemiologists. .

Symptoms of Depression and Anxiety as Barriers to Participation in Cardiac Rehabilitation Programs Among Arab and Jewish Patients in Israel.

PURPOSE: Despite its proven efficacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. METHODS: Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. RESULTS: Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a significant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. CONCLUSION: Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.

Ultra-Low Contrast Volume for Patients with Advanced Chronic Kidney Disease Undergoing Coronary Procedures.

BACKGROUND/AIMS: Contrast induced nephropathy (CIN) is associated with adverse clinical outcomes in patients undergoing coronary interventions, particularly in patients with advanced chronic kidney. The study was aimed to assess the real-life feasibility and safety of ultra-low volume coronary procedures in patients with advanced chronic kidney disease. METHODS: A prospective study that included patients with an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2) was conducted. Coronary procedures were performed using an ultra-low contrast volume technique. RESULTS: The 30 patients had a mean eGFR of 31.8(±8) mL/min/1.73 m2. Indications for coronary angiography were non-ST elevation myocardial infarction (63.3%), unstable (20%), and stable angina pectoris (16.7%). Median contrast volume for diagnostic coronary angiography was 13 mL (interquartile ranges [IQR] 12-14.9), and an additional 13 mL (IQR 8.8-14.3) for percutaneous coronary intervention (PCI). In 3 patients (10%), a ≥25% increase was demonstrated in serum cystatin C levels 48 h following the procedure. None of the patients demonstrated a ≥25% increase in serum creatinine levels at 48 h. Following 6 months, no patient required renal replacement therapy or unplanned coronary intervention. CONCLUSIONS: In patients with advanced chronic kidney disease, the ultra-low contrast technique is feasible and effective and can be used safely without a significant deterioration in renal function. This technique may increase the utilization of PCI in high-risk coronary patients with chronic kidney disease.

Safety and efficacy of the FilterWire EZ in acute ST-segment elevation myocardial infarction.

Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) achieves a high epicardial reperfusion rate; however, it is often suboptimal in achieving myocardial reperfusion due to distal embolization of atherothrombotic particles. The present study assessed whether the capture of embolic particles during PCI would improve myocardial reperfusion outcome. In a multicenter, prospective, randomized, controlled study, 100 patients with STEMI and coronary angiographic evidence of thrombotic occlusion were randomly assigned to PCI using the FilterWire EZ (n=51) or a control group (n=49) using regular guidewires. The FilterWire EZ was successfully delivered across the lesion in 84% of patients in the FilterWire EZ group. Primary efficacy end points, including markers of epicardial (Thrombolysis In Myocardial Infarction grade flow) and myocardial reperfusion (myocardial blush score and percent early resolution of ST-segment elevation), did not differ between the 2 study groups. Further, 60- and 90-minute percent ST-segment resolutions were identical in the 2 groups. In a subgroup analysis, a blush score of 3 was achieved in 94% of patients in whom the filter's landing zone was in a vessel diameter>2.5 mm compared with only 55% in those with smaller vessel diameter (p=0.04). This corresponds to a better debris capture in filters located in large versus small vessels (p=0.08). In conclusion, in patients with STEMI, use of the FilterWire EZ as an adjunct to primary PCI did not improve angiographic or electrocardiographic measurements of reperfusion compared with conventional PCI only.

Comparison of 4 and 6 French catheters for coronary angiography: real-world modeling.

BACKGROUND: Femoral artery vascular complications are the most common adverse events following cardiac catheterization. Smaller diameter introducer sheaths and catheters are likely to lower the puncture site complication rate but may hinder visualization. OBJECTIVES: To evaluate the safety and angiographic quality of 4 French catheters. METHODS: The study was designed to simulate real-life operator-based experience. Diagnostic angiography was performed with either 4F or 6F diagnostic catheters; the size of the catheter used in each patient was predetermined by the day of the month. Patients undergoing 4F and 6F diagnostic angiography were ambulated after 4 and 6 hours, respectively. The following technical parameters were recorded by the operator: ease of introducer sheath insertion, ease of coronary intubation, ease of injection, coronary opacification, collateral flow demonstration, and overall assessment. Adverse events were recorded in all patients and included minor bleeding, major bleeding (necessitating blood transfusion), minor hematoma, major hematoma, pseudo-aneurysm formation and arteriovenous fistula. RESULTS: The study group included 177 patients, of whom 91 were in the 4F arm and 86 in the 6F arm. Demographic and procedural data were similar in both groups. Seventy-seven percent of 6F and 50% of 4F procedures were evaluated as excellent (P < 0.05). This difference was attributed to easier intubation of the coronary ostium and contrast material injection, increased opacification of the coronary arteries, and demonstration of collateral flow with 6F catheters. Complications occurred in 22% of patients treated with 6F catheters and in 10% of those treated with 4F catheters (P = 0.11). Of the 50 patients who switched from 4F to 6F 12% had complications. In patients undergoing diagnostic angiography, the complication rate was 10% vs. 27% (most of them minor) in the 4F and 6F groups, respectively (P < 0.05). CONCLUSIONS: Patients catheterized with 4F have fewer complications compared with 6F diagnostic catheters even when ambulated earlier. Although 4F had a reduced quality compared to 6F angiographies, they were evaluated as satisfactory or excellent in quality 85% of the time. 4F catheters have a potential for reduced hospitalization stay and are a good option for primary catheterization in patients not anticipated to undergo coronary intervention.