The Trans Radial Intervention and Patient Subsets (II)

The Very Old and The Very Sick Octogenerians, Acute Coronary Syndromes

M.Heigert Landeskrankenhaus Salzburg

Bad Gastein 10.02.2007

The Transradial Access: A way to prevent entry site

complications and thus adverse Outcomes of Cardiac

Interventions in the high risk subset of the elderly?

Aren`t the patients too sick and the access too complicateted ?

The Salzburg Experience n=2833 Patient Demografics and Procedural Data

irrespective of age radial(n=577) femoral (n=2256)

age 65,25 ±11,8 65,8 ±11,4

Gender (f/m) 190/387 (33% f) 773/1532 (34% f)

access without success* 28 (4,8%) 15 (0,6%)

exclusion or non significant CHD

34,2% 38,8%

3VD ± LM 27,8% 32,2%

exam.-time (median) 39min (12-167) 37min (6-207)

fluoroscopy time (median) 5min (1-50) 5min (1-69)

contrast-media 174,7 ± 91,9 ml 182,7 ± 107,9 ml

PCI-rate 48,5% 53,9%

acute or urgent PCI 16,1% 14%

exam.-time(only PCI, median)

60min (16-175) 49min (14-190)

The Salzburg Experience: Complications

radial(n=577)femoral (n=2256)

dissection/perfor. 4 (0,7%) 0

relev.bleeding* 2 (0,3%, konserv.) 25 (1,2%, 2 OP)

aneurysma spurium 0 22 (0,9%, 10 OP)

Symptomatic occlusion of vessel

2 (0,3%, konserv.) 2 (0,08%, 2 OP)

total 8 (1,4%) 47 (2%)

* Transfusions or prolonging hospitalisation

The Radial Access in General: necessity of energy and

dedication

Radial Failure Rate

Meta analysis

Radial failure = 1,9 %

If OCTOPLUS Study is excluded(patients > 80 years, RF 10,6%, FF 9,3%)

P.Agostini et al- JACC 2004; 44:349-56

Octoplus-Complications

The Salzburg Experience:

Octogenerians n=340

Radial (n=85) femoral (n=255)

age 83,06 2,26 83,02 2,93

Gender m:f 47:38 (55,3% f) 154:101 (60,4% f)

No signif. CHD 15 (17,6%) 50 (19,6%)

3 VD ± LM 30 (35,3%) 77 (30,2%)

PCI-rate 54% 40,45%

Acute/Urgent PCI

15 (17,6%) 50 (19,6%)

CABG 4 (4,7%) 13 (5%)

The Salzburg Experience:Octogenerians periprocedural data

radial (n=85) femoral (n=255)

Only diagnostic (n) 39 146

Time on the tablemedian (min/max)

35min (15 – 130) 26min (8-105)

Fluoroscopy time 3,3min (1-17) 2min (1-26)

Contrast 116,6ml ± 64,8 119ml (± 53,8)

PCI (n) 46 (54,1%, 8 akut) 109 (42,7%, 17 akut)

Time on the tablemedian (min/max)

55min (26-138) 51min (14-196)

Fluoroscopy time 12min (1-36) 9min (2-55)

Contrast 244ml ± 99,3 231,6ml ± 84

Multivessel- or LM-PCI 21 (24,7%) 43 (16,8%)

Shift of access-concept 3 (3,5%) 6 (2,3%)

Complications* 3 (3,5%) 8 (3,1%)

* Access site hematoma and vessel-problems

The Salzburg Experience:

Octogenerians n=340

Radial (n=85) femoral (n=255)

age 83,06 2,26 83,02 2,93

Gender m:f 47:38 (55,3% f) 154:101 (60,4% f)

No signif. CHD 15 (17,6%) 50 (19,6%)

3 VD ± LM 30 (35,3%) 77 (30,2%)

PCI-rate 54% 40,45%

Acute/Urgent PCI 15 (17,6%) 50 (19,6%)

CABG 4 (4,7%) 13 (5%)

The Salzburg Experience:Octogenerians periprocedural data

radial (n=85) femoral (n=255)

Only diagnostic (n) 39 146

Time on the tablemedian (min/max)

35min (15 – 130) 26min (8-105)

Fluoroscopy time 3,3min (1-17) 2min (1-26)

Contrast 116,6ml ± 64,8 119ml (± 53,8)

PCI (n) 46 (54,1%, 8 akut) 109 (42,7%, 17 akut)

Time on the tablemedian (min/max)

55min (26-138) 51min (14-196)

Fluoroscopy time 12min (1-36) 9min (2-55)

Contrast 244ml ± 99,3 231,6ml ± 84

Multivessel- or LM-PCI 21 (24,7%) 43 (16,8%)

Shift of access-concept 3 (3,5%) 6 (2,3%)

Complications* 3 (3,5%) 8 (3,1%)

* Access site hematoma and vessel-problems