7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
Seoul Radial Artery Access 2009 1
1. Howard A. Cohen, MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute LENOX HILL HOSPITAL TRANSRADIAL COURSE New York, NY October 23-24, 2009
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14. RANDOMIZED COMPARISON OF TRANSRADIAL AND TRANFEMORAL APPROACHES IN OCTAGENARIANS Louvard et al Am J Cardiol 92:17L, 2003 RADIAL P VALUE FEMORAL Crossover 11.7 NS 9.5 Angio Duration(min) 18.1 10.8 NS 16.4 10.8 Xray Duration(min) 6.1 4.8 0.001 4.4 3.4 PCI Success (%) 96.8 NS 94.7 PCI Duration(min) 27.6 18.2 NS 33.3 23.2 Xray Duration(min) 9.9 8.3 NS 10.7 10.2 Primary EP (%) 1.4 0.08 5.9(58.5% FCD) Hematoma >3cm(%) 2.2 0.004 11.4
24. BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MAJOR BLEEDING
25. BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MORTALITY
26. Radial Artery Access Improving Outcomes and Decreasing Costs Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 MORTALITY AND MAJOR BLEEDING
27. Radial Artery Access Improving Outcomes and Decreasing Costs Types of Major Bleeding by Treatment Group Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368
28. BLEEDING AND OUTCOMES WITH PCI IN ACS Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632
29. Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632 Kaplan-Meier Estimates of Adverse Events at 1 Year BLEEDING AND OUTCOMES WITH PCI IN ACS
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31. . Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 8F GUIDE USE
32. Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 IN HOSPITAL OUTCOMES 8F VS 6F GUIDES
33. Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 S STANDARDIZED MORTALITY RATE BASED ON GUIDE SIZE
34. Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 TEMPORAL USE OF 6,7 AND 8F GUIDES
35. Radial Artery Access Improving Outcomes and Decreasing Costs “… hospital savings were due primarily to a reduction in major bleeding.”
40. MORTAL STUDY 914 Matched Patients p=0.96 Chase et al. Heart ;94:1019-1025,2008 Trans No Trans ARR NNT RR 95% CI 30 Day Mortality 7.7% 2% 5.7 18 3.9 1.89-8.0 1 Year Mortality 19.3% 5.7% 12.5 7.4 3.38 2.22-5.14
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42. Rao, S. V. et al. J Am Coll Cardiol Intv 2008;1:379-386 Proportion of PCI Cases Performed Via TRA
45. UNADJUSTED RATES OF BLEEDING & VASCULAR COMPLICATIONS IN KEY SUB-GROUPS Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
46. Effect of Age, Gender,and Indication on Association of r-PCI Success and Bleeding Complications Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383
47. Unadjusted and Adjusted Association Between PCI and Primary Outcomes (f PCI as Reference) Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383 Outcome Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) Procedural Success 1.09 (0.97-1.23) 0.92 (1.02-1.12) Any Bleeding Comp 0.38 (0.26-.0.54) 0.42 (0.31-0.56)
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50. PREVAIL STUDY Pristipino et al. Heart :2009;95:476-82 Overall (1052) Femoral (543) Radial (509) P Value Male gender 71% 66% 75% <0.002 Prior radial 9% 4% 14% <0.0001 Prior PCI 20% 17% 24% <0.01 Chronic SAP 35% 28% 42% <0.0001 ACS 31% 35% 28% <0.01 Sheath size F 5.9 6.1 5.7 <0.0001 Heparin IU 4950 4270 5650 <0.0001 GP II IIIa RA 12% 8% 15% <0.002
51. Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82
52. Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Stable ACS
53. Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Adjusted Multivariate Analysis
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