Cath Lab Digest - February 2008 - (Page 48)

48 CLINICAL UPDATE FEBRUARY 2008 Table 1. Baseline characteristics Age, range Female, (%) Male (%) Diabetes mellitus, (%) Hypertension (%) Peripheral vascular disease (%) 28–98 48.5% 51.5% 30.5% 73.5% 10.5% transfusion, hematoma requiring blood transfusion, retroperitoneal hematoma, pseudoaneurysm/dissection, A-V fistula, and ischemic leg were the noted complications. Statistical analysis. The data were analyzed by using SAS V 9.1. A probability value of 0.05 was accepted as the limit of statistical significance. A multivariate logistic regression analysis was used to investigate the association of selected clinical factors (gender, age, body surface area, comorbidities, PCI, fluoroscopy time, type of closure device) to the occurrence of femoral access complications. Results Baseline clinical characteristics. Patients with angiographic complications and patients without such events were similar with respect to baseline characteristics, including atherosclerotic risk factors, prior cardiac events, gender, and body mass index (BMI) (Table 1). Patients with and without angiographic complications also had similar medications before coronary intervention, including similar use of aspirin, thienopyridines and heparin. Each gender had 10 individuals with a complication, 9.3% in males and 10.9% in females with no statistical significance (p-value = .81 using a two-sided Fisher’s Exact test). Procedural characteristics. Angiographic complications were associated with longer procedure durations; median time was 75–130 min for patients with events versus 36–70 min for patients without events (p = 0.001). If the procedure time was 75 minutes or more, there was nearly a 5-fold increase in the possibility of a complication (odds ratio = 4.903, 95% confidence interval [CI] of [1.403, 17.129]) (Figure 1). If the procedure was a PCI, there was nearly a 4-fold increase in the possibility of a complication (odds ratio = 3.885, 95% CI of [1.108, 13.623]). This is by way of logistic regression model. Maximum procedural activated clotting times were similar for patients with and without events. There were 124 individuals that had a diagnostic catheterization, 4 of whom had complications (3.23%); 76 individuals had PCI, 16 of whom had complications (21.05%), using two-sided Fisher’s exact test, p-value < 0.00011. The complication rate with a closure device is 7.3% and without a closure device it is 13.2%, but this is not statistically significant (p-value = 0.24 by way of a two-sided Fisher’s exact test). Eptifibatide and vascular complications. Of 175 individuals not given eptifibatide, 10 had complications (5.71%). Of 25 individuals given eptifibatide, 10 had complications (40%) (two-sided Fisher’s Exact test p 75 minutes increased the risk 5-fold. patch used was Chito-Seal (Abbott). For manual and mechanical hemostasis, the patients were kept on bed rest for 6 hours (hrs). For closure device hemostasis, the patients were kept on bed rest for 2 hours for patients undergoing diagnostic procedures and overnight for patients with PCI procedures.1 Complications observed. Hematoma not requiring blood Discussion Vascular access complications remain an important cause of catheterization procedure morbidity and mortality.1 There are a few critical findings of this study. First, eptifibatide use is associated with greater risk of post-procedure bleeding and secondly, the procedure time is one of the predictors of vascular complications. We did not observe complications such as ischemic leg or arteriovenous fistula. This study illustrates that eptifibatide may be associated with more bleeding complications than ischemic complications. Table 2. Overall incidence of vascular complications Complications No Complication Hematoma requiring blood transfusion Hematoma not requiring blood transfusion or causing hemodynamic compromise Retroperitoneal hematoma Frequency 180 3 15 2 Percent 90.00 1.50 7.50 1.00 Figure 2. Effect of eptifibatide on complication rate. The use of eptifibatide has an approximate 6-fold increase in complication rate.

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Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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