Cath Lab Digest - February 2008 - (Page 49)

49 The results of this study support the hypothesis that the greater the procedure time, the greater the risk of vascular complications. Accordingly, the procedure time should be kept as short as possible. is the common femoral artery.3,21 The common femoral artery is a reasonably large-diameter and superficial vessel, and hemostasis can be obtained by compressing it against the femoral head. The artery is accessed through anatomic landmarks including the inguinal ligament, radiographic visualization of the femoral head and the direct palpation of the artery.16,17 An arteriotomy below the distal common femoral bifurcation increases the risk of access site complications due to the inability to compress the artery against the femoral head for hemostasis.16,17 An arterial puncture above the inguinal ligament accesses the artery in the retroperitoneum. In our patient population, we included only the patients who have arteriotomy below the distal common femoral bifurcation. The increased association of eptifibatide and complications was evident in data from the ESPRIT trial, but our incidence was much higher, as we included almost all patients undergoing PCI and CA.3 whom the procedure appears to have gone smoothly. Study Limitations This study is limited by sample size and from being a prospective observational study. Reliability of the data concerning angiographic complications may be limited since the complications were self-reported by the investigators and not by a core laboratory blinded to treatment. We were unable to control and account for other possible risk factors like severe peripheral vascular disease and other possible risks of arterial site complications, such as multiple punctures of the artery. Conclusions Our results show that even with the most recent advances in stent technology, the incidence of vascular complications remains higher with the use of eptifibatide and emphasizes the benefit of keeping the procedure time to a minimum. Our data are unique in showing the reported procedure time to be one of the predictors. Our particular cohort of patients appears to differ substantatively in its outcome compared to published, pivotal studies that draw conclusions for similar populations observed. Because of the limitations (small sample size, observational design, and completion at a single institution), further studies will be necessary to confirm these findings. ■ The authors can be contacted at pneelu@gmail.com Catheter Cardiovasc Interv ence. 2001;52:289–295. Blankenship JC, Tasissa G, O’Shea JC, et al. Effect of glycoprotein IIb/IIIa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial. J Am Coll Cardiol 2001;38:653–658. Cohen DJ, O’Shea JC, Pacchiana CM, et al. In-hospital costs of coronary stent implantation with and without eptifibatide (the ESPRIT Trial). Enhanced suppression of the platelet IIb/IIIa receptor with integrilin. Am J Cardiol 2002;89:61–64. Fernandes LS, Tcheng JE, O’Shea JC, et al. Is glycoprotein IIb/IIIa antagonism as effective in women as in men following percutaneous coronary intervention? Lessons from the ESPRIT study. J Am Coll Cardiol 2002;40:1085–1091. Granada JF and Kleiman NS. Therapeutic use of intravenous eptifibatide in patients undergoing percutaneous coronary intervention: Acute coronary syndromes and elective stenting. Am J Cardiovasc Drugs 2004;4:31–41. Kereiakes DJ, Lincoff M, Miller DP, et al. Abciximab therapy and unplanned coronary stent deployment: Favorable effects on stent use, clinical outcomes, and bleeding complications. EPILOG Trial Investigators. Circulation 1998;97:857–864. Kini AS, Richard M, Suleman J, et al. Effectiveness of tirofiban, eptifibatide, and abciximab in minimizing myocardial necrosis during percutaneous coronary intervention (TEAM pilot study). Am J Cardiol 2002;90:526–529. Kleiman NS, Lincoff M, Kereiakes DJ, et al. Diabetes mellitus, glycoprotein IIb/IIIa blockade, and heparin: Evidence for a complex interaction in a multicenter trial. EPILOG Investigators. Circulation 1998;97:1912–1920. Konstance R, Tcheng JE, Wightman MB, et al. Incidence and predictors of major vascular complications after percutaneous coronary intervention in the glycoprotein IIb/IIIa platelet inhibitor era. J Interv Cardiol 2004;17:65–70. 13. Niebauer J, Sixt S, Zhang F, et al. Contemporary outcome of cardiac catheterizations in 1085 consecutive octogenarians. Int J Cardiol 2004;93:225–230. 14. O’Shea JC, Hafley GE, Greenberg S, et al. Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: The ESPRIT trial: A randomized controlled trial. JAMA 2001;285:2468–2473. 15. O'Shea JC and Tcheng JE. Eptifibatide in oercutaneous coronary intervention: The ESPRIT Trial results. Curr Interv Cardiol Rep 2001;3:62–68. 16. Rinder MR, Tamirisa PK, Taniuchi M, et al. Safety and efficacy of suture-mediated closure after percutaneous coronary interventions. Catheter Cardiovasc Interv 2001;54:146–151. 17. Shaw JA, Dewire E, Nugent A, et al. Use of suture-mediated vascular closure devices for the management of femoral vein access after transcatheter procedures. Catheter Cardiovasc Interv 2004;63:439–443. 18. Noto TJ, Johnson LW, Krone R, et al. Cardiac catheterization 1990: A report of the registry of the Society for Cardiac Angiography and Interventions. Cathet Cardiovasc Diagn 1991;24:75. 19. Safian RD, Freed MS. Coronary intervention preparation, equipment and technique. In: Safian RD, Freed MS (eds). The Manual of Interventional Cardiology, 3rd edition. Royal Oak, MI: Physicians' Press; 2001. 20. Baim DS, Grossman W. Complications of cardiac catheterization. In: Baim DS, Grossman W (eds). Grossman’s Cardiac Catheterization, Angiography, and Intervention, 6th edition. Philadelphia: Lippincott Williams and Wilkins; 2000: pp. 35–65. 21. Toursarkissian B. Changing patterns of access site complications with the use of percutaneous closure devices. Vasc Surg 2001;35:203–206. 22. Exaire JE, Tcheng JE, Kereiakes DJ, et al. Closure devices and vascular complications among percutaneous coronary intervention patients receiving enoxaparin glycoprotein IIb/IIIa inhibitors, and clopidogrel. Catheter Cardiovasc Interv 2005;64:369–372. 5. 6. 7. Implications for Practice There are two implications for clinical practice from this study. First, eptifibatide use, which is a uniform standard of clinical practice for angiographic interventions, is associated with a greater risk of vascular complications. Failure to prevent angiographic complications during coronary intervention may explain morbidity increasing the length of stay. This implies that pharmacologic interventions need to be minimized and used only if their use in absolutely indicated. Secondly, the results of this study support the hypothesis that the greater the procedure time, the greater the risk of vascular complications. Accordingly, the procedure time should be kept as short as possible. The paradox remains that the greatest absolute benefit is achieved among patients in 8. 9. References 1. Sherev DA, Shaw RE, Brent BN. Angiographic predictors of femoral access site complications: Implication for planned percutaneous coronary intervention. Catheter Cardiovasc Interv 2005;65:196–202. 2. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. The EPILOG Investigators. N Engl J Med 1997;336:1689–1696. 3. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): A randomized, placebo-controlled trial. Lancet 2000;356:2037–2044. 4. Chandrasekhar B, Doucet S, Bilodeau L, et al. Complications of cardiac catheterization in the current era: A single-center experi- 10. 11. 12. http://www.wavemark.net/CLD02 http://www.wavemark.net/

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

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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