TCT 2002 Abstracts

• Stent-Based Intervention and Complication
• Vascular Access and Complications

ESC 2002 Meeeting Coverage

Thrombin injection highly effective in treating pseudoaneurysms
with slide / Pseudoaneurysms of the femoral artery, a common problem after catheterization, can be treated easily and effectively by direct thrombin injection, a multicenter study in Germany shows. European Society of Cardiology Congress 2002 [ Sep 02, 2002 ]

ACC 2002 Meeeting Coverage

Need for emergent CABG after failed PCI still "unpredictable"
New data from the ACC-NCD Registry show that in current practice, though the need for emergent bypass surgery due to failed PCI is low at about 0.4%, it can occur in elective procedures, in patients with low-risk lesion morphology and "safe" total occlusions. The unpredictability of these complications means that some form of emergency surgical standby should remain the standard of practice, the researchers say. American College of Cardiology 51st Annual Scientific Session. [ Mar 28, 2002 ]

Summaries of important articles from major peer-reviewed journals

Dramatic decline in emergency CABG after failed PCI
with slide / A new study shows there has been a 10-fold drop in emergency bypass surgery following failed percutaneous coronary intervention over the course of almost 10 years in one US center. However, when emergency CABG is performed, morbidity and mortality remain high, the researchers warn 
Seshadri N et al. Circulation 2002, published online before print October 14, 2002. [ Oct 16, 2002 ]

Full text journal article Jul 2002
Current Clinical Characteristics and Economic Impact of Subacute Stent Thrombosis
Despite its low frequency, the hospital costs associated with SAT are substantial and prevention strategies are needed.

Full text journal article Sep 2002
Relationship Between Activated Clotting Time During Percutaneous Intervention and Subsequent Bleeding Complications
Percutaneous coronary intervention (PCI) is associated with blood loss and bleeding complications.

Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention
Rihal CS, et al.
Circulation 2002;105:2259-64.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12010907
http://www.circulationaha.org/cgi/content/full/105/19/2259
http://www.circulationaha.org/cgi/content/abstract/105/19/2259
The overall incidence of acute renal failure (ARF) after PCI is low. Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.

Review
Frequency and costs of ischemic and bleeding complications after percutaneous coronary interventions: rationale for new antithrombotic agents
Moscucci M.
J Invasive Cardiol 2002;14 Suppl B:55B-64B.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11967391

Angiographic access site complications in the era of arterial closure devices
Meyerson SL, et al.
Vasc Endovascular Surg 2002;36:137-44.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11951100
The results of this study demonstrate that closure devices facilitate arterial puncture site repair without an increase in access site complications. These devices can be safely utilized when rapid hemostasis is desired after coronary or peripheral angiography.

Practice patterns and outcomes of percutaneous coronary interventions in the United States: 1995 to 1997
Lauer MA, et al.
Am J Cardiol 2002;89:924-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950429
Acute events (death, urgent CABG, or PCI) decreased (p <0.001), whereas use of stents, abciximab, or both, increased (p <0.001). Dosages of heparin and bleeding complications declined significantly (p <0.001) over the 2-year period. Heparin dosages were higher in patients who experienced bleeding or death than in those who did not (p <0.001). The average hospital length of stay decreased significantly (p <0.001), largely driven by a reduction in time between the procedure and hospital discharge. By the end of the study period, bleeding was the most frequent (5.5%) complication of PCI and was associated with considerable costs, adding $10,225 to baseline costs.

Changing trends in incidence and predictors of radiographic contrast nephropathy after percutaneous coronary intervention with use of fenoldopam
Kini AS, et al.
Am J Cardiol 2002;89:999-1002.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950448

Relationship between coronary angioplasty laboratory volume and outcomes after hospital discharge
Kimmel SE, et al.
Am Heart J 2002;143:833-40.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12040345
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a122116&target=
Although our study confirmed the volume/complication relationship for inhospital CABG, it did not reveal an association between volume and postdischarge events. These results suggest that inhospital complications will remain the standard for assessing laboratory volume and that selective use of higher-volume laboratories may not improve long-term outcomes.

Effectiveness of mechanical compression devices in attaining hemostasis after femoral sheath removal
Jones T, et al.
Am J Crit Care 2002;11:155-62.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11888128
A gap exists in the literature on quality randomized controlled trials of various devices used to attain hemostasis after femoral sheath removal

Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction
Henriques JP, et al.
Eur Heart J 2002;23:1112-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12090749  
Distal embolization in patients treated with primary angioplasty is visible on the coronary angiogram in 15.2% of patients. It is related to reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Additional pharmacological interventions and/ or mechanical devices should be studied to prevent and/or treat distal embolization.

Stroke complicating percutaneous coronary interventions: incidence, predictors, and prognostic implications
Fuchs S, et al.
Circulation 2002;106:86-91.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12093775
http://www.circulationaha.org/cgi/content/full/106/1/86
http://www.circulationaha.org/cgi/content/abstract/106/1/86
Stroke associated with contemporary PCI is associated with substantial increased mortality. Elderly patients who experience intraprocedural complications necessitating the use of IABP are at particularly high risk.

Arterial infection and staphylococcus aureus bacteremia after transfemoral cannulation for percutaneous carotid angioplasty and stenting
Culver DA, et al.
J Vasc Surg 2002;35:576-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11877710
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a119398&target=

Frequency of abrupt vessel closure and side branch occlusion after percutaneous coronary intervention in a 6.5-year period (1994 to 2000) at a single medical center
Almeda FQ, et al.
Am J Cardiol 2002;89:1151-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12008166
The incidence of abrupt vessel closure (AVC) steadily decreased over the 6.5-year time period, and was associated with the increased use of stents and glycoprotein IIb/IIIa inhibitors (GPIs); conversely, ide branch occlusion (SBO) accounted for an increasing percentage of AVC over this time period.