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Objectives: To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI). Background: TRA-PCI failure has been reported in 5% to 10% of cases. Methods: TRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed. Results: From January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%. Conclusions: In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure. [Copyright &y& Elsevier]

Background: Transradial approach (TRA) for cardiac catheterizations and interventions improves clinical outcomes compared with transfemoral access, and its use is increasing worldwide. However, there are limited data on successive use of same artery for repeat procedures. Methods: Between May 2010 and May 2011, all consecutive patients undergoing a repeat TRA procedure (≥2) were retrospectively identified. Success rates and reasons for failure to use ipsilateral radial artery for repeat access were identified. Results: A total of 519 patients underwent 1,420 procedures. In 480 patients (92%), right radial artery was used as initial access, and left radial artery, in 39 patients. All patients underwent ≥2 procedures; 218 patients, ≥3; 87 patients, ≥4; 39 patients, ≥5; 19 patients, ≥6; 11 patients, ≥7; and 5 patients, ≥8 procedures. Two patients had, respectively, 9 and 10 procedures. The success rate for second attempt was 93%, 81% for third, and declining to 60% for ≥8. Linear regression analysis estimated a 5% failure rate for each repeat attempt (R 2 = 0.87, P = .007). The main reason for failure was related to clinical radial artery occlusion (RAO) including absent or faint pulse, poor oximetry, and failed puncture. All patients with clinical RAO were asymptomatic. By multivariate analysis, female gender (odds ratio [OR] 3.08, 95% CI 1.78-5.39, P < .0001), prior coronary artery bypass graft (OR 5.26, 95% CI 2.67-10.42, P < .0001), and repeat radial access (OR 2.14, 95% CI 1.70-2.76, P < .0001) were independent predictors of radial access failure. Conclusion: Successive TRA is both feasible and safe in most cases for up to 10 procedures. However, failure rate for TRA increases with successive procedures, primarily due to clinical RAO. Strategies to minimize the risks of chronic clinical RAO and allow repeat use of ipsilateral radial artery need to be further defined. [Copyright &y& Elsevier]

Background: Cognitive abilities between monolingual and bilingual individuals may differ, making it important to validate new cognitive screening tools using psychometric testing. Otherwise assessments could be subject to misinterpretation, leading to inaccurate diagnoses. The current project aimed to compare healthy older monolingual and bilingual anglophones on the English version of a new cognitive screening test designed for better recognition of atypical dementia; the Dépistage Cognitif de Québec (DCQ, www.dcqtest.org). The DCQ was developed at la Clinique Interdisciplinaire de mémoire de Québec, and its psychometric properties have been well studied, including its sensitivity and specificity to detect atypical dementia compared to current standardized cognitive screening tests (Laforce et al., 2018; Sellami et al., 2018). Methods: The DCQ was administered by qualified psychometricians to 85 healthy native English‐speaking participants aged 50 years and over, in various sites across North America. The Montreal Cognitive Assessment (MoCA) was used to determine participants' eligibility. Language proficiency was established using the Language Experience and Proficiency Questionnaire (LEAP‐Q). Results: Amidst the anglophone participants recruited, 30 monolingual anglophones and 29 bilingual anglophones met the inclusion criteria. The two groups had similar age, education and MoCA scores. Monolinguals and bilinguals were compared on their total DCQ scores as well as on each of the 5 indexes of the DCQ: Memory, Visuospatial, Executive, Language and Behavioural. Statistical analysis showed a significant advantage for the bilingual participants on the total DCQ scores and on the Language index, which was later washed out following a Bonferroni correction. No significant differences were found between groups on any of the other indexes. Conclusion: This study is the first to explore psychometric properties of the DCQ in older monolingual and bilingual participants tested in their native language. The results highlight the importance of identifying and characterizing linguistic diversity before using new screening tools in clinical settings. The potential cognitive advantages of bilingualism, even in healthy older adults, should be considered when interpreting test data and explicitly discussed in neuropsychological reports. Similar studies should be conducted for all future cognitive screening measures, especially to further examine the differences between groups on language‐related tasks. [ABSTRACT FROM AUTHOR]

Background: Cognitive abilities between monolingual and bilingual individuals may differ, making it important to validate new cognitive screening tools using psychometric testing. Otherwise assessments could be subject to misinterpretation, leading to inaccurate diagnoses. The current project aimed to compare healthy older monolingual and bilingual anglophones on the English version of a new cognitive screening test designed for better recognition of atypical dementia; the Dépistage Cognitif de Québec (DCQ, www.dcqtest.org). The DCQ was developed at la Clinique Interdisciplinaire de mémoire de Québec, and its psychometric properties have been well studied, including its sensitivity and specificity to detect atypical dementia compared to current standardized cognitive screening tests (Laforce et al., 2018; Sellami et al., 2018). Methods: The DCQ was administered by qualified psychometricians to 85 healthy native English‐speaking participants aged 50 years and over, in various sites across North America. The Montreal Cognitive Assessment (MoCA) was used to determine participants' eligibility. Language proficiency was established using the Language Experience and Proficiency Questionnaire (LEAP‐Q). Results: Amidst the anglophone participants recruited, 30 monolingual anglophones and 29 bilingual anglophones met the inclusion criteria. The two groups had similar age, education and MoCA scores. Monolinguals and bilinguals were compared on their total DCQ scores as well as on each of the 5 indexes of the DCQ: Memory, Visuospatial, Executive, Language and Behavioural. Statistical analysis showed a significant advantage for the bilingual participants on the total DCQ scores and on the Language index, which was later washed out following a Bonferroni correction. No significant differences were found between groups on any of the other indexes. Conclusion: This study is the first to explore psychometric properties of the DCQ in older monolingual and bilingual participants tested in their native language. The results highlight the importance of identifying and characterizing linguistic diversity before using new screening tools in clinical settings. The potential cognitive advantages of bilingualism, even in healthy older adults, should be considered when interpreting test data and explicitly discussed in neuropsychological reports. Similar studies should be conducted for all future cognitive screening measures, especially to further examine the differences between groups on language‐related tasks. [ABSTRACT FROM AUTHOR]