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Percutaneous coronary intervention complications and guide catheter size: bigger is not better.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2009 Jul; Vol. 2 (7), pp. 636-44. - Publication Year :
- 2009
-
Abstract
- Objectives: We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI).<br />Background: The association between guiding catheter size and complications of PCI in contemporary practice remains controversial.<br />Methods: Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared.<br />Results: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with incrementally more contrast agent use, and more post-PCI complications including contrast-induced nephropathy, vascular access site complications, bleeding, transfusion, major adverse cardiac event, and death. After multivariate analysis, the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18, p = 0.0004; 8-F OR: 1.44, p < 0.0001), vascular complications (7-F OR: 1.19, p = 0.0002, 8-F OR: 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR: 1.12, p < 0.0001, 8-F OR: 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR: 1.08, p = 0.03; 8-F OR: 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR: 1.06, p = 0.13; 8-F OR: 1.37, p < 0.0001) and in-hospital mortality (7-F OR: 1.11, p = 0.13; 8-F OR: 1.34, p = 0.03) were increased with 8-F but not 7-F guides.<br />Conclusions: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with more contrast medium use, renal complications, bleeding, vascular access site complications, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.
- Subjects :
- Aged
Angioplasty, Balloon, Coronary mortality
Blood Transfusion
Contrast Media adverse effects
Equipment Design
Female
Heart Diseases etiology
Hemorrhage etiology
Hemorrhage therapy
Hospital Mortality
Humans
Kidney Diseases chemically induced
Kidney Diseases therapy
Male
Middle Aged
Odds Ratio
Registries
Renal Dialysis
Risk Assessment
Risk Factors
Treatment Outcome
United States
Angioplasty, Balloon, Coronary adverse effects
Angioplasty, Balloon, Coronary instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 2
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 19628187
- Full Text :
- https://doi.org/10.1016/j.jcin.2009.05.012