Skip to main content
Erschienen in: Cardiovascular Intervention and Therapeutics 1/2017

24.02.2016 | Original Article

Impact of transradial coronary intervention on bleeding complications in octogenarians

verfasst von: Khalid Tammam, Yuji Ikari, Fuminobu Yoshimachi, Fumie Saito, Walid Hassan

Erschienen in: Cardiovascular Intervention and Therapeutics | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Percutaneous coronary intervention (PCI) in the elderly is a major hospital burden since this group of patients exhibits high mortality rates and many comorbidities. The aim of this study was to analyze the impact of a transradial intervention (TRI) approach for PCI on bleeding complications in octogenarians. We retrospectively analyzed a consecutive cohort of 2530 patients who underwent PCI at a tertiary care center in Japan. Octogenarians constituted 12 % (291 cases) of the total PCI cases during the study period. Bleeding complications and all-cause mortality were observed at 30 days after PCI. Average age was 83 ± 3 years and female gender was 32 %. Stable coronary artery disease was 59 %. TRI was performed in 218 patients (75 %) and transfemoral intervention (TFI) in 73 (25 %). Bleeding Academic Research Consortium (BARC) major bleeding unrelated to bypass surgery were observed in 7.6 %, which were significantly lower in TRI than TFI (5.1 vs. 15.1 %, P = 0.005). The 30-day mortality rate was significantly low in patients without bleeding (4.9 vs. 31 %, p < 0.0001). In octogenarians, major bleeding complication was significant at 30 days after PCI. TRI had lower bleeding complication rate than TFI in this population. Octogenarians may be a subgroup of patients who derive benefits from TRI.
Literatur
1.
Zurück zum Zitat Johnman C, Oldroyd KG, Mackay DF, Slack R, Pell AC, Flapan AD, et al. Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007. Circ Cardiovasc Interv. 2010;3:341–5.CrossRefPubMed Johnman C, Oldroyd KG, Mackay DF, Slack R, Pell AC, Flapan AD, et al. Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007. Circ Cardiovasc Interv. 2010;3:341–5.CrossRefPubMed
2.
Zurück zum Zitat Singh M, Rihal CS, Gersh BJ, Lennon RJ, Prasad A, Sorajja P, et al. Twenty-five-year trends in in-hospital and long-term outcome after percutaneous coronary intervention: a single-institution experience. Circulation. 2007;115:2835–41.CrossRefPubMed Singh M, Rihal CS, Gersh BJ, Lennon RJ, Prasad A, Sorajja P, et al. Twenty-five-year trends in in-hospital and long-term outcome after percutaneous coronary intervention: a single-institution experience. Circulation. 2007;115:2835–41.CrossRefPubMed
3.
Zurück zum Zitat Singh M, Peterson ED, Roe MT, Ou FS, Spertus JA, Rumsfeld JS, et al. Trends in the association between age and in-hospital mortality after percutaneous coronary intervention: national Cardiovascular Data Registry experience. Circ Cardiovasc Interv. 2009;2:20–6.CrossRefPubMed Singh M, Peterson ED, Roe MT, Ou FS, Spertus JA, Rumsfeld JS, et al. Trends in the association between age and in-hospital mortality after percutaneous coronary intervention: national Cardiovascular Data Registry experience. Circ Cardiovasc Interv. 2009;2:20–6.CrossRefPubMed
4.
Zurück zum Zitat Velders MA, James SK, Libungan B, Sarno G, Frobert O, Carlsson J, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001–2011: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J. 2014;167:666–73.CrossRefPubMed Velders MA, James SK, Libungan B, Sarno G, Frobert O, Carlsson J, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001–2011: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J. 2014;167:666–73.CrossRefPubMed
5.
Zurück zum Zitat Mehran R, Pocock SJ, Stone GW, Clayton TC, Dangas GD, Feit F, et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial. Eur Heart J. 2009;30:1457–66.CrossRefPubMedPubMedCentral Mehran R, Pocock SJ, Stone GW, Clayton TC, Dangas GD, Feit F, et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial. Eur Heart J. 2009;30:1457–66.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1815–23.CrossRefPubMed Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1815–23.CrossRefPubMed
7.
Zurück zum Zitat Valgimigli M, Gagnor A, Calabro P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465–76.CrossRefPubMed Valgimigli M, Gagnor A, Calabro P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465–76.CrossRefPubMed
8.
Zurück zum Zitat Hassan WM, Flaker GC, Feutz C, Petroski GF, Smith D. Improved anticoagulation with a weight-adjusted heparin nomogram in patients with acute coronary syndromes: a randomized trial. J Thromb Thrombolysis. 1995;2:245–9.PubMed Hassan WM, Flaker GC, Feutz C, Petroski GF, Smith D. Improved anticoagulation with a weight-adjusted heparin nomogram in patients with acute coronary syndromes: a randomized trial. J Thromb Thrombolysis. 1995;2:245–9.PubMed
9.
Zurück zum Zitat Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMed Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMed
10.
Zurück zum Zitat Tsuchida K, Ikegami R, Sato M, Shobugawa Y, Okubo T, Yano T, et al. Primary percutaneous coronary intervention and bleeding risk in the era of drug-eluting stent: a long-term cohort study. Cardiovasc Interv Ther. 2015;30:216–26.CrossRefPubMed Tsuchida K, Ikegami R, Sato M, Shobugawa Y, Okubo T, Yano T, et al. Primary percutaneous coronary intervention and bleeding risk in the era of drug-eluting stent: a long-term cohort study. Cardiovasc Interv Ther. 2015;30:216–26.CrossRefPubMed
11.
Zurück zum Zitat Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med. 2006;355:1006–17.CrossRefPubMed Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med. 2006;355:1006–17.CrossRefPubMed
12.
Zurück zum Zitat Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.CrossRefPubMed Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.CrossRefPubMed
13.
Zurück zum Zitat Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA. 2004;292:696–703.CrossRefPubMed Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA. 2004;292:696–703.CrossRefPubMed
14.
Zurück zum Zitat Guagliumi G, Stone GW, Cox DA, Stuckey T, Tcheng JE, Turco M, et al. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation. 2004;110:1598–604.CrossRefPubMed Guagliumi G, Stone GW, Cox DA, Stuckey T, Tcheng JE, Turco M, et al. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation. 2004;110:1598–604.CrossRefPubMed
15.
Zurück zum Zitat Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, et al. Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Int J Cardiol. 2015;195:259–64.CrossRefPubMed Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, et al. Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Int J Cardiol. 2015;195:259–64.CrossRefPubMed
16.
Zurück zum Zitat Ielasi A, Brugaletta S, Silvestro A, Cequier A, Iniguez A, Serra A, et al. Everolimus-eluting stent versus bare-metal stent in elderly (≥75 years) versus non-elderly (<75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the examination trial. Int J Cardiol. 2015;179:73–8.CrossRefPubMed Ielasi A, Brugaletta S, Silvestro A, Cequier A, Iniguez A, Serra A, et al. Everolimus-eluting stent versus bare-metal stent in elderly (≥75 years) versus non-elderly (<75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the examination trial. Int J Cardiol. 2015;179:73–8.CrossRefPubMed
17.
Zurück zum Zitat Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, et al. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol. 2014;64:1554–64.CrossRefPubMed Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, et al. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol. 2014;64:1554–64.CrossRefPubMed
18.
Zurück zum Zitat Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.CrossRefPubMed Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.CrossRefPubMed
19.
Zurück zum Zitat Masuda N, Matsukage T, Ogata N, Morino Y, Tanabe T, Ikari Y. Analysis of peripheral arterial bends that interfere with coronary catheterization. J Invasive Cardiol. 2010;22:197–203.PubMed Masuda N, Matsukage T, Ogata N, Morino Y, Tanabe T, Ikari Y. Analysis of peripheral arterial bends that interfere with coronary catheterization. J Invasive Cardiol. 2010;22:197–203.PubMed
20.
Zurück zum Zitat Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Labata C, Oliete C, et al. Results of primary percutaneous coronary intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol. 2014;113:452–6.CrossRefPubMed Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Labata C, Oliete C, et al. Results of primary percutaneous coronary intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol. 2014;113:452–6.CrossRefPubMed
21.
Zurück zum Zitat He PY, Yang YJ, Qiao SB, Xu B, Yao M, Wu YJ, et al. A comparison of transradial and transfemoral approaches for percutaneous coronary intervention in elderly patients based on a propensity score analysis. Angiology. 2015;66:448–55.CrossRefPubMed He PY, Yang YJ, Qiao SB, Xu B, Yao M, Wu YJ, et al. A comparison of transradial and transfemoral approaches for percutaneous coronary intervention in elderly patients based on a propensity score analysis. Angiology. 2015;66:448–55.CrossRefPubMed
Metadaten
Titel
Impact of transradial coronary intervention on bleeding complications in octogenarians
verfasst von
Khalid Tammam
Yuji Ikari
Fuminobu Yoshimachi
Fumie Saito
Walid Hassan
Publikationsdatum
24.02.2016
Verlag
Springer Japan
Erschienen in
Cardiovascular Intervention and Therapeutics / Ausgabe 1/2017
Print ISSN: 1868-4300
Elektronische ISSN: 1868-4297
DOI
https://doi.org/10.1007/s12928-016-0383-3

Weitere Artikel der Ausgabe 1/2017

Cardiovascular Intervention and Therapeutics 1/2017 Zur Ausgabe

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.