Abstract Background The safety and efficacy of triple therapy (TT; warfarin with dual antiplatelet therapy DAPT) in post–percutaneous coronary intervention (PCI) patients with atrial fibrillation ...(AF) are unclear. We aimed to determine whether TT is associated with a decreased stroke rate and an acceptable bleeding rate in this population. Methods This was a single-centre, retrospective study. Primary composite outcome was death, ischemic stroke, or transient ischemic attack. Secondary outcomes included components of primary outcome, bleeding, and blood transfusion rates. Results Of 602 post-PCI patients with AF between 2000 and 2009, 382 received TT, 220 DAPT. Mean follow-up post PCI was 5.9 ± 5.0 months. The TT group had a higher CHADS2 score (2.6 vs 2.1, P < 0.001), older age (72.9 vs 70.5 years, P = 0.039), more heart failure (72.3% vs 36.9%, P = 0.010), and more strokes (14.4% vs 6.4%, P = 0.010). Neither primary outcome, major bleeding, nor blood transfusion rates differed between treatment groups, but more gastrointestinal bleeding occurred with TT use (2.6% vs 0.5%, P = 0.045). Net clinical benefit was −5.2 (CHADS2 ≤ 2), 0.9 (CHADS2 > 2), and −3.2 (overall) per 100 patient-years. Conclusions Although we found no association with TT usage and a reduction in cerebrovascular ischemic or major bleeding events in post-PCI patients with AF regardless of CHADS2 score vs DAPT, the study was likely underpowered to demonstrate a clinically relevant reduction. TT was associated with a 5-fold increase in gastrointestinal bleeding vs DAPT. Net clinical benefit calculations suggest benefits of TT in patients with CHADS2 > 2. Stratification with CHADS2 might be useful to determine the optimal antithrombotic therapy post PCI.
Abstract Background Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor ...for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter. Methods Using ultrasound, we prospectively measured radial, ulnar, and brachial artery diameters of 130 patients who presented for elective percutaneous coronary intervention or diagnostic angiography. Using prespecified candidate variables we used multivariable linear regression to identify predictors of radial artery diameter. Results Mean internal diameters of the right radial, ulnar, and brachial arteries were 2.44 ± 0.60, 2.14 ± 0.53, and 4.50 ± 0.88 mm, respectively. Results for the left arm were similar. The right radial artery was larger in men than in women (2.59 vs 1.91 mm; P < 0.001) and smaller in patients of South Asian descent (2.00 vs 2.52 mm; P < 0.001). Radial artery diameter correlated with wrist circumference ( r2 = 0.26; P < 0.001) and shoe size ( r2 = 0.25; P < 0.001) and weakly correlated with height ( r2 = 0.14; P < 0.001), weight ( r2 = 0.18; P < 0.001), body mass index ( r2 = 0.07; P = 0.002), and body surface area ( r2 = 0.22; P < 0.001). The independent predictors of a larger radial artery were wrist circumference ( r2 = 0.26; P < 0.001), male sex ( r2 = 0.06; P < 0.001), and non-South Asian ancestry ( r2 = 0.05; P = 0.006; final model r2 = 0.37; P < 0.001). A risk score using these variables predicted radial artery diameter (c-statistic, 0.71). Conclusions Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries.
Fractional flow reserve (FFR) measurement is the current benchmark for assessing the physiologic significance of a coronary stenosis. Intravenous / intra-coronary adenosine is a commonly used agent ...to induce hyperaemia, required for FFR measurement. In our institute, we have observed three cases of ventricular fibrillation (VF) after intra-coronary adenosine injection. Volume of the injections appeared to be the responsible mechanism, supported by evidence from optical coherence tomography (OCT) experience. Since doubling the concentration of adenosine to reduce the volume of injection by half, no further incidence of VF has been noted.
