The Potential Relationship Between Coronary Artery Tortuosity And Radial Artery Tortuosity And The Analysis Of Influencing Factors For Their Cooccurrence

ObjectiveExplore the potential relationship between coronary artery tortuosity(CAT)and transradial access(TRA)tortuosity,and explore the clinical characteristics and influencing factors of TRA tortuosity or TRA complex tortuosity in CAT patients.MethodsRetrospective selection of patients admitted to the Department of Cardiology of Subei People’s Hospital from August 2019 to August 2022 who underwent percutaneous radial artery coronary angiography for the first time.According to the angiographic results,①52 patients with CAT tortuosity but no TRA tortuosity were assigned to the non-tortuosity group;② A total of 186 patients with CAT combined with TRA tortuosity were divided into TRA tortuosity group;Among them,102 patients with CAT and TRA vessel S-shaped tortuosity were divided into S-shaped tortuosity group;A total of 84 patients with CAT complicated with Ω-shaped tortuosity or circular malformation of TRA vessels(including radial ulnar ring,radial artery ring,brachial artery ring,axillary-subclavian-brachiocephalic artery ring)were divided into complex tortuosity group;③ Among 186 patients with CAT combined with TRA tortuosity,49 patients with coronary artery stenosis less than 50%were assigned to the correction TRA tortuosity group;④Eighty-six patients with no tortuosity of coronary artery and TRA artery,and the angiographic results showed that the degree of coronary artery stenosis was less than 50%,were set as normal control group;General data(gender,age,weight,height,and body mass index(BMI)),basic medical history(hypertension,diabetes,hyperlipidemia),smoking history,admission heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,blood routine(hemoglobin(Hb),neutrophil count(NEU).lymphocyte count(LYM),platelet count(PLT),mean platelet volume(MPV)Liver and kidney function(serum albumin(ALB),urea,creatinine),blood lipid analysis(triglyceride(TG),total cholesterol(TC),highdensity lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)),CysC,fibrinogen(FIB),D-dimer,and calculate the ratio of LDL-C to HDL-C(LDL-C/HDL-C),neutrophil count/lymphocyte count(NLR);Collect patients’ cardiac function data(heart failure symptoms(NYHA grade Ⅲ/Ⅳ or Killip Ⅱ/Ⅲ/Ⅳ),NT-ProBNP,echocardiographic indexes(aortic root diameter(Ao),LVs(left ventricular end-systolic diameter),LVd(left ventricular end-diastolic diameter),LVEF(left ventricular ejection fraction),E/A<1))Operation data(including ① TRA tortuous segment angiography:tortuous artery name,tortuous shape,tortuous vessel diameter,and treatment plan for tortuous artery during operation;②coronary angiography(CAG):coronary artery distortion degree,tortuous coronary artery name,tortuous coronary artery branch number conforming to CAT definition,coronary artery muscle bridge,tortuous stenosis,coronary artery lesion branch number,and Gensini score calculation..Results① Compared with no tortuosity,TRA tortuosity group had more severe coronary tortuosity(Z=-4.065,P<0.001),more tortuous coronary branches(Z=-1.998,P=0.046)and more coronary lesion branches(Z=-3.514,P<0.001);There were statistically significant differences in the degree of coronary tortuosity,the number of tortuous coronary artery branches and the number of coronary artery lesions in the four groups of no,S-shaped,omega shaped,and circular malformation tortuosity(P<0.001),and there was grade correlation(rs=0.468,P<0.001;rs=0.287,P<0.001;rs=0.163,P=0.012);There were significant differences in age,hypertension ratio,systolic blood pressure,diastolic blood pressure,mean arterial pressure,NEU,NLR,Cys-C,ALB,Gensini score,heart failure symptom ratio,NTProBNP,Ao,LVs,LVd,E/A<1 ratio between TRA tortuous and non-tortuous groups(P<0.05);Age(OR=1.046),mean arterial pressure(OR=1.065),and moderate coronary tortuosity(OR=8.960)were independent influencing factors of TRA tortuosity in CAT patients;Age and mean arterial pressure have predictive value for the occurrence of TRA tortuosity in CAT patients(area under the curve of age(AUC=0.699,95%CI:0.662-0.776;P<0.001),and area under the curve of mean arterial pressure(AUC=0.678,95%CI:0.599-0.756;P<0.001)),and the difference between the two ROC curves is statistically significant(P<0.05);② There were statistically significant differences in the female ratio,age,systolic blood pressure,diastolic blood pressure,mean arterial pressure,Hb,ALB,NLR,Cys-C,D-dimer,NT-ProBNP,E/A<1 ratio between the corrected TRA tortuosity group and the normal control group(P<0.05);③ The differences in systolic blood pressure,diastolic blood pressure,mean arterial pressure,MPV,Cys-C,incidence of RCA tortuosity,and incidence of LAD tortuosity between the two groups with complicated tortuosity and S-shaped tortuosity were statistically significant(P<0.05);④ There were significant differences in age,hypertension history ratio,systolic blood pressure,diastolic blood pressure,mean arterial pressure,NEU,NLR,Cys-C,ALB,RCA tortuosity rate,LAD tortuosity rate,coronary muscle bridge.Gensini score,heart failure symptom ratio,BNP,LVd,E/A<1 ratio between complex tortuosity group and nontortuosity group(P<0.05);Age(or=1.078),LVD(or=1.142),and moderate tortuosity of the coronary arteries(or=17.165)were independent factors for TRA complex tortuosity in CAT patients;And age and LVD had a predictive value for the occurrence of TRA complex tortuosity in CAT patients(area under the curve for age(AUC=0.739,95%CI:0.655-0.824;P<0.001)and area under the curve for LVD(AUC=0.631,95%CI:0.536-0.726;P=0.010)),but there was no significant difference in the area under the ROC curve between them.ConclusionThe presence or absence of tra vessel tortuosity and its degree of tortuosity correlated more significantly with cat tortuosity,the number of tortuous vessels,and the number of diseased vessels;There was some association between age,mean arterial pressure,and the degree of coronary tortuosity with the occurrence of TRA tortuosity in CAT patients;Age and mean arterial pressure were predictive of the occurrence of TRA tortuosity in CAT patients.Further analysis revealed that age,LVD,and degree of coronary tortuosity were also associated with the development of TRA complex tortuosity in CAT patients;Age and LVD were predictive for the occurrence of TRA complex tortuosity in CAT patients.For radial artery path tortuosity,especially the presence of Omega shaped tortuosity and annular deformity of the radial artery path,repeated attempts have been made to induce vasospasm by not only increasing patient suffering and increasing access site complications,but also often damaging the vascular endothelium and even finally having to switch access;This study,to some extent,is helpful in guiding the clinic,making a correct decision for the procedure smoothly by estimating the complexity of transradial angiography or interventional treatment procedure in advance through easily available indexes or preliminary coronary CAT examination,and has a certain degree of clinical application value.