| Objective: Percutaneous coronary intervention(PCI) has been applied to mature for several years, with the rising number of surgery, new technology constantly emerging. This research conducted a series of technological improvement in order to better improve and serve the clinical. Include a few parts: the effect of dalteparin versus unfractionated heparin on the levels of cardiac troponin I(c Tn I) and creatine kinase is oenzy me MB(CK-MB) in elective percutaneous coronary intervention; performance of single reshaped Judkins left catheter for transradial coronary angiography; brachial artery flow-mediated dilation(FMD) predicts arterial occlusion during transradial coronary interventions. Methods: ①In this prospective, randomized, open-label design study, 733 patients undergoing elective PCI were divided into an unfractionated heparin group(group 1, 323 patients) or a dalteparin group(group 2, 410 patients). Blood samples were collected before and 18-24 h after the PCI procedure to determine the serum levels of c Tn I and CK-MB. Major adverse cardiac events(MACEs) and bleeding events during hospitalization were also recorded. Patients with an increased level of serum c Tn I before PCI were excluded from the study. ②A total of 198 consecutive patients were enrolled in the first step study. Patients were randomly assigned to brachial type catheter group(BRACT group) or Judkins left catheter group(Judkins group). The inclusion criterion was the left coronary angiography could be accomplished by either a brachial type catheter or a reshaped Judkins left catheter. The successful procedure was de- fined as both right and left coronary angiography could be completed with a single reshaped Judkins left catheter or a brachial type catheter. Furthermore, 1873 consecutive patients were continuous enrolled to observe the success rate of single Judkins left catheter for transradial coronary angiography. ③ The study population consisted of 150 patients scheduled for transradial diagnostic catheterization in whom ad hoc PCI was performed. FMD was measured 1–2 days before PCI and 24 h after the PCI. The primary endpoint of radial artery occlusion(RAO) after operator. Procedural parameters were also recorded. Results: ① After PCI, the c Tn I values were greater than three times the upper limit of normal in 43 cases(13.3%) in group 1 and 52 cases(12.7%) in group 2, without a statistically significant difference between the two groups(P=0.801). An increased creatine kinase isoenzyme MB level of greater than two times the upper limit of normal was found in 10 cases(3.1%) in group 1 and 12 cases(2.9%) in group 2, without a statistically significant difference between the two groups(P=0.894). Postoperative bleeding was observed in nine patients(2.8%) in group 1 and six patients(1.5%) in group 2. Postoperative MACEs were observed in two patients(0.6%) in group 1 and two patients(0.5%) in group 2. There were no significant differences between the two groups with respect to bleeding events or MACEs. ② Of the 198 patients, 191 were finally enrolled in this study according to the inclusion criteria, with 95 patients in BRACT group and 96 in Judkins group. There were no significant differences on baseline between the two groups. Procedure success rate was 84.10% with a fluoroscopic exposure time of 3.81 ± 0.43 min in BRACT group, and 81.60% with a fluoroscopic exposure time of 4.05 ± 0.48 min in Judkins group(P >0.05). No severe complications were found in either of the two groups. The success rates of 1869 patients with single Judkins left catheter for transradial coronary angiography were 75.33%. There were no complications in those patients. ③ A total of 150 patients(102 male, age 60.3±9) were included. Radial artery spasm(RAS) was recorded in 9 patients(6.0%) and occlusion was recorded in 2 patients(1.3%). FMD showed a very significant univariate association with the occurrence of spasm and occlusion(P < 0.001) and was the most important predictor of spasm in the multivariate logistic regression analysis(OR 1.23; P < 0.001), followed by baseline radial artery diameter(P = 0.04), the number of catheters used(P = 0.049) and the administered volume of contrast medium(P = 0.017). Postoperative operation side FMD significantly lower values(P < 0.05), catheter is a part in vascular endothelial damage. Conclusion: ①Our study showed that dalteparin might be as effective and safe as unfractionated heparin for anticoagulation during elective PCI. ② Transradial coronary angiography with a reshaped single Judkins left catheter is feasible and practical, with an accepted procedure success rate. This method should be worthy of further clinical validation in a lager scale population. ③FMD is a significant predictor of arterial spasm and occlusion before elective transradial PCI. It is a low cost, safe, and feasible noninvasive modality, whose results might be taken into account when deciding on the vascular access route for an elective procedure, the size of sheaths or catheters to be used or the intensity of antispasm medication. |
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