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Interaction between access choice and pharmacotherapy for coronary intervention: the results of a UK survey.

Kinnaird TD, Ossei-Gerning N, Mitra R, Anderson RA - Open Heart (2014)

Bottom Line: Percutaneous coronary intervention (PCI) has changed significantly over the past decade with the uptake of radial access and the development of newer and more potent antiplatelets and safer antithrombins.There is a significant interaction between years since qualification and access choice.Although there is no established consensus on access site or drugs, default radial operators are significantly more likely to utilise new generation antiplatelets and bivalirudin than femoral operators.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology , University Hospital of Wales , Cardiff , UK.

ABSTRACT

Introduction: Percutaneous coronary intervention (PCI) has changed significantly over the past decade with the uptake of radial access and the development of newer and more potent antiplatelets and safer antithrombins. This survey examined the default access route and pharmacology choice and their interaction in UK interventional practice.

Methods: An email-based survey invited interventional cardiologists to answer questions regarding arterial access and pharmacology use during PCI. Respondents were categorised into femoral, radial and radial(+) (if the other radial was used rather than femoral if the right radial attempt failed). Data were analysed using χ(2) or the Student t test.

Results: 81% of the 204 respondents reported the radial artery as their default access site with a significant interaction between years since qualification and access choice (21.1 years for radial(+) vs 23 years for radial (p=0.027) vs 26.6 years for femoral (p=0.013) vs radial (p=0.0005) vs radial(+)). There were 19 different combinations of access and pharmacology reported. For non-ST elevation myocardial infarction PCI, there was a significant trend for radial(+) and radial operators to favour ticagrelor or tailored therapy versus femoral operators (54.8% vs 47.8% vs 35%, respectively, p=0.018). For primary PCI (PPCI), radial(+) and radial operators were much more likely to choose ticagrelor or prasugrel than femoral operators (77.2% (p<0.001) vs 73.9% (p=0.023) vs 50%, respectively (p<0.0001) for trend). For PPCI, glycoprotein inhibitor use was similar between groups (26.1% vs 25%, not significant); radial operators were much more likely to choose bivalirudin (52.8% vs 10%, p<0.0001) and much less likely to use heparin only (19.8% vs 65%, p<0.0001) than femoral operators.

Conclusions: There is a significant interaction between years since qualification and access choice. Although there is no established consensus on access site or drugs, default radial operators are significantly more likely to utilise new generation antiplatelets and bivalirudin than femoral operators.

No MeSH data available.


Related in: MedlinePlus

Choice of routine pharmacology for PPCI by default access route (GPI, glycoprotein inhibitor; PPCI, primary percutaneous coronary intervention).
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Related In: Results  -  Collection

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OPENHRT2014000094F2: Choice of routine pharmacology for PPCI by default access route (GPI, glycoprotein inhibitor; PPCI, primary percutaneous coronary intervention).

Mentions: For PPCI, 23.7% of operators chose a heparin-only strategy, 26.5% routine GPI use and 48.6% routine bivalirudin use. However, during PPCI, although GPI use was similar between groups (26.1% vs 25%, p Value NS), radial operators were much more likely to choose bivalirudin (52.8% vs 10%, p<0.0001) and much less likely to use heparin-only (19.8% vs 65%, p<0.0001) than femoral operators (table 3 and figure 2). Overall, radial operators were more than twice as likely to choose bivalirudin or a GPI than femoral operators (78.9% vs 35%, p<0.0001). Additionally, if a heparin-only strategy was not used, femoral operators were much more likely to choose a GPI than bivalirudin (71.4% vs 33.2%, p<0.001). A similar interaction was noted between access site and adjunctive pharmacology choice in the radial+ operator subgroup. For bailout, operators mostly chose a GPI (40.7%) with a small amount of bivalirudin use (1.7%). All of the bivalirudin bailout users were radial+ access by default.


Interaction between access choice and pharmacotherapy for coronary intervention: the results of a UK survey.

Kinnaird TD, Ossei-Gerning N, Mitra R, Anderson RA - Open Heart (2014)

Choice of routine pharmacology for PPCI by default access route (GPI, glycoprotein inhibitor; PPCI, primary percutaneous coronary intervention).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195931&req=5

OPENHRT2014000094F2: Choice of routine pharmacology for PPCI by default access route (GPI, glycoprotein inhibitor; PPCI, primary percutaneous coronary intervention).
Mentions: For PPCI, 23.7% of operators chose a heparin-only strategy, 26.5% routine GPI use and 48.6% routine bivalirudin use. However, during PPCI, although GPI use was similar between groups (26.1% vs 25%, p Value NS), radial operators were much more likely to choose bivalirudin (52.8% vs 10%, p<0.0001) and much less likely to use heparin-only (19.8% vs 65%, p<0.0001) than femoral operators (table 3 and figure 2). Overall, radial operators were more than twice as likely to choose bivalirudin or a GPI than femoral operators (78.9% vs 35%, p<0.0001). Additionally, if a heparin-only strategy was not used, femoral operators were much more likely to choose a GPI than bivalirudin (71.4% vs 33.2%, p<0.001). A similar interaction was noted between access site and adjunctive pharmacology choice in the radial+ operator subgroup. For bailout, operators mostly chose a GPI (40.7%) with a small amount of bivalirudin use (1.7%). All of the bivalirudin bailout users were radial+ access by default.

Bottom Line: Percutaneous coronary intervention (PCI) has changed significantly over the past decade with the uptake of radial access and the development of newer and more potent antiplatelets and safer antithrombins.There is a significant interaction between years since qualification and access choice.Although there is no established consensus on access site or drugs, default radial operators are significantly more likely to utilise new generation antiplatelets and bivalirudin than femoral operators.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology , University Hospital of Wales , Cardiff , UK.

ABSTRACT

Introduction: Percutaneous coronary intervention (PCI) has changed significantly over the past decade with the uptake of radial access and the development of newer and more potent antiplatelets and safer antithrombins. This survey examined the default access route and pharmacology choice and their interaction in UK interventional practice.

Methods: An email-based survey invited interventional cardiologists to answer questions regarding arterial access and pharmacology use during PCI. Respondents were categorised into femoral, radial and radial(+) (if the other radial was used rather than femoral if the right radial attempt failed). Data were analysed using χ(2) or the Student t test.

Results: 81% of the 204 respondents reported the radial artery as their default access site with a significant interaction between years since qualification and access choice (21.1 years for radial(+) vs 23 years for radial (p=0.027) vs 26.6 years for femoral (p=0.013) vs radial (p=0.0005) vs radial(+)). There were 19 different combinations of access and pharmacology reported. For non-ST elevation myocardial infarction PCI, there was a significant trend for radial(+) and radial operators to favour ticagrelor or tailored therapy versus femoral operators (54.8% vs 47.8% vs 35%, respectively, p=0.018). For primary PCI (PPCI), radial(+) and radial operators were much more likely to choose ticagrelor or prasugrel than femoral operators (77.2% (p<0.001) vs 73.9% (p=0.023) vs 50%, respectively (p<0.0001) for trend). For PPCI, glycoprotein inhibitor use was similar between groups (26.1% vs 25%, not significant); radial operators were much more likely to choose bivalirudin (52.8% vs 10%, p<0.0001) and much less likely to use heparin only (19.8% vs 65%, p<0.0001) than femoral operators.

Conclusions: There is a significant interaction between years since qualification and access choice. Although there is no established consensus on access site or drugs, default radial operators are significantly more likely to utilise new generation antiplatelets and bivalirudin than femoral operators.

No MeSH data available.


Related in: MedlinePlus