Use of pulmonary artery pressure and pacing catheter during PTCA

How to maximize the safety of coronary and pulmonary angiography in patients receiving thrombolytic therapy

Patients who receive thrombolytic therapy in close temporal relationship to undergoing coronary or pulmonary angiography are at high risk of developing hemorrhagic complications, particularly at the vascular access site. A single-wall percutaneous puncture technique, use of a sheath for vascular access, use of a pigtail catheter for pulmonary angiography, avoidance of a temporary pacing catheter, and shortening the duration of thrombolytic therapy will decrease these complications. However, to maximize the safety of thrombolytic therapy, invasive vascular procedures should be avoided whenever possible.

Results of percutaneous transluminal coronary angioplasty by multiple, relatively low frequency operators: 1986-1987 experience

The initial results of percutaneous transluminal coronary angioplasty (PTCA) in this institution were described previously and were comparable with national statistics despite the comparatively small number of cases performed by individual physicians. Two years later, the number and complexity of cases have increased significantly. In the present study, the experience of 3 physicians (group 1) who performed greater than 100 PTCAs (143 +/- 35, mean +/- standard deviation) was compared with that of 14 physicians (group 2) who performed less than 100 PTCAs (25 +/- 16) during a recent 12-month period. Group 1 and group 2 performed 430 and 351 PTCAs, with a 91 and 84% success rate, respectively (p less than 0.01). Group 1 and group 2 attempted dilatation of 595 and 444 narrowings with an 85 and 81% success rate, respectively (p less than 0.025). The differences reflect outcomes with "complex lesions," with which group 1 had a higher success rate than group 2 (81 vs 69%, p less than 0.05) and a lower complication rate (3.1 vs 7.5%, difference not significant). Outcomes with "simple lesions" were similar for the 2 groups (93 vs 90%). As a result, the conclusions of the previous study should be modified. The present data suggest that while low frequency operators can perform PTCA of "simple lesions" with quite satisfactory results in the setting of an institution in which large numbers of PTCAs are performed and in which an expert team is available for support, outcomes with "complex lesions" are likely to be better in more experienced hands.

Use of temporary pacemakers during coronary angioplasty: an evolving experience with ventricular fibrillation in 400 cases

Because of a perceived high frequency of ventricular fibrillation when a pacemaker catheter was placed in the right ventricular apex during PTCA, we reviewed our first 400 cases for this complication. The incidence of ventricular fibrillation in the entire group was 10 of 400 cases (2.5%) compared with 17 of 3,806 (0.4%) diagnostic coronary arteriograms performed in our laboratory during the same time period (P less than .001). Ventricular fibrillation occurred more frequently during PTCA when the pacemaker catheter tip was placed in the right ventricular apex (8 of 63 cases, 12.6%) than when it was positioned in either the pulmonary artery, vena cava, or when a pacemaker catheter was not used (2 of 337 cases, 0.6%, P less than .001). Based on these data we have developed a policy of inserting temporary pacemakers prophylactically during PTCA only for patients undergoing dilation of dominant right or dominant left circumflex coronary arteries and in patients with acute myocardial infarction.