Coronary Intravascular Lithotripsy

Coronary artery calcification is strongly associated with adverse cardiac events and can impede the success of percutaneous coronary intervention (PCI) due to challenges with delivery of equipment and expansion of stents. Current treatment modalities for mitigation of coronary calcification have limitations and inherent risk of complications. Coronary intravascular lithotripsy (IVL) is a novel technique to modify coronary artery calcification via acoustic pressure waves. IVL utilizes an easy-to-use device, which does not require a steep learning curve. Prospective studies have shown this technique to be safe and effective and can be used to adequately modify calcified coronary stenoses in preparation for PCI and stent deployment and optimization. IVL has unique features that can be used alone or as an adjunctive therapy to other available calcium modification tools. As compared to the currently established modalities of calcium modification, IVL has the potential to facilitate successful PCI with fewer serious procedural complications. In this review article, we discuss the importance of coronary artery calcification, the role of IVL, its mechanism, the current clinical data behind its use and future directions. Overall, coronary IVL is a promising technology for the treatment of severely calcified coronary stenoses, with a need for, long-term clinical outcome data of IVL-facilitated PCI.

Escalation from intra-aortic balloon pump to axillary impella 5.5 support: Staged removal of the femoral access

Background: With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.5.Results: From January 1, 2022 to June 30, 2022, a total of 6 patients have undergone IABP removal during Impella 5.5 insertion. The IABP was subsequently removed over the long wire with manual compression on the femoral artery to control bleeding. An 8 or 9 Fr short sheath is inserted over the wire. Staged hemostasis was successfully performed in 4 patients, and the remaining two patients required escalation of support to veno-arterial membrane oxygenation as EC-PELLA utilizing the femoral arterial sheath.Conclusion: This does not only achieve secured hemostasis but also enables a smooth transition to further escalate support such as extracorporeal membrane oxygenation support, if necessary.

Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients

PURPOSE/OBJECTIVE(S)

Treatment related lymphopenia is a known toxicity for glioblastoma (GBM) patients and several single-institution studies have linked lymphopenia with poor survival outcomes. We performed a systematic review and pooled analysis to evaluate the association between lymphopenia and overall survival (OS) for GBM patients undergoing chemotherapy and radiation therapy (RT).

MATERIALS/METHODS

Following PRISMA guidelines, a systematic literature review of the MEDLINE database and abstracts from ASTRO, ASCO, and SNO annual meetings was conducted. A pooled analysis was performed using inverse variance-weighted random effects to generate a pooled estimate of the hazard ratio of association between lymphopenia and OS.

RESULTS

Ten of 104 identified studies met inclusion criteria, representing 1,718 patients. The lymphopenia cutoff value varied (400-1100 cells/uL) and as well as the timing of its onset. Studies were grouped as time-point (i.e., lymphopenia at approximately 2-months post-RT) or time-range (any lymphopenia occurrence from treatment-start to approximately 2-months post-RT. The mean overall pooled incidence of lymphopenia for all studies was 31.8%, and 11.8% vs. 39.9% for time-point vs. time-range studies, respectively. Lymphopenia was associated with increased risk of death, with a pooled HR of 1.78 (95% CI 1.46-2.17, P < 0.00001) for the time-point studies, and a pooled HR of 1.38 (95% CI 1.24-1.55, P < 0.00001) for the time-point studies. There was no significant heterogeneity between studies.

CONCLUSION

These results strengthen observations from previous individual single-institution studies and better defines the magnitude of the association between lymphopenia with OS in GBM patients, highlighting lymphopenia as a poor prognostic factor.

Cadmium (Cd) influences calcium (Ca) levels in the skeleton of a freshwater fish Channa gachua

Abstract Environmental contamination with heavy metals is a threat to the organisms due to their toxicity, persistence and bioaccumulation in food chains. The study was aimed to assess cadmium (Cd) effect on calcium (Ca) level in bones of a freshwater fish Channa gachua. 42 fish individuals were kept into six (6) aquaria; labelled aq.0, 1, 2, 3,4 and 5 in the laboratory for treatment. Aq.0 was control group and aq.1, 2,3,4,5 were experimental with treatment solution of Cd 0, 0.1ppm, 0.5ppm, 1ppm, 2.5ppm and 5ppm respectively for three months. After exposure, bones tissue were examined for Cd accumulation and Ca concentration. Highest accumulation of Cd were recorded in aq.5 mean 46.86 ± 0.46 mgkg-1 .and lowest in the control group with mean 0.61 ± 0.06 mgkg-1. The order of Cd bioaccumulation in bones were aq.5 > aq.4 >aq.3 > aq.2 > aq.1 > aq.0. Highest concentration of Ca were noted in aq.0 (Control group) mean 7888.06 ± 4827.22 mgkg-1 and lowest were 1132.36 ± 203.73 mgkg-1 in aq.5 (at 5.0 ppm). Generally a pattern of decreasing Ca level were observed with each rise of Cd bioaccumulation aq.0 > aq.1 > aq.2 > aq.3 > aq.4 > aq.5. Current study indicated that Cd accumulation have substantial effect on Ca level in bones and hence on skeleton system. Strict rules must be implemented by government to control metals pollution and exploitations of biota.

Effects of replacement of dietary fish oil with plant oil on growth performance and fatty acid composition of spinefoot rabbitfish, Siganus rivulatus

Abstract A 95-day feeding study was carried out to evaluate the impact of complete replacement of fish oil by plant oils in the growth performance, feed consumption fatty acid and body composition of juvenile rabbitfish, Siganus rivulatus. There were four treatments i.e., A (fish oil diet), (linseed oil diet), C (soybean meal oil diet) and D (sunflower oil diet). The experimental trial was conducted in twelve 1.5-m3 fiber glass tanks (n=3). Spinefoot rabbitfish juveniles had an average initial weight of 0.948 g ± 0.124 g and they were stocked at 50 fish per tank. Fish fed diet A showed significantly better growth rate, final body weight, and total body weight than fish fed on the other diets. Moreover, the best FCR was observed for diet A followed by diet C and diets B and D had the worst FCR. Fish body composition for crude protein, dry matter, ashes and gross energy at the end of the trial had not differed between the treatments. The highest polyunsaturated fatty acids (PUFA) was found in fish fed diet A followed in decreasing order by diets D, B, and C. Fish oil is a better dietary lipid source for Spinefoot rabbitfish juveniles, Siganus rivulatus, than plant oils. Among plant oils, soybean oil was better than linseed oil and sunflower oil as the main dietary fat source.

Intravascular Lithotripsy in Peripheral Artery Disease

Peripheral artery disease affects millions of people worldwide, and it is associated with significantly higher morbidity and mortality. In addition, it represents a significant challenge for the interventional operators to appropriately and successfully revascularize heavily calcified stenoses. There are several established atherectomy devices with the risk of procedural complications including dissection and perforation, among others. Intravascular lithotripsy (IVL) is a novel tool with relatively less procedural risk compared to the existing modalities. It is a device that emits high-energy ultrasound waves mounted on a balloon catheter that causes fractures on the calcium plaques allowing balloon expansion and luminal gain. Five trials have been published showing the safety and effectiveness of IVL, including one trial evaluating the device in common femoral artery and infrapopliteal arteries. The available data from the limited number of trials are very encouraging and demonstrates minimal risk. Additional studies on a larger scale are needed further to understand the its long-term effects and possible risks.

Size at sexual maturity estimation for 36 species captured by bottom and mid-water trawls from the marine habitat of Balochistan and Sindh in the Arabian Sea, Pakistan, using maximum length (Lmax) and logistic (L50) models

Abstract The aim of this study was to estimate the size at first sexual maturity (Lm) for 36 species belonging to 24 families from the marine habitat of Balochistan and Sindh in Arabian Sea, Pakistan through maximum length based an empirical and logistic model using commercial catch during June 2020 to May 2021. Individual total length (TL) was noted up to 0.1 cm using measuring broad. The Lm was calculated using two formulae; (i) log (Lm) = - 0.1246 + 0.9924 * log (Lmax) for Elasmobranchs and (ii) log (Lm) = -0.1189 + 0.9157* log (Lmax) for ray-finned fishes. The minimum Lm was recorded as 10.27 cm TL for Caranx malabaricus and 108.38 cm TL for Isurus oxyrinchus, respectively. Around Lm with 58.33% species were ranges from 19.00 cm to 25.00 cm TL. This study was estimated 16 newly Lm which is globally absent and rest 20 Lm are absent in the Arabian Sea (Pakistan coastal habitats). Therefore, the results will be helpful for the sustainable management and conservation of these marine fishes through the establishment of mesh size of trawl nets based on the size at sexual maturity (Lm).

Practical approach to confirm femoral artery patency after percutaneous closure for veno-arterial extracorporeal membrane oxygenation decannulation

BACKGROUND

We describe a technique to assess blood flow distal to the decannulation site after deployment of Perclose ProGlide (Abbott Vascular, Abbott Park, Ill) in patients on femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support.

TECHNIQUE

An antegrade distal perfusion catheter was placed in all patients, and decannulation was primarily performed at bedside (N = 11/12). With the VA-ECMO circuit switched off, a needle was inserted into the arterial tubing, passed through the femoral arterial cannula into the artery. The arterial cannula was removed over a wire and the previously placed Proglide Perclose sutures were secured. Back bleeding from the antegrade distal perfusion catheter, confirmed using a three-way connector, indicated blood flow to the superficial femoral artery. This was followed by confirmation of blood flow to the lower leg using a Doppler ultrasound. Hemostasis of the antegrade perfusion catheter was achieved through manual compression.

RESULTS

We implemented this technique in 12 patients with a technical success rate of 100%. There were no ipsilateral leg ischemia, bleeding, pseudoaneurysm, or infection after decannulation.

CONCLUSIONS

This technique allows prompt assessment of blood flow to the distal leg immediately following arterial decannulation.

Sonication results in variable quality and enhanced sensory attributes of Adajamir (Citrus assamensis) juice: A study on an underutilized fruit

Citrus assamensis, commonly known as Adajamir, is an underutilized fruit with distinctive sensory and nutritional properties. The limited amount of research on this particular citrus type was recognized as one of the research gaps for this study. The objective of this study was to evaluate and compare the impacts of sonication, pasteurization, and thermosonication techniques on the quality and sensory attributes of Adajamir juice. A randomized experimental design was used in the study, wherein the juice underwent three different treatments. The results indicate that there were no significant changes in pH or titratable acidity following all treatments. Yet, notable differences in juice color were observed. The use of sonication and thermosonication resulted in an increase in β-carotenoid levels. Additionally, total phenolic content and antioxidant activities were observed to increase. All three treatments led to a reduction in ascorbic acid levels relative to the control. However, the complete elimination of microbial growth was observed during the thermal treatment. Compared to other approaches, sonication has been shown to be notably more efficacious in enhancing both the flavor and aroma. Sonication has been observed to improve the perceived bitterness to a certain degree. These findings support the potential of sonication as an alternative preservation method for Adajamir juice, offering enhanced quality and sensory acceptance.

Capturing Acidic CO2 Using Surface-Active Difunctional Core-Shell Composite Polymer Particles via an Aqueous Medium

Multifunctional surface-active polymeric composites are attractive materials for the adsorption of various small molecules. Herein, dual-functionalized micron-sized surface-active composite polymer particles were prepared by a three-step process for CO2 adsorption. First, polystyrene (PS) seed particles were prepared via the dispersion polymerization of styrene. PS/P(MMA-AAm-EGDMA) composite polymer particles were then synthesized by aqueous seeded copolymerization of methyl methacrylate (MMA) and acrylamide (AAm) in the presence of an ethylene glycol dimethacrylate (EGDMA) cross-linker. Finally, the amide moieties of PS/P(MMA-AAm-EGDMA) composite particles were converted into an amine-functionalized composite by using the Hofmann degradation reaction. The presence of primary amine groups on the surface of aminated composite particles was confirmed by some conventional chemical routes, such as diazotization and Schiff's base formation reactions. The formation and functionality of the PS seed, PS/P(MMA-AAm-EGDMA), and aminated PS/P(MMA-AAm-EGDMA) composite polymer particles were confirmed by Fourier transform infrared (FTIR) spectra analyses. Scanning electron microscopy (SEM) analysis revealed spherical shape, size, and surface morphologies of the PS seed, reference composite, and aminated composites. The elemental surface compositions, surface porosity, pore volume, pore diameter, and surface area of both composite particles were evaluated by energy-dispersive X-ray (EDX) mapping, X-ray photoelectron spectroscopy, and Brunauer-Emmett-Teller (BET) and Barrett-Joyner-Halenda (BJH) analyses. Dynamic light scattering (DLS) and ζ-potential measurements confirmed the pH-dependent surface properties of the functionalized particles. The amount of the adsorbed anionic emulsifier, sodium dodecyl sulfate (SDS), on the surface of aminated PS/P(MMA-AAm-EGDMA) is higher at pH 4 than that at pH 10. A vice versa result was found in the case of cationic surfactant, hexadecyltrimethylammonium bromide (HTABr), adsorption. Synthesized aminated composite particles were used as an adsorbent for CO2 adsorption via bubbling CO2 in an aqueous medium. The changes in dispersion pH were monitored continuously during the adsorption of CO2 under various conditions. The amount of CO2 adsorption by aminated composite particles was found to be 209 mg/g, which is almost double that of reference composite particles.

Partial bicorporeal uterus with unexpected cervical findings and a longitudinal obstructing vaginal septum - a case report

Mullerian duct anomalies are prevalent in 4-7% of the female population and come in many different shapes and forms. A lot of effort has already gone into trying to classify these anomalies, and some are still found that do not match any of the subcategories. We report a 49-year-old patient, presenting with abdominal pressure and recent onset of abnormal vaginal bleeding. A laparoscopic hysterectomy was performed, which revealed a U3a-C(?)-V2 mullerian anomaly with three cervical ostia. The origin of the third ostium remains unclear. Early and correct diagnosis of Mullerian anomalies is of the utmost importance to provide individually tailored care and to avoid unnecessary surgeries.

Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry

BACKGROUND

Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail.

OBJECTIVES

The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown.

METHODS

From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year.

RESULTS

The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91).

CONCLUSIONS

In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.

Work stress among physicians, dubai health authority, in the year 2018-2019

Background: Work stress is a significant problem that affects physicians. Multiple sources can contribute to this problem. High-stress rates among physicians can manifest in various expressions, including cognitive, behavioral, and somatic expressions. Work performance and quality of medical care administered to patients can be undermined by over-stressed physicians. The study aimed to assess the prevalence of stress among physicians working in governmental health facilities in Dubai (2018-2019) and their relationship with socio-demographic and job factors.  Methods: It is a cross-sectional study. This study population includes all physicians practicing in Dubai Health Authority hospitals and primary health care centers in the Year 2018-2019. Target Number is 1337 taken from the registry of Dubai health authority administration, but only 668 questionnaires were included with a RR of 49.9%. The data tool used in this study is a modified self-administered questionnaire from both validated health and safety executive (Barbaranelli et al., 2018) occupational stress and stress questionnaire by International Stress Management Association UK 2013. It consists of 22 items which were divided into demographic, stress indicators, factors, and other domains. They were distributed as hard copies by hand.  Findings: The study concluded that 40.2% were more likely to experience stress, while 59.8% were most prone to stress. Furthermore, the study showed a strong association with different factors such as the role of managers, shift duty, and multi-task work.  Conclusion: Work stress is a prevalent problem among physicians working at Dubai health authority. The stress is associated with factors: such as multi-task work, shift hours’ duties, time pressure, and the role of line manager. Implications for Occupational Health Nursing Practice or Implications for Occupational Health Practice: Healthier working environment will promote the well-being of its staff and ensure the proper delivery of care to the community.

Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model

BACKGROUND

Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies.

OBJECTIVES

This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis.

METHODS

Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort.

RESULTS

Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right.

CONCLUSIONS

A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.

Minimalist transcatheter aortic valve replacement misses paravalvular regurgitation: Incidence and echocardiographic distribution of missed paravalvular regurgitation

BACKGROUND

Paravalvular regurgitation (PVR) may be missed intraoperatively with transthoracic echocardiography (TTE) guided minimalist TAVR. We sought to determine the incidence and echocardiographic distribution of PVR missed on intra-op TTE, but detected on predischarge TTE.

METHODS

From July 2015 to 2020, 475 patients with symptomatic severe native aortic stenosis underwent TTE-guided minimalist TAVR. Missed PVR was defined as predischarge PVR that was ≥1 grade higher than the corresponding intra-op PVR severity. PVR was classified as anterior or posterior on the four standard TTE views; parasternal short-axis (PSAX), parasternal long-axis (PLAX), apical 3-chamber (A3C), and 5-chamber (A5C). Location-specific risk of missed PVR was then determined.

RESULTS

Mild or greater PVR was seen in 55 (11.5%) cases intra-op and 91 (19.1%) at predischarge, with no severe PVR. Among the 91 patients with ≥mild predischarge PVR, missed PVR was present in 42 (46.2%). Compared to the corresponding anterior jets, missed PVR rate was significantly higher for posterior jets in PLAX (62.5% vs. 25.0%, p = 0.005), A5C (56.9% vs. 25.0%, p = 0.009), PSAX (66.7% vs. 24.3%, 0.001), but not A3C (58.5% vs. 40.0%, p = 0.28).

CONCLUSIONS

Intraoperative TTE-guided minimalist TAVR either misses nearly half of ≥mild PVR or underestimates PVR by ≥1 grade when compared to predischarge TTE. Posterior PVR jets are more likely to be missed. Transesophageal echo guidance may help minimize missing PVR. Further studies are warranted.

Trends in outcomes, complications and readmission rates in patients undergoing transcatheter aortic valve implantation: a nationwide analysis from 2012 to 2019

Background

Transcatheter aortic valve implantation (TAVI) has evolved over the years from a procedure requiring surgical vascular access and general anesthesia, to one that can be completed entirely percutaneously with conscious sedation. Advancement in procedural techniques and operator experience has resulted in better outcomes for patients undergoing TAVI.

Purpose

The purpose of our study was to analyze the trends over the years in outcomes, complications and unplanned readmission rate in patients undergoing TAVI.

Methods

The United States Nationwide Readmission Database for the years 2012 to 2019 was queried to identify all adult patients who underwent elective TAVI. The primary outcome of the study was inpatient mortality during TAVI hospitalization. Secondary outcomes included periprocedural complications (like acute kidney injury, bleeding requiring transfusion, need for permanent pacemaker implantation, stroke), length of stay, hospitalization cost, and unplanned 30-day readmission rate. Appropriate International Classification of Diseases (ICD-9 and ICD-10) codes were used to identify comorbidities and complications.

Results

A total of 283,409 patients who underwent TAVI were included in the study. The baseline characteristics of these patients are shown in picture 1. The inpatient mortality during TAVI admission declined steadily and significantly from 5.3% in the year 2012 to 0.0% in the year 2019 (p value for trend &lt;0.001). There was a significant reduction in peri-TAVI occurrence of acute kidney injury (from 18.1% in 2012 to 8.7% in 2019), bleeding requiring transfusion (from 28.0% in 2012 to 4.3% in 2019), and stroke (from 1.8% in 2012 to 0.1% in 2019) (p value for trend &lt;0.001 for all). Periprocedural conduction abnormalities requiring permanent pacemaker implantation increased from 7.4% in 2012 to 12.1% in 2015, before coming down to 8.9% in 2019 (p value for trend &lt;0.001). The mean length of hospital stay and inflation-adjusted costs during admission for TAVI decreased from 9.6 days and $64,695 in the year 2012, to 3.6 days and $49,710 in the year 2019, respectively (p value for both &lt;0.001). The unplanned 30-day all-cause readmission rate after TAVI also reduced steadily and significantly from 18.2% in 2012 to 11.5% in 2019 (p value &lt;0.001).

Conclusion

Over the years, there has been a significant reduction in inpatient mortality, periprocedural complications (such as acute kidney injury, need for blood transfusion, stroke), length of hospital stay, and inflation-adjusted hospital costs in patients undergoing transcatheter aortic valve implantation. Furthermore, there has been a significant decline in the 30-day unplanned readmission rate after transcatheter aortic valve implantation.

Funding Acknowledgement

Type of funding sources: None.

Same-day discharge following transcatheter aortic valve replacement: a propensity-matched analysis from national readmission database

Background

The length of hospital stay following transcatheter aortic valve replacement (TAVR) has decreased in recent years, and next-day discharge strategy is being increasingly adopted in some centers. Whether it is safe to further expedite discharge post-TAVR in selected patients by allowing discharge on the same day as the procedure remains unknown. In addition to potentially decreasing hospitalization costs, it could also limit the inpatient footprint and strain on healthcare resources.

Purpose

The purpose of our study was to compare the 30-day readmission rate in patients receiving TAVR who were discharged the same day (same-day discharge or SDD group) with those who were discharged on a different day (different-day discharge or DDD group). Additionally, we aimed to identify risk factors for readmission after TAVR.

Methods

We used the United States Nationwide Readmission Database to identify all adults who underwent elective TAVR in the years 2015–2019. The primary outcome of this study was all-cause 30-day readmission rate. The secondary outcomes were total hospital costs for the index admission, and risk factors for 30-day readmission. Propensity score matching was conducted to compare the SDD and DDD groups. Independent risk factors of 30-day readmission were identified using multivariate Cox proportional hazards regression analysis of the unmatched cohort.

Results

Of the 196,618 patients who received TAVR (mean age 79.5±8.4 years, 45.0% females), 245 (0.12%) patients were discharged on the same day they received TAVR (SDD group), and the remaining 196,373 were discharged on a different day (DDD group). In the DDD group, the median length of hospital stay was 2 days (interquartile range 1–4 days). A 1:3 propensity score analysis generated a matched cohort including 245 and 889 patients in the SDD and DDD groups, respectively. The 30-day readmission rate was similar between the SDD and DDD groups (11.0% versus 10.8%, hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.59–1.71, p=0.989). Hospitalization costs were significantly lower in the SDD group than the DDD group ($37,811±18,029 versus $49,130±27,007, p&lt;0.001) (see Picture 1). Age, female gender, history of diabetes, chronic kidney disease, chronic pulmonary disease, oxygen use, prior stroke, peripheral vascular disease, anemia, liver disease, and cancer were found to be independent risk factors for 30-day readmission after TAVR (see Picture 2).

Conclusion

In this large nationwide database analysis, patients receiving uncomplicated TAVR who were discharged on the same day as the procedure had a similar all-cause 30-day readmission rate and significantly lower hospital costs compared to those discharged on a different day. These results indicate that same-day discharge after TAVR may be a safe and feasible option in carefully selected patients.

Funding Acknowledgement

Type of funding sources: None.

Comparison between 2 futility scores in comatosed survivors of out of hospital cardiac arrest in a large tertiary centre in the United Kingdom: MIRACLE2 vs NULL-PLEASE

Background

The management of patients presenting with an out of hospital cardiac arrest (OHCA) is resource intensive, and mortality remains very high. Several scoring systems have been developed to predict mortality and adverse neurological outcomes, and thus aid decision making for patients arriving to heart attack centres. Two of the most commonly used scoring systems are NULL-PLEASE (1) and MIRACLE2 (2).

Purpose

The MIRCALE2 score predicts poor neurological outcome at 6 months, as measured by Cerebral Performance Category (CPC). The NULL-PLEASE score predicts in-hospital morality. We aimed to compare both scores in predicting their primary end-points in a large tertiary centre in the UK.

Method and results

This was a retrospective analysis of 435 patient who were admitted with OHCA via the primary PCI pathway to a large tertiary cardiac centre between January 2016 and September 2020. Only comatosed OHCA survivors requiring pre-hospital ventilatory support were included. 319 patients were eligible 238 patients had complete set of data and were included in the final analysis.

The association of the primary outcome was examined using logistic regression analysis. The predictive ability of the scores for the primary endpoint was tested using AUC analysis.

In-hospital mortality was 45% (108 patients), with 53% having good neurological outcome at 6 months (CPC &lt;3). The median MIRACLE2 score for our cohort was 5 (total score 10). The median neurological outcome measured by CPC was 2. The median NULL-PLEASE score was 2 (total 14). A ROC curve for both scores was plotted, with area under the curve at 0.73 for the MIRACLE2, and 0. 0.81 for NULL-PLEASE (figure 1 and 2). Our final analysis demonstrated a MIRACLE2 score of 5 or more had sensitivity of 67% to predict poor neurological outcome (CPC 3–5). The NULL-PLEASE, score of &gt;3 had 74% sensitivity to predict in hospital mortality.

Conclusion

To our knowledge, this is the first study to compare the MIRCLE2 and NULL-PLEASE scoring systems. Both scores did not perform as expected in our large retrospective analysis. The NULL-PLEASE was more sensitive in predicting in-hospital mortality, although MIRACLE 2 score was easier to use as it had less variables to collect.

Funding Acknowledgement

Type of funding sources: None.

Myers-Briggs Type Indicator Personality Types of Female Intern Doctors and Their Specialty Preference

The Myers-Briggs Type Indicator (MBTI) personality types were established in 1940s. Career planning of doctors were found related to the MBTI personality. There are 16 subtypes of MBTI based on 4 dichotomies. Relationship between MBTI and career choice has been changed gradually in last few decades. Extroverted doctors are supposed to select surgery and introverted are prone to choose medicine according to MBTI study. This was a cross-sectional study on the female interns of Sylhet Women's Medical College Hospital, Bangladesh from September 2021 to November 2021, to evaluate their MBTI personality type and the career planning of these individual subtypes. Commonest subtypes of participants ISTP (Introverted, Sensing, Thinking, Perceiving) (14.13%) and ESTP (Extraverted, Observant, Thinking and Prospecting) (14.13%). Other common MBTI personality subtypes were ISTJ (Introversion, Sensing, Thinking and Judgment) (9.78%), ISFP (Introverted, Sensing, Feeling, Perceiving) (8.69%), ESFJ (Extraverted, Sensing, Feeling and Judging) (6.52%), ENTP (Extraverted, Intuitive, Thinking and Perceiving) (5.43%), INFJ (Introverted, Intuitive, Feeling and Judging) (5.43%), INTJ (Introverted, Intuitive, Thinking and Judging) (5.43%) and ISFJ (Introverted, Sensing, Feeling and Judging) (5.43%). Introverted (57.7%) participants were more than extroverted (42.3%) participants. Percentage of general surgery and OBG were higher in the extroverted group and the percentage of medicine was more in the introverted group but the differences were not statistically significant (p>0.05). The career planning of ENFJ, ENFP, ESTP and ISTJ subtypes of participants of this study had similarity of those of MBTI database.

Impact of COVID-19 on patients awaiting ablation for atrial fibrillation

Objective

Atrial fibrillation (AF) ablation services were significantly affected by the COVID-19 pandemic. We aimed to evaluate a symptom-based clinician prioritisation scheme for waiting list management compared with patient-completed quality of life (QoL) scores. We also sought to understand factors influencing QoL, particularly the impact of COVID-19, on patients awaiting AF ablation, via a bespoke questionnaire.

Methods

Patients awaiting AF ablation were sent two QoL questionnaires (Atrial Fibrillation Effect on QualiTy of Life (AFEQT) and EuroQol 5D (EQ5D-5L)) and the bespoke questionnaire. At a separate time point, patients were categorised as C1—urgent, C2—priority or C3—routine by their cardiologist based on review of clinic letters.

Results

There were 118 patients included with priority categorisation available for 86 patients. Median AFEQT scores were lower in C2 (30.4; 17.2–51.9) vs C3 patients (56.5; 32.1–74.1; p<0.01). Unplanned admission occurred in 3 patients in C3 with AFEQT scores of <40. Although 65 patients had AF symptoms during the pandemic, 43.1% did not seek help where they ordinarily would have. An exercise frequency of ≥3–4 times a week was associated with higher AFEQT (56.5; 41.2–74.1; p<0.001) and EQ5D (0.84; 0.74–0.88; p<0.0001) scores.

Conclusion

The QoL of patients awaiting AF ablation is impaired and AFEQT helps to identify patients at risk of admission, over and above physician assessment. COVID-19 influenced patients seeking medical attention with symptomatic AF when they normally would. Regular exercise is associated with better QoL in patients awaiting AF ablation.

Development of Kaya Slice (coconut jam slice): evaluation of physicochemical, sensory evaluation and macronutrients composition when cooperated with gelatin

Kaya Slice is a nutritious traditional breakfast-on-the-go that was innovated from the traditional kaya. In this study, the traditional kaya was transformed into square shape gelatin to make it a more convenient and ready-to-eat breakfast. A total of six formulations were developed by using commercial and fresh coconut milk together with different percentages of gelatin (2%, 4%, and 6%). This insight was investigated by sensory evaluation using a 9-point hedonic and scoring test in descriptive data set. The best formulation obtained from the evaluation of 35 panellists was then characterized in terms of physicochemical properties (Texture Profile Analysis (firmness), Brix, Protein, Fat, Fiber, and Calories). From the descriptive data, all formulations were accepted by the panellist. Nevertheless, ANOVA analysis indicated that C2 (commercial coconut milk + 4% of gelatin) is the best formulation. In macronutrient analysis, Kaya Slice was found to have good dietary fibre content (0.11 g/100 g), high-fat content (0.49 g/100 g), protein content (0.32 g/100 g) compare to the commercial kaya (0.00 g/100 g), (1.00 g/100 g), and (0.00 g/100 g) respectively. Low-calorie content in Kaya Slice with 45 % of °Brix value is the minimal degree of Brix and the texture was softer (hardness) (significantly different (p<0.05)) to commercially processed cheese slice as standard. Overall, Kaya Slice has a great potential in becoming new emergent of traditional nutritious breakfast on the go.

Green synthesis of gold nanaoparticles using Delphinium Chitralense tuber extracts, their characterization and enzyme inhibitory potential

Green synthesis has been introduced as an alternative to chemical synthesis due to the serious consequences. Metal nanoparticles synthesized through green approach have different pharmaceutical, medical and agricultural applications. The present study followed a green and simple route for the preparation of potentially bioactive gold nanoparticles (Au NPs). Au NPs were prepared via green synthesis approach using crude basic alkaloidal portion of the tuber of Delphinium chitralense. The green synthesized Au NPs were characterized by transmission electron microscopy (TEM), scanning electron microscopy (SEM), X-ray diffraction (XRD) fourier transform infrared (FTIR), and UV-Visible spectrophotometer. Morphological analysis shows that Au NPs have cubic geometry with different sizes. UV-Vis spectroscopic analysis confirmed the synthesis of Au NPs while XRD proved their pure crystalline phase. The Au NPs showed promising dose dependent inhibition of both AChE and BChE as compared to the crude as well as standard drug.

Impact of mesoporous SiO2 support for Ni/polypyrrole nanocomposite particles on their capacitive performance

The inclusion of mesoporous H2N-SiO2 support in H2N-SiO2/Ni/PPy nanocomposite particles improved their electrochemical performance, suitable for energy storage devices.

Integrated de novo Analysis of Transcriptional and Metabolic Variations in Salt-Treated Solenostemma argel Desert Plants

Solenostemma argel (Delile) Hayne is a desert plant that survives harsh environmental conditions with several vital medicinal properties. Salt stress is a major constraint limiting agricultural production around the globe. However, response mechanisms behind the adaptation of S. argel plants to salt stress are still poorly understood. In the current study, we applied an omics approach to explore how this plant adapts to salt stress by integrating transcriptomic and metabolomic changes in the roots and leaves of S. argel plants under salt stress. De novo assembly of transcriptome produced 57,796 unigenes represented by 165,147 transcripts/isoforms. A total of 730 differentially expressed genes (DEGs) were identified in the roots (396 and 334 were up- and down-regulated, respectively). In the leaves, 927 DEGs were identified (601 and 326 were up- and down-regulated, respectively). Gene ontology and Kyoto Encyclopedia of Genes And Genomes pathway enrichment analyses revealed that several defense-related biological processes, such as response to osmotic and oxidative stress, hormonal signal transduction, mitogen-activated protein kinase signaling, and phenylpropanoid biosynthesis pathways are the potential mechanisms involved in the tolerance of S. argel plants to salt stress. Furthermore, liquid chromatography-tandem mass spectrometry was used to detect the metabolic variations of the leaves and roots of S. argel under control and salt stress. 45 and 56 critical metabolites showed changes in their levels in the stressed roots and leaves, respectively; there were 20 metabolites in common between the roots and leaves. Differentially accumulated metabolites included amino acids, polyamines, hydroxycinnamic acids, monolignols, flavonoids, and saccharides that improve antioxidant ability and osmotic adjustment of S. argel plants under salt stress. The results present insights into potential salt response mechanisms in S. argel desert plants and increase the knowledge in order to generate more tolerant crops to salt stress.

The role of far-field intravascular ultrasound in transcatheter aortic valve replacement

Precise and accurate characterization of the aortic valve complex is a vital step in the procedure planning for transcatheter aortic valve replacement (TAVR). Far-field intravascular ultrasound (IVUS) is a novel technology that can be utilized to assess aortic valve annulus and predict paravalvular leak, with comparable results to multi-detector computed tomography-the current gold standard in the preprocedural planning in TAVR. Far-field IVUS carries the advantage of minimal contrast use and lower radiation exposure. In this commentary, we describe two cases of far-field IVUS use during TAVR procedures and review its role as a complementary tool to current the imaging modalities used in TAVR.

Safety and efficacy of cerebral embolic protection devices in patients undergoing transcatheter aortic valve replacement: a meta-analysis of in-hospital outcomes

The evidence regarding the impact of cerebral embolic protection devices (EPDs) on outcomes following transcatheter aortic valve replacement (TAVR) is limited. The objective of this study was to evaluate in-hospital outcomes with the use of cerebral EPDs in TAVR. We performed a comprehensive EMBASE and PUBMED search to investigate randomized control studies or propensity score-matched retrospective studies which assessed patients undergoing TAVR with or without EPD up to April 2021. Endpoints of interest were in-hospital mortality, stroke, acute kidney injury, pacemaker implantation, major bleeding, vascular complication, length of stay. Ten studies involving 173,002 patients with EPD (n = 16,898, 9.8%) and those without (n = 156,104, 90.2%) fulfilled the inclusion criteria. The use of EPD was associated with significantly lower risk of in-hospital stroke (odds ratio [95% confidential interval]: 0.64 [0.46; 0.89]), but similar rate of in-hospital mortality (odds ratio [95% confidential interval]: 0.75 [0.54; 1.05]). No differences were observed in acute kidney injury, pacemaker implantation, major bleeding, vascular complication, length of stay. EPD during TAVR was associated with lower in-hospital stroke but did not affect procedural complications and length of stay.

Vancomycin conjugated iron oxide nanoparticles for magnetic targeting and efficient capture of Gram-positive and Gram-negative bacteria

Drug conjugated iron oxide magnetite (Fe₃O₄) nanoparticles are of great interest in the field of biomedicine. In this study, vancomycin (Van) conjugated magnetite (Fe₃O₄) nanoparticles were envisioned to capture and inhibit the growth of bacteria. Hydrophobic Fe₃O₄ nanoparticles were synthesized by using co-precipitation of ferrous (Fe²⁺) and ferric (Fe³⁺) ions following a surface modification step with oleic acid as stabilizers. Thereafter, a ligand exchange technique was employed to displace oleic acid with hydrophilic dopamine (DOPA) molecules which have a catechol group for anchoring to the iron oxide surface to prepare water dispersible nanoparticles. The surface of the resulting Fe₃O₄/DOPA nanoparticles contains amino (–NH₂) groups that are conjugated with vancomycin via a coupling reaction between the –NH₂ group of dopamine and the –COOH group of vancomycin. The prepared vancomycin conjugated Fe₃O₄/DOPA nanoparticles were named Fe₃O₄/DOPA/Van and exhibited a magnetic response to an external magnetic field due to the presence of magnetite Fe₃O₄ in the core. The Fe₃O₄/DOPA/Van nanoparticles showed bactericidal activity against both Gram positive Bacillus subtilis (B. subtilis) and Streptococcus and Gram-negative bacteria Escherichia coli (E. coli). Maximum inhibition zones of 22 mm, 19 mm and 18 mm were found against B. subtilis, Streptococcus and E. coli respectively. Most importantly, the vancomycin conjugated nanoparticles were effectively bound to the cell wall of the bacteria, promoting bacterial separation and growth inhibition. Therefore, the prepared Fe₃O₄/DOPA/Van nanoparticles can be promising for effective bacterial separation and killing in the dispersion media.

(a) The separation of bacteria by vancomycin conjugated Fe₃O₄/DOPA/Van nanoparticles and (b) H-bonding interactions between the vancomycin molecule and the d-alanyl-d-alanine dipeptide of the bacterial surface.

2 μm passively mode-locked thulium-doped fiber lasers with Ta2AlC-deposited tapered and side-polished fibers

In this work, mode-locked thulium-doped fiber lasers operating in the 2 µm wavelength region were demonstrated using tantalum aluminum carbide (Ta2AlC)-based saturable absorbers (SAs) utilizing the evanescent wave interaction. The Ta2AlC MAX Phase was prepared by dissolving the Ta2AlC powder in isopropyl alcohol and then deposited onto three different evanescent field-based devices, which were the tapered fiber, side-polished fiber, and arc-shaped fiber. Flame-brushing and wheel-polishing techniques were used to fabricate the tapered and arc-shaped fibers, respectively, while the side-polished fiber was purchased commercially. All three SA devices generated stable mode-locked pulses at center wavelengths of 1937, 1931, and 1929 nm for the tapered, side-polished, and arc-shaped fibers. The frequency of the mode-locked pulses was 10.73 MHz for the tapered fiber, 9.58 MHz for the side-polished fiber, and 10.16 MHz for the arc-shaped fiber. The measured pulse widths were 1.678, 1.734, and 1.817 ps for each of the three SA devices. The long-term stability of the mode-locked lasers was tested for each configuration over a 2-h duration. The lasers also showed little to no fluctuations in the center wavelengths and the peak optical intensities, demonstrating a reliable, ultrafast laser system.

From Muscles to Wires: Report of Two Cases and Literature Review on COVID-19 Vaccination and Cardiac Conduction Disturbance

Since the end of 2020, several vaccines have become available as part of the global efforts to contain the adverse health outcomes of the coronavirus disease 2019 (COVID-19) pandemic. Although research has confirmed their safety on large scales, several post-marketing reports have revealed some rare cardiovascular side effects. Towards the end of the first half of 2021, multiple reports indicate possible links between COVID-19 vaccines (both mRNA-based vaccine and vector-based vaccines) and myopericarditis. Nevertheless, cardiac conduction disease in this context has only rarely been reported. In this report, we present two cases of probable vaccination-induced cardiac conduction disturbances along with a thorough literature review. In addition, we discuss probable pathophysiological mechanisms and insights into the suggested areas for future research. To our knowledge, these are the first published cases to result in permanent pacemaker implantation.

Larvicidal efficacy of temephos impregnated onto kenaf cellulose nanofibre to control Aedes aegypti (Diptera: Culicidae) larvae

Larviciding is an effective control method in managing mosquito-borne diseases. However, most of the current larvicide formulations have raised environmental concerns due to the presence of non-biodegradable inert or carrier materials. Therefore, the utilisation of biodegradable natural cellulosic fibres has created much attention. This study aims to evaluate the application of biodegradable kenaf cellulose nanofibre (KCNF) in larvicide formulation where the larvicide, namely temephos, is impregnated onto the fibre matrix (KCNF+T). The bioefficacy of the formulation was evaluated against Aedes aegypti ( A. aegypti) mosquito larvae. The presence of the temephos on the KCNF was evaluated through micro- morphological analysis using a field emission scanning electron microscope (FESEM) and a transmission electron microscope (TEM), while the quantity of temephos impregnated, released, and retained on the fibres upon dispersion in water were determined using high performance liquid chromatography (HPLC). It was observed that 97% of the temephos (0.1 mg) were impregnated on the KCNF. Upon dispersion in water, 53% of the temephos were released from the KCNF+T and the retention of temephos on the KCNF+T gradually decreased to 30%, 17%, and 7% on the first, third, and fifth month, respectively. Exposure of the A. aegypti larvae to the KCNF+T at concentrations ranging between 0.006 to 0.01 mg/L was effective in killing A. aegypti larvae at 17-25 folds as compared to using the temephos without KCNF. Microscopic examination revealed the accumulation of the KCNF on the larval appendages. In conclusion, this study demonstrated that the utilisation of KCNF in pesticide formulation is an effective way of delivering the temephos to control A. aegypti mosquito larva.

Women's mobility and transport in the peripheries of three African cities: Reflecting on early impacts of COVID-19

This paper reflects on the mobility experiences of women in African cities in COVID-19, based on research conducted both prior to and following entry into the COVID-19 'moment'. It draws on material collected during an ongoing action research study aimed at addressing the everyday transport and mobility challenges faced by young women living in poor peripheral communities of three African cities - Abuja, Cape Town and Tunis. The project has the specific objective of supporting young women's improved access to employment opportunities through trialling various mobility/transport-related skills interventions (based on prior in-depth analysis of mobility constraints). With the onset of COVID-19 some readjustments to the research focus and planned interventions became necessary. The research teams, together with an NGO partner, are now working to chart how young women's everyday experiences of mobility and transport - both as transport users and as transport sector workers - are changing as processes of lockdown and their relaxation evolve. The paper covers the period from early 2019 through to March 2021, and offers reflections regarding 'lived experiences' of mobility practice pre-pandemic, during the pandemic, and the potential longer-term mobility-related impacts for women resident in low-income neighbourhoods in a post-COVID-19 era. This leads to consideration of key policy lessons. There is potential for prioritisation of Non-Motorised Transport interventions towards a green restart that would benefit women (for instance through promoting women's cycling), and for growing women's participation as transport operators, even perhaps the usage of drones to aid women's safer pedestrian travel. But such interventions will require far greater representation of women in COVID-19 and wider transport decision-making entities than has hitherto been the case.

Antioxidative and Metabolic Contribution to Salinity Stress Responses in Two Rapeseed Cultivars during the Early Seedling Stage

Measuring metabolite patterns and antioxidant ability is vital to understanding the physiological and molecular responses of plants under salinity. A morphological analysis of five rapeseed cultivars showed that Yangyou 9 and Zhongshuang 11 were the most salt-tolerant and -sensitive, respectively. In Yangyou 9, the reactive oxygen species (ROS) level and malondialdehyde (MDA) content were minimized by the activation of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) for scavenging of over-accumulated ROS under salinity stress. Furthermore, Yangyou 9 showed a significantly higher positive correlation with photosynthetic pigments, osmolyte accumulation, and an adjusted Na⁺/K⁺ ratio to improve salt tolerance compared to Zhongshuang 11. Out of 332 compounds identified in the metabolic profile, 225 metabolites were filtrated according to p < 0.05, and 47 metabolites responded to salt stress within tolerant and sensitive cultivars during the studied time, whereas 16 and 9 metabolic compounds accumulated during 12 and 24 h, respectively, in Yangyou 9 after being sown in salt treatment, including fatty acids, amino acids, and flavonoids. These metabolites are relevant to metabolic pathways (amino acid, sucrose, flavonoid metabolism, and tricarboxylic acid cycle (TCA), which accumulated as a response to salinity stress. Thus, Yangyou 9, as a tolerant cultivar, showed improved antioxidant enzyme activity and higher metabolite accumulation, which enhances its tolerance against salinity. This work aids in elucidating the essential cellular metabolic changes in response to salt stress in rapeseed cultivars during seed germination. Meanwhile, the identified metabolites can act as biomarkers to characterize plant performance in breeding programs under salt stress. This comprehensive study of the metabolomics and antioxidant activities of Brassica napus L. during the early seedling stage is of great reference value for plant breeders to develop salt-tolerant rapeseed cultivars.

Prevalence of active HCV infection and genotypic distribution among the general population of district Mardan, Pakistan

Hepatitis C virus (HCV) is the serious global public health burden of liver disease. Approximately 170 million people in the world are infected with (HCV). In Pakistan, where the disease has high occurrence rate. The present study envisages an up-to-date prevalence of HCV and genotypic distribution in the general population of Mardan District, Khyber Pakhtunkhwa (KP), Pakistan. The blood samples from 6,538 individuals including 3,263 males and 3,275 females were analyzed for hepatitis C surface antigen by Immuno-chromatographic test (ICT), Enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction (PCR). It was found that 396 (12.13%) out of 3263 individuals contained antibodies in their blood against HCV, while among the different age groups, the highest incidences of HCV antibodies were found in the 31-40 age group (11.01%). The ICT positive samples were further screened by nested PCR to determine the existence of active HCV-RNA. It was identified that 7.11% (3263) of the total population (6538) tested was positive, among which the 461 (14.07%) females possessed antibodies in their blood against HCV. Our data showed total HCV infection in the investigated population was 5.78%. Higher percentage of HCV prevalence was detected in males than females in the age group 31-40 and 41-50. To compare the prevalence of HCV genotypes age-wise in male and female genotype 3a was found most prevalent genotype followed by 1a, 2a and 3b, respectively.

Radial vs. Femoral Access for Percutaneous Coronary Artery Intervention in Patients With ST-Elevation Myocardial Infarction

BACKGROUND

We aimed to compare the safety and efficacy of transradial vs transfemoral access for coronary angiography and intervention in patients presenting with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock.

METHODS

PubMed, Embase and Cochrane Central were searched for randomized controlled trials (RCTs) comparing outcomes of STEMI patients who underwent transradial angiography (TRA) compared to transfemoral angiography (TFA). Our outcomes of interest were major adverse cardiac events (MACE), all-cause mortality, severe bleeding, access site bleeding, myocardial infarction, stroke, and major vascular complications. Summary statistics are reported as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

In a pooled analysis of 17 RCTs with 12,118 randomized patients, the use of transradial compared to transfemoral approach in STEMI patients without cardiogenic shock was associated with a significant reduction in MACE [OR 0.85 (95% CI 0.73-0.99; p = 0.04; NNT = 111; I² = 0%)] and all-cause mortality [OR 0.71 (95% CI 0.57-0.88; p < 0.01; NNT = 111; I² = 0%)]. Severe bleeding [OR 0.57 (95% CI 0.44-0.74; p < 0.01; NNT = 77; I² = 0%)], access-site bleeding [OR 0.39 (95% CI 0.26-0.59; p < 0.01; NNT = 67; I² = 24%)], and major vascular complications [OR of 0.31 (95% CI 0.17-0.55; p < 0.01; NNT = 125; I² = 0%)] were lower in TRA compared to TFA. There was no difference in stroke (0.6% vs 0.5%) or recurrent myocardial infarction (2.01% vs 2.02%) between the two approaches.

CONCLUSIONS

For coronary intervention in STEMI patients without cardiogenic shock, there is a clear mortality benefit with the TRA over TFA. Further studies are needed to see if this mortality benefit persists over the long-term.