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Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention.
Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding.
Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629. The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290).
Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal.
Keywords: Femoral; percutaneous coronary intervention; radial

BACKGROUND: Many military veterans in the United States with coronary artery disease continue to smoke despite undergoing percutaneous coronary intervention (PCI). Previous studies have described improved cardiovascular outcomes in smokers, the so‐called "smokers' paradox." In this study, we examined the effects of smoking on cardiovascular outcomes following PCI. HYPOTHESIS: Do patients who smoke have different post‐PCI outcomes than nonsmokers? METHODS: All patients who underwent PCI at a single US Veterans Administration hospital from 2004 to 2009 were followed. Outcomes of interest included myocardial infarction, unplanned coronary intervention, unplanned cardiac hospitalization, death, and a composite of events for 6 months after PCI. Changes in traditional risk factors were also assessed. RESULTS: Unadjusted analysis revealed that in almost all categories, smokers had lower incidence of adverse events than nonsmokers. However, after adjusting for the older age of the nonsmokers, no favorable statistical trend toward smokers was seen. Significant improvement in blood pressure and lipid levels were seen in both groups. CONCLUSIONS: After adjusting for differences in age, there did not appear to be any protective effect of smoking on cardiovascular outcomes following PCI. Smokers achieved similar degrees of risk factor optimization during the follow‐up period as their nonsmoker counterparts. Aggressive efforts to decrease the prevalence of smoking must be maintained.

Coronary heart disease is a degenerative disease. One of the techniques that can open blood vessels and return blood through the coronary arteries is Percutaneous Coronary Intervention (PCI). Hemodynamic conditions are one of the patient's preparations for PCI, but anxiety can respond to the cardiovascular system, one of which is a disturbance in a person's hemodynamics. Problems that often arise in pre PCI patients are anxiety.Percutaneous Coronary Intervention is one of the techniques that have been invented to open the blood vessels and return blood through the coronary arteries (PCI). PCI, also known as cardiac catheterization, is a procedure that involves inserting one or more catheters into the heart and blood arteries. The catheter is inserted through a peripheral vessel, usually femoral, then non-operatively invasive so that complications can be kept as low as possible. Percutaneous Coronary Intervention (PCI) can cause complications in the form of myocardial infarction, stroke, arrhythmia and death. This causes a person to feel himself threatened, someone feels himself threatened can cause the effect of Anxiety (anxiety). The problem that often arises in pre PCI patients is anxiety. One of the efforts to overcome anxiety is the Emotional Freedom Technique (EFT). This type of research is a quantitative study using a quasi-experimental design with a pretest-posttest with a control group, namely by conducting a pretest in both groups and followed by an intervention in the experimental group and then conducting a posttest in both groups, with a sample of 34 respondents. The results showed that the effect of EFT on the anxiety of pre PCI patients in the intervention group with p-value = 0.000, while in the control group with p-value = 0.650. Furthermore, it is hoped that clients who will undergo PCI will not be hindered from doing PCI because the client has been given Emotional Freedom Technique (EFT) therapy.

Abstract
Coronary artery chronic total occlusions (CTO) are common — approximately one-third of patients with significant coronary artery disease on angiography have at least 1 CTO. Invasive treatment of these lesions still remain a major challenge for interventional cardiology due to their complexity. Historically, success rates have improved to about 60–70% by using only the traditional antegrade approach. The results have dramatically improved during the last decade after more widespread application of new retrograde techniques. The aim of our study was to review and analyse single hospital experience in CTO invasive treatment and to evaluate the long-term results. A total of 519 patients undergoing percutaneous coronary interventions (PCI) for CTO at a single tertiary PCI centre (Rīga East University Hospital), were included in the study. The median age was 64 years (38–88), and 80% were male. The retrograde approach (RA) was used for 167 (32.2%) of the CTO PCI patients. The overall patient success rate was 81.3% and it increased from 73.9% in 2007 to 95.2% in 2015 (p < 0.001). Mean patient observation time was five years. Overall survival was found significantly better in patients group after successful CTO PCI procedures (Long-rank test, p = 0.013).

An in-depth understanding of psychological symptoms and mindfulness of men and women with percutaneous coronary intervention (PCI) may help develop sex-specific treatments and outcomes. This study aimed to examine differences in depression, anxiety, stress, and mindfulness between men and women undergoing PCI using a convenience sample of 114 participants (81 men and 33 women) with PCI at a university hospital in 2013. The Depression Anxiety Stress Scales and the Korean version of the Mindfulness Attention Awareness Scale were administered. The depression, anxiety, and stress scores of women were higher than those of men, with no significant differences in mindfulness between the two sexes. The comparison of cutoff scores for severity (normal scores vs. ≥ mild) of depression, anxiety, and stress for men versus women revealed a higher proportion of women in the ≥ mild categories for the three components. Women who received PCI showed greater psychological distress than men. Therefore, awareness of these differences may alert cardiovascular nurses to employ systematic vigilance in assessing and mitigating this distress among cardiac patients, particularly women.

BackgroundThough past studies have shown wide variation in aggregate hospital price indices and specific procedures, few have documented or explained such variation for distinct and common episodes of care.ObjectivesWe sought to examine the variability in charges for percutaneous coronary intervention (PCI) with a drug-eluting stent and without major complications (MS-DRG-247), and determine whether hospital and market characteristics influenced these charges.MethodsWe conducted a cross-sectional analysis of adults admitted to California hospitals in 2011 for MS-DRG-247 using patient discharge data from the California Office of Statewide Health Planning and Development. We used a two-part linear regression model to first estimate hospital-specific charges adjusted for patient characteristics, and then examine whether the between-hospital variation in those estimated charges was explained by hospital and market characteristics.ResultsAdjusted charges for the average California patient admitted for uncomplicated PCI ranged from $22,047 to $165,386 (median: $88,350) depending on which hospital the patient visited. Hospitals in areas with the highest cost of living, those in rural areas, and those with more Medicare patients had higher charges, while government-owned hospitals charged less. Overall, our model explained 43% of the variation in adjusted charges. Estimated discounted prices paid by private insurers ranged from $3,421 to $80,903 (median: $28,571).ConclusionsCharges and estimated discounted prices vary widely between hospitals for the average California patient undergoing PCI without major complications, a common and relatively homogeneous episode of care. Though observable hospital characteristics account for some of this variation, the majority remains unexplained.

Background: Though past studies have shown wide variation in aggregate hospital price indices and specific procedures, few have documented or explained such variation for distinct and common episodes of care. Objectives: We sought to examine the variability in charges for percutaneous coronary intervention (PCI) with a drugeluting stent and without major complications (MS-DRG-247), and determine whether hospital and market characteristics influenced these charges. Methods: We conducted a cross-sectional analysis of adults admitted to California hospitals in 2011 for MS-DRG-247 using patient discharge data from the California Office of Statewide Health Planning and Development. We used a two-part linear regression model to first estimate hospital-specific charges adjusted for patient characteristics, and then examine whether the between-hospital variation in those estimated charges was explained by hospital and market characteristics. Results: Adjusted charges for the average California patient admitted for uncomplicated PCI ranged from $22,047 to $165,386 (median: $88,350) depending on which hospital the patient visited. Hospitals in areas with the highest cost of living, those in rural areas, and those with more Medicare patients had higher charges, while government-owned hospitals charged less. Overall, our model explained 43% of the variation in adjusted charges. Estimated discounted prices paid by private insurers ranged from $3,421 to $80,903 (median: $28,571). Conclusions: Charges and estimated discounted prices vary widely between hospitals for the average California patient undergoing PCI without major complications, a common and relatively homogeneous episode of care. Though observable hospital characteristics account for some of this variation, the majority remains unexplained. © 2014 Hsia et al.

Importance of the Exercise Test Follow-up Programme for Patients with Coronary Artery Disease who Underwent Percutaneous Coronary Intervention
The clinical course and prognosis of coronary heart disease (CHD) can be modified favourably with percutaneous coronary intervention (PCI) in combination with medication. A follow-up programme was developed in the Latvian Centre of Cardiology, which included a stress electrocardiogram for patients after PCI. This is the first study in Latvia, and provides wide opportunities to evaluate functional status of patients, treatment effectiveness, possible risks and prognosis after PCI. Exercise tests are widely used for the evaluation and diagnostics of CHD. This method has been successfully implemented in diagnostics of restenosis in coronary arteries, a process which pathophysiologically differs from primary atherosclerosis. A total of 7,300 patients with CHD were followed-up in one year after PCI. An exercise test was conducted one, three, six and twelve months after PCI. Clinical and functional status of patients and risk of restenosis were evaluated and corrections in medications were made. Seventeen percent of patients had chest pain and 13% had significant ST-segment changes in electrocardiogram. Restenosis of coronary arteries in angiography were established in 6.4%. In half of those patients above restenosis was diagnosed early — three to six months after PCI. We established a patient subgroup (22%) with "silent" ischemia (positive exercise test without chest pain), out of whom 41% had restenosis. For left main (LM) disease patients 50% of all restenosis diagnoses also were diagnosed early (three to six month after PCI). Restenosis was associated with ST-segment deviation in the exercise electrocardiogram. A lower Robinson index (RI) was registered in the same group of patients. A focussed follow-up programme performing exercise test allows to determine timely possible risk of restenosis, to adapt medication doses, to reduce risk factors and to influence positively patients' compliance.

Funding Information: I would like to thank the Deutsche Forschungsgemeinschaft (DFG) for the financial support of our conference. Part of the funding for the conference also came from the European Union's Horizon 2020 research and innovation program (RISE) under the Marie Skłodowska‐Curie grant agreement No. 101008129 ( project acronym "Mycobiomics"). Last but not least, I would like to thank Mr. Georg Schabel for the nice photographs that he took during the meeting. ; Peer reviewed ; Publisher PDF

This article belongs to the Special Issue Novel Biomarkers for Heart Disease. ; Restoration of epicardial coronary blood flow, achieved by early reperfusion with primary percutaneous coronary intervention (PPCI), is the guideline recommended to treat patients with ST-segment-elevation myocardial infarction (STEMI). However, despite successful blood restoration, increasing numbers of patients develop left ventricular adverse remodelling (LVAR) and heart failure. Therefore, reliable prognostic biomarkers for LVAR in STEMI are urgently needed. Our aim was to investigate the role of circulating microRNAs (miRNAs) and their association with LVAR in STEMI patients following the PPCI procedure. We analysed the expression of circulating miRNAs in blood samples of 56 patients collected at admission and after revascularization (at 3, 6, 12 and 24 h). The associations between miRNAs and left ventricular end diastolic volumes at 6 months were estimated to detect LVAR. miRNAs were also analysed in samples isolated from peripheral blood mononuclear cells (PBMCs) and human myocardium of failing hearts. Kinetic analysis of miRNAs showed a fast time-dependent increase in miR-133a, miR-133b, miR-193b, miR-499, and miR-320a in STEMI patients compared to controls. Moreover, the expression of miR-29a, miR-29b, miR-324, miR-208, miR-423, miR-522, and miR-545 was differentially expressed even before PPCI in STEMI. Furthermore, the increase in circulating miR-320a and the decrease in its expression in PBMCs were significantly associated with LVAR and correlated with the expression of miR-320a in human failing myocardium from ischaemic origin. In conclusion, we determined the time course expression of new circulating miRNAs in patients with STEMI treated with PPCI and we showed that miR-320a was positively associated with LVAR. ; This research was funded by the Institute of Carlos III [grant numbers: PI18/01197; PI15/00203; CB16/11/00431]; the Spanish Ministry of Economy and Competitiveness [grant number: BFU2016-74932-C2]; and the Andalusia Government [grant number: PI-0313-2016]. This study was co-financed by FEDER Funds.

Background: Although current guidelines recommend that primary percutaneous intervention (PCI) should be performed for ST-elevation myocardial infarction (STEMI), accessibility to this important health care service for severe heart emergency among floating population in Guangzhou remains largely unstudied and poorly understood. This retrospective study explored the variations in the odds of receiving primary PCI for STEMI patients among floating population and residential population in Guangzhou. Methods: Study data were collected from the First People's Municipal Hospital of Guangzhou to conduct a cross-sectional study of 1,216 patients with STEMI (code 410 of ICD-9) for the period from 2009 to 2014. Data in this study, including demographic and clinical characteristics, invasive treatment and pre-hospital delay time, was retrieved from electronic medical record system developed in 2005 and maintain a comprehensive electronic record of all patients of hospital. Chi-square test was performed to evaluate the differences in demographic characteristics and coexisting condition among STEMI patients between floating population and residential population. Differences in receipt primary PCI, pre-hospital delay time and door-toballoon time between two population groups were evaluated by a binary logistic regression model. To evaluate the performance odds, I adjusted for age, gender, and coexisting conditions. Data of the study was analysed using the SPSS 21 package software. Result: Compare to residential population, STEMI patients in floating population were less likely to receive primary PCI ( 20.5% vs 26.3%, P=0.049). On adjusting for sex, age and coexisting conditions, the odds of receipt primary PCI for STEMI patients in floating population was lower than residential population (floating population, OR=0.63, 95% CI=0.45-0.88; residential population, OR=1.0). More pre-hospital delays of STEMI patients undergoing primary PCI were found in floating population, the odds of delay time >6 hours was higher than residential population ( OR=4.27, 95% CI=1.49-12.24). There was no statistical difference in door-to-balloon time >90 minutes between two population groups (OR=1.61, 95% CI=0.60-4.32). Conclusion: Patients with STEMI in Guangzhou floating population were less likely to receive primary PCI. Policy interventions including government subsidy on severe disease in population, pilot medical insurance schemes, and transferability of insurance payment cross provinces are needed to increase the accessibility to emergency severe health care for STEMI patients in floating population. Additionally, an educational program on early symptoms and rapid response of STEMI should be established to increase the awareness at national level, especially in floating population. ; published_or_final_version ; Public Health ; Master ; Master of Public Health