Cardiology 2013 (Full reference info)
March 9, 2014
Reference Type: Journal Article
Record Number: 606Author: Bakris, G. L.
Title: Interventional cardiology: Indications for renal denervation: a balanced approach?
Journal: Nat Rev Cardiol
Short Title: Interventional cardiology: Indications for renal denervation: a balanced approach?
Alternate Journal: Nature reviews. Cardiology
ISSN: 1759-5010 (Electronic)
Accession Number: 23736520
Keywords: Antihypertensive Agents/therapeutic use
*Blood Pressure/drug effects
Practice Guidelines as Topic
Abstract: Renal denervation for the treatment of resistant hypertension is approved in Europe and is being studied in the USA. A newly published ESC consensus document integrates all the published data on this procedure, and summarizes how best to define, evaluate, and follow up patients who are candidates for the procedure.
Notes: Bakris, George L
Nat Rev Cardiol. 2013 Aug;10(8):434-6. doi: 10.1038/nrcardio.2013.85. Epub 2013 Jun 4.
Reference Type: Journal Article
Record Number: 741Author: Balwanz, C. R., Javed, U., Singh, G. D., Armstrong, E. J., Southard, J. A., Wong, G. B., Yeo, K. K., Low, R. I., Laird, J. R., Jr. and Rogers, J. H.
Title: Transradial and transfemoral coronary angiography and interventions: 1-year outcomes after initiating the transradial approach in a cardiology training program
Journal: Am Heart J
Short Title: Transradial and transfemoral coronary angiography and interventions: 1-year outcomes after initiating the transradial approach in a cardiology training program
Alternate Journal: American heart journal
ISSN: 1097-6744 (Electronic)
Accession Number: 23453098
Coronary Angiography/adverse effects/*methods
Percutaneous Coronary Intervention/adverse effects/*methods
Abstract: BACKGROUND: Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs. METHODS: From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods. RESULTS: A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35%) of the CAs and in 72 (28%) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 +/- 6.0 vs 11.0 +/- 8.9, P = .63) or procedure (31.8 +/- 11.5 vs 33.2 +/- 13.8, P = .55) time throughout the academic year with a significant trend toward lower contrast use (128 +/- 52 vs 110 vs 50, P = .04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 +/- 8.9 vs 6.7 +/- 6.8, P = .001) and procedure (33.2 +/- 13.8 vs 27.2 +/- 11.6, P = .0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups. CONCLUSION: A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.
Notes: Balwanz, Christopher R
Singh, Gagan D
Armstrong, Ehrin J
Southard, Jeffrey A
Wong, Garrett B
Yeo, Khung Keong
Low, Reginald I
Laird, John R Jr
Rogers, Jason H
Am Heart J. 2013 Mar;165(3):310-6. doi: 10.1016/j.ahj.2012.10.014. Epub 2012 Nov 17.
Author Address: Division of Cardiovascular Medicine, University of California, Sacramento, CA, USA.