A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention. (1st June 2015)

• Record Type: Journal Article
• Authors: Giannopoulos, Georgios; Raisakis, Konstantinos; Synetos, Andreas; Davlouros, Periklis; Hahalis, George; Alexopoulos, Dimitrios; Tousoulis, Dimitrios; Lekakis, John; Stefanadis, Christodoulos; Cleman, Michael W.; Deftereos, Spyridon
• Is Part Of: International journal of cardiology. Volume 188(2015)
• Page Start: 76
• Page End: 80
• Publication Date: 2015-06-01
• Subjects: PCI -- Transradial access -- Spasm -- Risk score -- Vascular access; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.04.024
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objective: Radial artery spasm may hinder completion of transradial angiography or PCI, leading to access site crossover, prolonged procedure times and complications. The aim of this study was to derive a radial artery spasm risk score in patients undergoing elective percutaneous coronary intervention (PCI), prospectively validate it, and apply it in a real-life clinical setting. Methods: The study population consisted of 3 cohorts of patients undergoing elective PCI with transradial access: the derivation cohort (N = 1006), the validation cohort (N = 576) and the intervention cohort (N = 140), consisting of patients with high risk score, in whom intensified spasm-preventive measures were applied. Results: Multivariable analysis in the derivation cohort showed that 5 weighted factors could be used to construct a risk score for spasm: body-mass index, height, current smoking, hypertension and peripheral artery disease (c-statistic 0.945, with an optimal cut-off of 4). In the validation cohort, the cut-off of 4 predicted spasm with a sensitivity of 84.5% and a specificity of 74.7%. In the intervention cohort, which included only patients with a spasm-risk score of ≥ 4, the rate of spasm was drastically reduced (odds ratio 0.32, 95% confidence interval 0.17–0.61), compared to the corresponding high spasm risk subgroup of patients of the validation cohort. Conclusion: A spasm risk score can be used to predict radial artery spasm during elective transradial PCI. Using this score, a high spasm risk patient subgroup can be identified, where intensive spasm-preventive measures can lead to a significant reduction in the frequency of spasm. Highlights: Radial artery spasm can complicate transradial interventions. A risk score of 5 weighted factors can be used to predict spasm. In particular: BMI, height, hypertension, smoking and peripheral artery disease High spasm risk patients can, thus, be selected and managed to avoid spasm.