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(HealthNewsDigest.com) – ANN ARBOR, Mich. – To relieve the crushing pain caused by a heart attack, interventional cardiologists perform a variety of procedures, called percutaneous coronary interventions, to restore blood flow in
diseased arteries.
But when it comes to choosing a catheter to reach those trouble spots
in the arteries, bigger is not better.
A study led by the University of Michigan showed patients who had
coronary interventions, such as angioplasty, performed with larger
catheters had significantly worse outcomes and higher death rates than
those who underwent the procedures with smaller catheters. Results of
the multi-hospital study will appear in the July 28 issue of the Journal
of American College of Cardiology Cardiovascular Interventions.
Death rates were more than 30 percent higher in patients who had
procedures with the larger 8F catheter than the smaller 6F catheter,
according to the study produced by 31 Michigan hospitals participating
in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Other complications such as kidney damage, need for blood transfusions,
and need for emergency open heart surgery were also significantly higher
among patients who had the larger catheter.
“While overall death rates associated with PCIs are still low, the
decision to use a smaller catheter significantly and independently
increases the chance for patient survival and decreases the likelihood
of other serious complications,” says lead author Paul Michael
Grossman, M.D., assistant professor in internal medicine at the U-M
Medical School and director of the VA Ann Arbor Cardiac Catheterization
Laboratory.
With more than 103,000 patients observed at Michigan hospitals over
five years, it’s one of the largest studies of its kind to look at
catheter size and complications from PCI.
The findings could guide choices made by cardiac specialists and
influence the development of devices designed to treat heart artery
disease.
A variety of interventionists were part of the study that tracked the
kinds of catheters used in PCIs. A PCI, sometimes referred to as balloon
angioplasty or stenting, may be performed after rushing to the hospital
following a heart attack, or as an elective surgery to unblock the
artery before a heart attack occurs.
A PCI is done by threading a balloon-tipped tube – called a catheter –
from the groin to an artery in the heart and the balloon inflated to
compress a build-up of fats, cholesterol and plague that reduce blood
flow, or block the artery completely. A metal stent is often left behind
to prop up the artery like scaffolding.
Data gathered for the study shows some cardiologists in the group
already prefer the smaller catheters because of their association with
fewer vascular complications and quicker post-PCI recovery. However a
significant number of interventionists use larger guide catheters
because of perceived ease of use and the recommendation of some medical
textbooks.
The study was funded by Blue Cross Blue Shield of Michigan.The BMC2 PCI
is a statewide collaborative effort focused on improving patient safety
and quality of care.
Additional authors: Hitinder S. Gurm, Richard McNamara, Thomas
LaLonde, Hameem Changezi, David Share, Dean E. Smith, Stanley J.
Chetcuti, and Mauro Moscucci, for the Blue Cross Blue Shield of Michigan
Cardiovascular Consortium.
Reference: Journal of the American College of Cardiology:
Cardiovascular Interventions; Vol. 2, No. 7, 2009.
Funding: Blue Cross Blue Shield of Michigan
Resources:
U-M Cardiovascular Center
http://www.med.umich.edu/cvc/
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