Percutaneous Coronary Intervention Complications and Guide Catheter Size. Bigger Is Not Better

P. Michael Grossman, Hitinder S. Gurm, Richard McNamara, Thomas LaLonde, Hameem Changezi, David Share, Dean E. Smith, Stanley J. Chetcuti, Mauro Moscucci

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI). Background: The association between guiding catheter size and complications of PCI in contemporary practice remains controversial. Methods: Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared. Results: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with incrementally more contrast agent use, and more post-PCI complications including contrast-induced nephropathy, vascular access site complications, bleeding, transfusion, major adverse cardiac event, and death. After multivariate analysis, the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18, p = 0.0004; 8-F OR: 1.44, p < 0.0001), vascular complications (7-F OR: 1.19, p = 0.0002, 8-F OR: 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR: 1.12, p < 0.0001, 8-F OR: 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR: 1.08, p = 0.03; 8-F OR: 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR: 1.06, p = 0.13; 8-F OR: 1.37, p < 0.0001) and in-hospital mortality (7-F OR: 1.11, p = 0.13; 8-F OR: 1.34, p = 0.03) were increased with 8-F but not 7-F guides. Conclusions: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with more contrast medium use, renal complications, bleeding, vascular access site complications, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.

Original languageEnglish
Pages (from-to)636-644
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume2
Issue number7
DOIs
StatePublished - Jul 1 2009

Fingerprint

Percutaneous Coronary Intervention
Catheters
Odds Ratio
Contrast Media
Blood Vessels
Hemorrhage
Hospital Mortality
Blood Transfusion
Dialysis
Multivariate Analysis
Kidney
Mortality

Keywords

  • coronary guide catheter size
  • coronary intervention complications
  • coronary intervention outcomes
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Grossman, P. M., Gurm, H. S., McNamara, R., LaLonde, T., Changezi, H., Share, D., ... Moscucci, M. (2009). Percutaneous Coronary Intervention Complications and Guide Catheter Size. Bigger Is Not Better. JACC: Cardiovascular Interventions, 2(7), 636-644. https://doi.org/10.1016/j.jcin.2009.05.012

Percutaneous Coronary Intervention Complications and Guide Catheter Size. Bigger Is Not Better. / Grossman, P. Michael; Gurm, Hitinder S.; McNamara, Richard; LaLonde, Thomas; Changezi, Hameem; Share, David; Smith, Dean E.; Chetcuti, Stanley J.; Moscucci, Mauro.

In: JACC: Cardiovascular Interventions, Vol. 2, No. 7, 01.07.2009, p. 636-644.

Research output: Contribution to journalArticle

Grossman, PM, Gurm, HS, McNamara, R, LaLonde, T, Changezi, H, Share, D, Smith, DE, Chetcuti, SJ & Moscucci, M 2009, 'Percutaneous Coronary Intervention Complications and Guide Catheter Size. Bigger Is Not Better', JACC: Cardiovascular Interventions, vol. 2, no. 7, pp. 636-644. https://doi.org/10.1016/j.jcin.2009.05.012
Grossman, P. Michael ; Gurm, Hitinder S. ; McNamara, Richard ; LaLonde, Thomas ; Changezi, Hameem ; Share, David ; Smith, Dean E. ; Chetcuti, Stanley J. ; Moscucci, Mauro. / Percutaneous Coronary Intervention Complications and Guide Catheter Size. Bigger Is Not Better. In: JACC: Cardiovascular Interventions. 2009 ; Vol. 2, No. 7. pp. 636-644.
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abstract = "Objectives: We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI). Background: The association between guiding catheter size and complications of PCI in contemporary practice remains controversial. Methods: Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared. Results: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with incrementally more contrast agent use, and more post-PCI complications including contrast-induced nephropathy, vascular access site complications, bleeding, transfusion, major adverse cardiac event, and death. After multivariate analysis, the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18, p = 0.0004; 8-F OR: 1.44, p < 0.0001), vascular complications (7-F OR: 1.19, p = 0.0002, 8-F OR: 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR: 1.12, p < 0.0001, 8-F OR: 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR: 1.08, p = 0.03; 8-F OR: 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR: 1.06, p = 0.13; 8-F OR: 1.37, p < 0.0001) and in-hospital mortality (7-F OR: 1.11, p = 0.13; 8-F OR: 1.34, p = 0.03) were increased with 8-F but not 7-F guides. Conclusions: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with more contrast medium use, renal complications, bleeding, vascular access site complications, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.",
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N2 - Objectives: We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI). Background: The association between guiding catheter size and complications of PCI in contemporary practice remains controversial. Methods: Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared. Results: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with incrementally more contrast agent use, and more post-PCI complications including contrast-induced nephropathy, vascular access site complications, bleeding, transfusion, major adverse cardiac event, and death. After multivariate analysis, the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18, p = 0.0004; 8-F OR: 1.44, p < 0.0001), vascular complications (7-F OR: 1.19, p = 0.0002, 8-F OR: 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR: 1.12, p < 0.0001, 8-F OR: 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR: 1.08, p = 0.03; 8-F OR: 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR: 1.06, p = 0.13; 8-F OR: 1.37, p < 0.0001) and in-hospital mortality (7-F OR: 1.11, p = 0.13; 8-F OR: 1.34, p = 0.03) were increased with 8-F but not 7-F guides. Conclusions: Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with more contrast medium use, renal complications, bleeding, vascular access site complications, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.

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