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Bertrand OF 201110
 

Radial Approach: An International Journey

Radial Approach: An International Journey

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    Bertrand OF 201110 Bertrand OF 201110 Presentation Transcript

    • Radial Approach: An International Journey ! Olivier F. Bertrand, MD, PhD Associate-Professor of Medicine, Laval University Adjunct-Professor, Department of Mechanical Engineering, McGill University Quebec Heart-Lung Institute DUKE TRANSRADIAL ADVANCED COURSE, 20 OCTOBER 2011Friday, October 21, 2011
    • Disclosures Research grants: Cordis, Eli-Lilly, Bristol- Myers-Squibb,GE Healthcare, Sanofi- Aventis, Eurocor Consultant: Cordis, Astra-Zeneca, Opsens Research-Scholar from Quebec Foundation for Health ResearchFriday, October 21, 2011
    • The PastFriday, October 21, 2011
    • Friday, October 21, 2011
    • COURTESY OF B FAURIE ANDJ MONSEGU, MD (PARIS, 2010) ADAPTED FROM S RAO, 2011Friday, October 21, 2011
    • PATIENT QUALITY OF LIFE SF-36 ONE WEEK POST-CATH (N=200) COOPER C ET AL. AM HEART J 1999;138:430-6Friday, October 21, 2011
    • PATIENT QUALITY OF LIFE > SCIAHBASI A ET AL. INT J CARDIOL 2009;137:199-205Friday, October 21, 2011
    • NURSING WORKLOAD AMOROSO G ET AL. EUR J CARDIOVASC NURS 2005;4:234-41Friday, October 21, 2011
    • MDs Quality of LifeFriday, October 21, 2011
    • N = 1107 75 countries 01-08-2010 BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
    • CAPUTO R ET AL. CCI 2011 (IN PRESS)Friday, October 21, 2011
    • Quebec Heart-Lung Institute 91-93% RADIAL FOR ANGIO AND PCI 1ST PTCA ALL PCI OPERATORS ALL OPERATORS ALL OPERATORS 7 FR 6 FR 6 FR 5-6 FR FEMORAL KIT 19G NEEDLE ADHOC PCI SAME-DAY DISCHARGE GB ADAPTED FROM TIZON-MARCOS H. ET AL. (2009)Friday, October 21, 2011
    • QHLI- RADIAL VS FEMORAL APPROACHES PER OPERATOR Radial (%) Femoral (%) 100 16 14 12 10 9 8 8 7 7 6 5 2 98 94 95 92 92 93 93 90 91 88 86 84 75 50 VARIATION IN RADIAL USE IN STEMI 25 AMONG 12 OPERATORS 0 JR SR BN CN EL GP RL LR GB JPD OG OBFriday, October 21, 2011
    • “Radialist” Feeling After Radial Access Failure...Friday, October 21, 2011
    • TRA NOT A RELIGION! BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
    • Published (Radial) 160 140 140 120 100 85 Kiemeneij F 80 54 60 51 52 Campeau L 47 49 45 40 29 24 26 15 17 14 20 8 1 0 0 1 1 2 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Friday, October 21, 2011
    • Meta-Analysis Ischemic outcomes: All-cause death and the combined incidence of Death-MI Bleeding included both standardized and study- specific definitions. Most definitions involved fatal or intracranial bleeding, bleeding associated with Hb drop ≥ 3 g/dl or ≥ 5 g/dl, or access-related bleeding requiring transfusion or surgery Transfusion rates Early (≤ 30 days)Friday, October 21, 2011
    • Studies Selection TOTAL OF 761,919 PATIENTSFriday, October 21, 2011
    • Impact on Bleeding RANDOMIZED OR 0.21 (95% CR I: 0.15-0.28) OR 0.27 (95% CR I: 0.08-0.47) OBSERVATIONALFriday, October 21, 2011
    • Impact on Transfusion RANDOMIZED OR 0.19 (95% CR I: 0.09-0.30) OBSERVATIONAL OR 0.25 (95% CR I: 0.01-1.07)Friday, October 21, 2011
    • Impact on Death (Early) RANDOMIZED OR 0.52 (95% CR I: 0.40-0.63) OBSERVATIONAL OR 0.80 (95% CR I: 0.49-1.23)Friday, October 21, 2011
    • EHJ 2005Friday, October 21, 2011
    • JACC 2009Friday, October 21, 2011
    • JACC 2011:...PRESENT BUT NO RECOMMENDATIONFriday, October 21, 2011
    • EHJ-SEP 2011 STILL NO RECOMMENDATION !!Friday, October 21, 2011
    • CCI 2011 (IN PRESS, NOVEMBER ISSUE)Friday, October 21, 2011
    • Friday, October 21, 2011
    • RADIATION AND EXPERIENCE NEILL J. ET AL. AM J CARDIOL 2010;106:936-40Friday, October 21, 2011
    • JACOB S ET AL. BMC PUBLIC HEALTH, 2010;10:537Friday, October 21, 2011
    • NO LEADED GLASSES CATHPAX NO LEAD APRON DOSIMETER = OUTPUT FACTOR 10 << << << << RADPAD << COURTESY J ARSENAULT, 2011Friday, October 21, 2011
    • S RAO, 2011Friday, October 21, 2011
    • EASY-Bivalirudin To Reduce Bleeding (B2B) Patients at high risk of non-access site bleeding ie ≥ 2 risk-factors: Age > 70, female, CKD, recent GI or organ bleeding, anemia, diabetes, prior GPI/Tnk. ≃ 2500 Transradial PCI HEPARIN BIVALIRUDIN 1ST END-POINT: DEATH, MI, URGENT REVASCULARIZATION, BARC BLEEDING 2,3,5 AT 30 DAYS FUFriday, October 21, 2011
    • Friday, October 21, 2011
    • Friday, October 21, 2011
    • FUNDING FOR RADIAL TRIALS RESEARCH ??Friday, October 21, 2011
    • TRA PRACTICE IN THE FUTURE ? 50% BERTRAND OF ET AL. JACC INTV 2010;3:1022-31Friday, October 21, 2011
    • Supporting the adoption of transradial access theradialist.org redesigned 50% RADIAL IN 5 YEARSFriday, October 21, 2011
    • Supporting the adoption of transradial access FacebookFriday, October 21, 2011
    • Conclusion: Think Different! Transradial practice is already used worldwide Use will likely continue to increase significantly over next few years Physicians = Education, EBM (Publications !!) Health systems = Cost reduction Patients = Qol, better outcomes Still ways for improvement (RAO...)Friday, October 21, 2011
    • IT IS NOT ABOUT YOU!! IT IS ABOUT THE PATIENT AND BETTER OUTCOMES... “Great invention and I’d love to invest, but I can’t spend time to learn how to use it and I never have trouble getting places when I have to anyway. I’ll just stick with what I’m doing…” ADAPTED FROM I GILCHRISTFriday, October 21, 2011
    • EHJ 2010...STILL NO RECOMMENDATION !!Friday, October 21, 2011
    • Friday, October 21, 2011
    • ANTITHROMBOTIC REGIMENS AND RESIDUAL BLEEDING RISK HAMON ET AL. EUROINTERVENTION, 2009Friday, October 21, 2011
    • 0 1 2 0 20 40 60 80 100 120 140 160Friday, October 21, 2011 1989 1 1989 1990 0 1990 1991 0 1991 1992 1 1992 1993 1 1993 1994 2 1994 1995 8 1995 1996 1996 1997 15 1997 1998 24 1998 1999 14 2000 1999 17 2001 2000 47 Randomized Trials (Radial vs Femoral) 2002 2001 26 2003 2002 29 2004 2003 49 2005 2004 54 2006 2005 2007 45 2006 2008 51 2007 2009 52 2010 2008 85 2011 2009 140
    • 0 2 4 6 8 10 12 14Friday, October 21, 2011 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Observational Studies (Radial vs Femoral) 2004 2005 2006 2007 2008 2009 2010 2011
    • Objectives To conduct a systematic review and meta-analysis of all observational studies and randomized trials comparing TRA to FA for PCIFriday, October 21, 2011
    • PI: S. RAO, M. KRUCOFFFriday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • JOLLY S ET AL. LANCET 2011, 377:1409-20Friday, October 21, 2011
    • Friday, October 21, 2011
    • Friday, October 21, 2011