Application of percutaneous coronary intervention under the monitoring of floating catheter in patients with high critical coronary heart disease

doi:10.3877/cma.j.issn.2095-6568.2022.04.004

Abstract

Abstract:

Objective

To investigate the feasibility and safety of percutaneous coronary intervention (PCI) under the monitoring of floating catheterisaion via the median cubital vein in patients with complex and high-risk coronary artery disease and with indications for interventional therapy (CHIP).

Methods

This is a single center, retrospective, observational study. CHIP received PCI from January 2020 to June 2022 were selected from the Department of Cardiology of the Second Hospital of Tianjin Medical University. The patients under the monitoring of floating catheter via the median cubital vein were the observation group, and the non-users at the same time were the control group. The parameters of age, sex, complication, blood lipid and so on were documented. The incidence of major adverse cardiovascular events (MACE) during hospitalization were compared in the two groups. Preoperative, intraoperative and postoperative relevant pressure monitoring such as pulmonary capillary wedge pressure(PCWP), pulmonary artery pressure(PAP), right atrial pressure(RAP), right ventricular pressure(RVP) were compared in the observation group.

Results

A total of 98 patients were enrolled, aged (67.16 ± 11.56) years, including 35 women. There were 49 in the observation group and 49 in the control group. There was no significant difference in age, sex, complications and blood lipid between the two groups. Compared with the control group, the observation group had a lower incidence of MACE during hospitalization after surgery[16.33% (8/49) vs. 4.08% (2/49), P=0.045]. Compared with pre PCI, PCWP [(22.58±7.78) mmHg vs. (18.25±6.93) mmHg, P=0.000], PAP [(31.03±9.68) mmHg vs. (25.92±8.63) mmHg, P=0.000], RAP [(14.26±5.80) mmHg vs. (12.06±5.65) mmHg, P=0.002] and RVP [(23.69±8.81) mmHg vs. (21.43±7.75) mmHg, P=0.021] decreased in the observation group after PCI.

Conclusion

Routine monitoring of floating catheterisation in CHIP-PCI can accurately determine right heart pressure, guide treatment, and reduce the incidence of perioperative MACE with good clinical utility.

Key words: Coronary artery disease, Floating catheterization, Percutaneous coronary intervention, Median cubital vein

Haifeng Zhang, Mengzhu Zhou, Ning Huo, Yange Chen, Huaying Fu, Tong Liu, Guangping Li, Changle Liu. Application of percutaneous coronary intervention under the monitoring of floating catheter in patients with high critical coronary heart disease[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(04): 209-214.

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Figures/Tables 4

基线资料	总体	对照组	观察组	P值
例数	98	49	49	1.000
年龄（岁， $x ¯$ ±s）	67.16±11.56	65.57±11.41	68.76±11.61	0.174
年龄>80岁［例（%）］	15（15.31）	7（14.29）	8（16.33）	0.779
女性［例（%）］	35（35.71）	15（30.61）	20（40.82）	0.292
复杂冠状动脉病变［例（%）］	75（76.53）	38（77.55）	37（75.51）	0.812
合并症
心功能不全［例（%）］	43（43.88）	13（26.53）	30（61.22）	0.001
肾功能不全［例（%）］	21（21.43）	7（14.29）	14（28.57）	0.085
糖尿病［例（%）］	51（52.04）	30（61.22）	21（42.86）	0.069
严重瓣膜病变［例（%）］	7（7.14）	4（8.16）	3（6.12）	0.695
实验室检查指标
NT-proBNP ［pg/ml，M（IQR）］	506.50（70.35，2376.90）	241.30（56.80，918.10）	1117.95（210.08，7842.53）	0.006
CK ［U/L，M（IQR）］	86.85（50.30，157.58）	76.50（59.50，131.00）	86.85（50.30，157.58）	1.000
CK-MB ［U/L，M（IQR）］	13.20（9.60，19.90）	13.89（10.35，20.50）	11.63（8.50，17.98）	0.167
cTnI ［ng/ml，M（IQR）］	0.05（0.01，0.56）	0.03（0.01，0.11）	0.06（0.02，1.15）	0.016
Cr ［µmol/L，M（IQR）］	87.15（64.95，114.15）	76.20（60.23，91.05）	100.60（75.45，168.55）	0.001
TC（mmol/L， $x ¯$ ±s）	4.16±1.10	3.93±1.11	4.35±1.06	0.073
TG（mmol/L， $x ¯$ ±s）	1.78±1.22	1.88±1.35	1.71±1.11	0.521
HDL-C（mmol/L， $x ¯$ ±s）	1.05±0.31	1.01±0.24	1.08±0.35	0.299
LDL-C（mmol/L， $x ¯$ ±s）	2.57±0.86	2.39±0.83	2.72±0.86	0.073
VLDL-C（mmol/L， $x ¯$ ±s）	0.56±0.39	0.57±0.48	0.55±0.32	0.872
超声心动图指标
LVEDD（mm， $x ¯$ ±s）	51.70±7.72	51.35±8.48	52.06±6.93	0.687
LAD（mm， $x ¯$ ±s）	42.22±6.63	41.68±7.18	42.76±6.06	0.472
RVEDD（mm， $x ¯$ ±s）	20.72±1.90	20.48±1.81	20.97±1.98	0.264
PAD（mm， $x ¯$ ±s）	22.29±2.37	22.24±2.37	22.36±2.42	0.850
LVEF（%， $x ¯$ ±s）	52.64±12.41	56.50±10.00	48.78±13.48	0.005
LVEF<40%［例（%）］	19（19.39）	5（10.20）	14（28.57）	0.021

基线资料	总体	对照组	观察组	P值
例数	98	49	49	1.000
年龄（岁， $x ¯$ ±s）	67.16±11.56	65.57±11.41	68.76±11.61	0.174
年龄>80岁［例（%）］	15（15.31）	7（14.29）	8（16.33）	0.779
女性［例（%）］	35（35.71）	15（30.61）	20（40.82）	0.292
复杂冠状动脉病变［例（%）］	75（76.53）	38（77.55）	37（75.51）	0.812
合并症
心功能不全［例（%）］	43（43.88）	13（26.53）	30（61.22）	0.001
肾功能不全［例（%）］	21（21.43）	7（14.29）	14（28.57）	0.085
糖尿病［例（%）］	51（52.04）	30（61.22）	21（42.86）	0.069
严重瓣膜病变［例（%）］	7（7.14）	4（8.16）	3（6.12）	0.695
实验室检查指标
NT-proBNP ［pg/ml，M（IQR）］	506.50（70.35，2376.90）	241.30（56.80，918.10）	1117.95（210.08，7842.53）	0.006
CK ［U/L，M（IQR）］	86.85（50.30，157.58）	76.50（59.50，131.00）	86.85（50.30，157.58）	1.000
CK-MB ［U/L，M（IQR）］	13.20（9.60，19.90）	13.89（10.35，20.50）	11.63（8.50，17.98）	0.167
cTnI ［ng/ml，M（IQR）］	0.05（0.01，0.56）	0.03（0.01，0.11）	0.06（0.02，1.15）	0.016
Cr ［µmol/L，M（IQR）］	87.15（64.95，114.15）	76.20（60.23，91.05）	100.60（75.45，168.55）	0.001
TC（mmol/L， $x ¯$ ±s）	4.16±1.10	3.93±1.11	4.35±1.06	0.073
TG（mmol/L， $x ¯$ ±s）	1.78±1.22	1.88±1.35	1.71±1.11	0.521
HDL-C（mmol/L， $x ¯$ ±s）	1.05±0.31	1.01±0.24	1.08±0.35	0.299
LDL-C（mmol/L， $x ¯$ ±s）	2.57±0.86	2.39±0.83	2.72±0.86	0.073
VLDL-C（mmol/L， $x ¯$ ±s）	0.56±0.39	0.57±0.48	0.55±0.32	0.872
超声心动图指标
LVEDD（mm， $x ¯$ ±s）	51.70±7.72	51.35±8.48	52.06±6.93	0.687
LAD（mm， $x ¯$ ±s）	42.22±6.63	41.68±7.18	42.76±6.06	0.472
RVEDD（mm， $x ¯$ ±s）	20.72±1.90	20.48±1.81	20.97±1.98	0.264
PAD（mm， $x ¯$ ±s）	22.29±2.37	22.24±2.37	22.36±2.42	0.850
LVEF（%， $x ¯$ ±s）	52.64±12.41	56.50±10.00	48.78±13.48	0.005
LVEF<40%［例（%）］	19（19.39）	5（10.20）	14（28.57）	0.021

项目	对照组	观察组		P值
冠脉病变情况
LM病变	4（8.16）	7（14.29）		0.337
LAD病变	35（71.43）	45（91.84）		0.009
LCX病变	30（61.22）	30（61.22）		1.000
RCA病变	33（67.35）	32（65.31）		0.831
双支病变	20（40.82）	11（22.45）		0.051
三支病变	17（34.69）	23（46.94）		0.218
CTO病变	0	7（14.29）		0.006
术后并发症	1（2.04）		3（6.12）	0.307
左桡动脉穿刺口血肿	0	1（2.04）
左桡动脉穿刺口渗血	1（2.04）	2（4.08）
术中不良事件
心室颤动	1（2.04）	0		0.315
术后住院期间MACE	8（16.33）		2（4.08）	0.045
支架内血栓	0	0
心衰急性发作	5（10.20）	2（4.08）
症状驱动的再次血运重建	0	0
急性心肌梗死	2（4.08）	0
心源性死亡	1（2.04）	0
其他不良事件
肾功能恶化	1（2.04）	0		0.315

部位	术前压力	术后压力	P值
观察组总体
PCWP	22.58±7.78	18.25±6.93	<0.001
PAP	31.03±9.68	25.92±8.63	<0.001
RAP	14.26±5.80	12.06±5.65	0.002
RVP	23.69±8.81	21.43±7.75	0.021
前降支
PCWP	19.67±6.04	16.28±6.22	0.003
PAP	27.44±8.68	22.89±8.59	0.015
RAP	12.28±5.51	10.61±5.34	0.116
RVP	20.78±9.19	19.17±7.45	0.255
回旋支
PCWP	28.25±8.26	24.25±8.30	0.543
PAP	34.20±7.46	33.40±6.27	0.815
RAP	15.75±4.79	14.75±6.99	0.707
RVP	26.50±5.00	27.00±7.26	0.872
右冠状动脉
PCWP	25.30±9.61	18.70±7.78	0.005
PAP	35.50±11.68	26.60±8.75	0.005
RAP	17.00±6.54	12.89±6.27	0.005
RVP	28.11±9.13	23.22±8.98	0.022

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