RESUMEN
Background Multiple studies have shown that trans-radial access (TRA) for women undergoing coronary angiography/intervention (CA/I) has a lower risk of vascular access site complications as compared with trans-femoral access (TFA). In patients who had previously undergone coronary artery bypass grafting (CABG), studies also showed no significant difference between TRA and TFA in terms of contrast amount (CA), procedure time (PT), and fluoroscopy time (FT). However, those studies mainly included men. Limited information is available on the relative merits of TRA as compared with TFA for cardiac catheterization in females who previously undergone CABG. The purpose of this study was to determine the efficacy and safety of TRA versus TFA in women with prior CABG surgery who are undergoing CA/I in regard to CA, PT, and FT. Methods In this single-center retrospective cohort study, females with a history of CABG who underwent CA/I in the period from January 2013 to September 2016 were included. A total of 584 patients were included and divided into two groups: TRA group (49 patients) and TFA group (535 patients). The primary endpoints were CA, PT, and FT. The means for the primary outcomes were compared between the two using the independent t-score test. Results A total of 584 female patients with a history of CABG had cardiac catheterization from January 2013 to September 2016 at our center. Trans-femoral access accounted for 91.6% (n=535) of the patients while trans-radial access accounted for 8.4% (n=49) of the patients. A comparison of procedural variables between TRA and TFA revealed that there was no statistical significance in procedure time, fluoroscopy time, or the contrast volume. The access site crossover rate was 6.12% (n=3) from radial to femoral while there was a 0% rate in the femoral to radial access. Conclusion The key findings of this study suggest that in female patients with a prior history of CABG, TRA is an equally reliable and efficacious approach for both diagnostic angiography and intervention compared to TFA.
RESUMEN
BACKGROUND: The Kardia Mobile Cardiac Monitor (KMCM) detects atrial fibrillation (AF) via a handheld cardiac rhythm recorder and AF detection algorithm. The algorithm operates within predefined parameters to provide a "normal" or "possible atrial fibrillation detected" interpretation; outside of these parameters, an "unclassified" rhythm is reported. The system has been increasingly used, but its performance has not been independently tested. OBJECTIVE: The objective of this study was to evaluate whether the KMCM system can accurately detect AF. METHODS: A single-center, adjudicator-blinded case series of 52 consecutive patients with AF admitted for antiarrhythmic drug initiation were enrolled. Serial 12-lead electrocardiograms (ECGs) and nearly simultaneously acquired KMCM recordings were obtained. RESULTS: There were 225 nearly simultaneously acquired KMCM and ECG recordings across 52 enrolled patients (mean age 68 years; 67% male). After exclusion of unclassified recordings, the KMCM automated algorithm interpretation had 96.6% sensitivity and 94.1% specificity for AF detection as compared with physician-interpreted ECGs, with a κ coefficient of 0.89. Physician-interpreted KMCM recordings had 100% sensitivity and 89.2% specificity for AF detection as compared with physician-interpreted ECGs, with a κ coefficient of 0.85. Sixty-two recordings (27.6%) were unclassified by the KMCM algorithm. In these instances, physician interpretation of KMCM recordings had 100% sensitivity and 79.5% specificity for AF detection as compared with 12-lead ECG interpretation, with a κ coefficient of 0.71. CONCLUSION: The KMCM system provides sensitive and specific AF detection relative to 12-lead ECGs when an automated interpretation is provided. Direct physician review of KMCM recordings can enhance diagnostic yield, especially for unclassified recordings.