This Article Figures Only Full Text Full Text (PDF) View Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Grossman, P. M. PubMed Articles by Grossman, P. M.

Percutaneous Coronary Intervention Complications and Guide Catheter Size

Bigger Is Not Better

P. Michael Grossman, MD^_*,,_*, Hitinder S. Gurm, MD^_*,, Richard McNamara, MD, Thomas LaLonde, MD^||, Hameem Changezi, MD^¶, David Share, MD, MPH, Dean E. Smith, PhD^_*, Stanley J. Chetcuti, MD^_*,, Mauro Moscucci, MD^_* for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)

^_* Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Hospitals and Health Center, Ann Arbor, Michigan
Departments of Family Medicine and Pediatrics, University of Michigan Hospitals and Health Center, Ann Arbor, Michigan
Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
Spectrum Health, Grand Rapids, Michigan
^|| St. John's Hospital and Medical Center, Detroit, Michigan
^¶ Genesys Regional Medical Center, Grand Blanc, Michigan

^_* Reprint requests and correspondence: Dr. P. Michael Grossman, University of Michigan Hospitals and Health System and Veterans Administration Ann Arbor Health System, 1500 East Medical Center Drive, SPC 5869, Ann Arbor, Michigan 48109-5869 (Email: pagross{at}umich.edu).

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.

Key Words: percutaneous coronary intervention • coronary guide catheter size • coronary intervention complications • coronary intervention complications • coronary intervention outcomes

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CIN = contrast-induced nephropathy   Hgb = hemoglobin   MACE = major adverse cardiovascular event   MI = myocardial infarction   PCI = percutaneous coronary intervention