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Increased risk of coronary artery dissection during coronary angiography with 6F catheters
K C Prewitt1, B Zen, D C Wortham
1Cardiology Service, Walter Reed Army Medical Center, Washington, DC.
Insights
Smaller 6F catheters for coronary angiography (CA) increase dissection risk, especially for less experienced doctors. However, they may reduce major vascular complications compared to 8F catheters.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Safety
Background:
- Increasing use of smaller 6 French (6F) catheters for coronary angiography (CA).
- Limited data exists on the safety profile of 6F catheters in CA procedures.
Purpose of the Study:
- To evaluate and compare the safety of 6F versus 8F catheters in adult patients undergoing coronary angiography.
Main Methods:
- Retrospective review of adult CA cases using 6F and 8F catheters between 1988 and June 1990.
- Comparison of patient demographics, procedure characteristics, and complication rates between the two catheter groups.
Main Results:
- The 6F group (n=597) had higher rates of elective procedures, no coronary disease, and procedures performed by non-first-year fellows compared to the 8F group (n=2,409).
- Coronary artery dissection incidence was significantly higher in the 6F group (0.67%) versus the 8F group (0.04%) (p = .007).
- First-year fellows using 6F catheters showed a significantly higher dissection rate (1.7%) than those using 8F catheters (p = .008).
- Major vascular complication rates tended to be lower in the 6F group (0.17%) compared to the 8F group (0.95%) (p = .068).
Conclusions:
- Coronary angiography with 6F catheters is associated with an elevated risk of coronary artery dissection, particularly among less experienced operators.
- A trend towards a reduced risk of major vascular complications was observed with 6F catheters compared to 8F catheters.
Abstract:
The use of smaller sized catheters for coronary angiography (CA) is increasing, but little is known about the safety of CA with 6F catheters. The authors reviewed all cases of CA in which 6F and 8F catheters were used in adult patients between 1988 and June, 1990. There were 597 patients in the 6F group and 2,409 patients in the 8F group. Cases of CA with 6F catheters were more likely to be elective (95% vs 87%), to have no coronary disease (35% vs 24%), and to be performed by nonfirst-year fellows (70% vs 54%) when compared with CA with 8F catheters. There were 5 cases of coronary artery dissection. The incidence of dissections was significantly higher (p = .007) in the 6F group (0.67%) than in the 8F group (0.04%). The incidence of dissections was highest for first-year fellows using 6F catheters (1.7%), which was significantly higher (p = .008) than for first-year fellows using 8F catheters. The incidence of major vascular complications tended to be lower (p = .068) in the 6F group (0.17%) than in the 8F group (0.95%). In summary, CA with 6F catheters is associated with an increased risk of coronary artery dissection, particularly with less experienced operators, but tends to be associated with a lower risk of major vascular complications.