Baylor University Medical Center Proceedings October 2017 - 406
Table 1. Characteristics of study patients undergoing coronary catheterization
via the radial or femoral artery approach
Variable
Femoral (n = 30)
Radial (n = 30)
P value
Male
22 (73%)
19 (63%)
0.41
Age (years): mean ± SD
65.2 ± 9.6
63.6 ± 13.1
0.6
± SD
30.4 ± 5.6
31.4 ± 5.3
0.46
0.51
BMI
(kg/m2): mean
Black
3 (10%)
1 (3%)
White
25 (83%)
28 (93%)
2 (7%)
1 (3%)
Hypertension
27 (90%)
20 (69%)
0.06
Diabetes mellitus
12 (40%)
6 (20%)
0.09
Dyslipidemia
27 (90%)
23 (77%)
0.17
Peripheral arterial disease
3 (10%)
1 (3%)
0.61
Heart failure
7 (23%)
3 (10%)
0.29
Atypical chest pain
10 (33%)
14 (47%)
0.29
Stable angina pectoris
12 (40%)
4 (14%)
0.04
ACS/unstable angina
10 (33%)
4 (13%)
0.13
Myocardial infarction
13 (43%)
6 (20%)
0.05
TIA/CVA
1 (3%)
2 (7%)
NA
Chronic kidney disease
2 (8%)
1 (4%)
NA
Hispanic
Severe valvular disease
1 (3%)
0 (0%)
NA
Prior PCI
16 (55%)
11 (39%)
0.23
Prior coronary bypass
11 (37%)
1 (4%)
0.002
Never smoked
10 (35%)
3 (13%)
0.18
Ex-smoker
14 (48%)
16 (70%)
Current smoker
5 (17%)
4 (17%)
Hospitalization in the past 30 days
11 (38%)
3 (10%)
0.02
75.3 ± 20.9
72.9 ± 20.5
0.67
eGFR (mL/min/1.73
m2): mean
± SD
BUN (mg/dL): median (range)
18.5 (4-55)
17 (7-27)
0.32
Glucose (mg/dL): median (range)
115.5 (91-292)
104 (80-157)
0.001
Hemoglobin (mg/dL): mean ± SD
13.2 ± 1.7
13.9 ± 1.4
0.06
Systolic BP (mm Hg): mean ± SD
136.5 ± 19.1
137.6 ± 19.9
0.84
Diastolic BP (mm Hg): mean ± SD
76.1 ± 10.4
76.6 ± 17.7
0.9
Heart rate (bpm): median (range)
71.5 (51-104)
64.5 (40-120)
0.35
Left ventriculogram
25 (86%)
22 (73%)
0.33
Sinus rhythm
23 (77%)
21 (72%)
0.71
0 (0%)
1 (4%)
NA
Preprocedure
Intraprocedure
IABP
Pacing device
4 (16%)
4 (13%)
NA
Aspirin
18 (60%)
16 (55%)
0.71
1 (3%)
2 (7%)
0.61
Heparin
18 (60%)
26 (93%)
0.003
Isovue
0 (0%)
4 (13%)
0.11
Bivalirudin
Omnipaque
30 (100%)
26 (87%)
Total contrast used (cc): median (range)
120 (55-300)
97.5 (36-250)
0.04
Fluoroscopy time (min): median (range)
10.35 (1.2-90)
7.5 (2.4-20.4)
0.59
Fluoroscopy dose (mGy): median (range)
946.5 (240-3272)
712.3 (122-2291)
0.04
406
values did not differ between the two approaches
(Table 3).
Eight patients (13.3%) were readmitted within 30 days of the procedure (4 femoral, 4 radial).
Reasons for readmission included coronary artery
bypass, heart failure, aortic valve replacement,
aortic stenosis, gastrointestinal procedure, cystoprostatectomy, neck surgery, and fever. None of
the patients in our cohort experienced an AKI.
DISCUSSION
Our study demonstrated that preprocedural
values of urinary biomarkers (HSP27, thioredoxin, taurine, talose, sulfuric acid) did not vary
between TFA and TRA. All postprocedural values except for thioredoxin were similar between
the approaches. However, we also found that
irrespective of the arterial access, the postprocedural values of thioredoxin were lower and the
postprocedural values of talose were higher than
their preprocedural measures. The baseline values
differed by gender for some of these metabolites;
higher levels of talose were evident in diabetic
patients.
Biomarkers are useful in identifying the physiological, pharmacological, and/or pathological
processes in the human system. Metabolite and
protein profiling are the primary methods employed to identify specific biomarkers in clinical
medicine. Precision medicine has benefited from
the discovery of several biomarkers, which have
been utilized in the identification of disease, prediction of prognosis, and management of medications (12). The intensity of the pattern changes of
metabolites and proteins is based on the extent of
injury and the degree of cell damage. Systematic
analysis of urine has led to a better understanding
of the changes in disease states of renal, cardiac,
bladder, and ovarian diseases. Urine samples are
easy to obtain and are likely to be rich in biomarkers arising from the kidneys (13). PCI and
balloon coronary angioplasty have been associated
with increases in oxidative stress and the inflammatory processes. C-reactive protein and various
cytokines have been identified as potential biomarkers for prediction of coronary artery disease
(14). Neutrophil gelatinase-associated lipocalin,
IL-18, kidney injury molecule-1, and liver-type
fatty acid binding protein have been identified
as potential markers of AKI and as a predictor of
contrast-induced nephropathy (15).
HSP27 plays a protective role in minimizing
the damaging effect of oxidative and chemical
stress. It is found to be overexpressed in conditions such as renal injury, diabetes, and cancer
(7). Animal studies have shown that HSP27 is
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