JACC: PCI guide catheters--size does matter, but smaller is better
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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 and greater need for post-procedure transfusion. PCIs performed with 8-F guides were also associated with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality, according to a study in the July issue of JACC: Cardiovascular Interventions.

P. Michael Grossman, MD, from University of Michigan Hospitals and Health System and Veterans Administration Ann Arbor Health System in Ann Arbor, Mich., and colleagues evaluated the association between guiding catheter size and complications of PCI, which remains a controversial issue in contemporary practice.

Researchers compared procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (64,335), 7-F (32,676) and 8-F (6,059) guide catheters.

Compared with 6-F guides, the investigators found that 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 investigators found that the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18; 8-F OR: 1.44), vascular complications (7-F OR: 1.19; 8-F OR: 1.68), decline in hemoglobin greater than 3 g/dl (7-F OR: 1.12; 8-F OR: 1.72), and post-procedure blood transfusion (7-F OR: 1.08; 8-F OR: 1.80), whereas major adverse cardiac events (7-F OR: 1.06; 8-F OR: 1.37) and in-hospital mortality (7-F OR: 1.11; 8-F OR: 1.34) were increased with 8-F but not 7-F guides.

Whereas the higher adjusted in-hospital post-PCI major adverse cardiac event and mortality were associated with 8-F guide catheter size, the researchers noted that a larger percentage of patients underwent multivessel PCI in the 8-F group.

Grossman and colleagues wrote that both the device industry and clinicians have shown an increasing preference for smaller-size catheters over the past several years. Nevertheless, the study shows many interventionalists still use larger size catheters "based on perceived better support and ease of use, and to provide more options to treat complex or bifurcation lesions and to use atheroablative devices."

Based on their findings, the authors concluded that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.