ABC | Volume 113, Nº5, November 2019

Original Article Impact of One-Catheter Strategy with TIG I Catheter on Coronary Catheterization Performance and Economic Costs Joan Costa-Mateu, 1 Diego Fernández-Rodríguez, 1 Kristian Rivera, 1 Juan Casanova, 1 Patricia Irigaray, 1 Marta Zielonka, 1 Eduardo Pereyra-Acha, 1 Albina Aldomà, 1 Fernando Worner 1 Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, 1 Lleida – Spain Mailing Address: Diego Fernández-Rodríguez • University Hospital Arnau de Vilanova, University of Lleida - Rovira Roure Av. 80. Postal Code: 25198, Lleida – Spain E-mail: d.fernan.2@hotmail.com Manuscript received October 28, 2018, revised manuscript March 03, 2019, accepted April 24, 2019. DOI: 10.5935/abc.20190232 Abstract Background: Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. Objective: The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. Methods: Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. Results: From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701procedures to two‑catheter strategy. Therewerenodifferences inbaseline characteristics between the groups.One-catheter strategy required less iodinated contrast [primary endpoint; (60–105)-mL vs. 92 (64–120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2–8.0)-min vs. 4.8 (2.9–8.3)-min, p = 0.001] and saved costs [149 (140–160)- € /procedure vs. 171 (160–183)- € /procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. Conclusions: One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography. (Arq Bras Cardiol. 2019; 113(5):960-968) Keywords: Cineagiography/methods; Cardiac Catheterization/economic; Radiation, Ionizing;; Fluoroscopy; Cost Savings/economic. Introduction Coronary angiography is the “gold standard” technique for the evaluation of coronary arteries. 1 Due to its invasive nature, coronary angiography is associated with multiple complications. However, the rate of complications of coronary angiography procedures has decreased over time. 1 Transradial access plays a key role by reducing vascular complications and mortality in patients undergoing invasive coronary procedures. 1-3 Transradial access is currently the recommended strategy by clinical practice guidelines for coronary angiography. 1 Nevertheless, there is no standard recommendation about the optimal coronary angiography strategy to perform these procedures. One-catheter strategy for radial coronary diagnostic procedures could help reduce radial spasm, complications related to contrast administration and exposure to ionizing radiation, since it avoids the exchange of angiography catheters during coronary procedures. 4-8 However, despite the potential benefits, one-catheter strategy for coronary angiography by transradial access is not routinely used in many centres. This fact may be due, among other factors, to the need for operators to perform the learning curve or to the scarcity of data about its impact on catheterization performance and economic costs. Therefore, the objective of our study is to compare two strategies: a one-catheter strategy with TIG catheters 6,9 vs. a traditional two-catheter strategy with Judkins catheters, in order to determine if one-catheter strategy allows to reduce the amount of iodinated contrast, radial spasm, exposure to ionizing radiation and direct economic costs in diagnostic coronary angiography. 960