ABC | Volume 113, Nº5, November 2019

Original Article Costa-Mateu et al. Catheterization with one-catheter strategy Arq Bras Cardiol. 2019; 113(5):960-968 Table 2 – Procedural indications and angiographic characteristics Total procedures (n = 1,953) One-catheter strategy (n = 252) Two-catheter strategy (n = 1,701) p-value Coronary angiography indication 0.684 Chronic ischemic heart disease, n (%) 610 (31.2%) 74 (29.4%) 536 (31.5%) Acute coronary syndrome, n (%) 615 (31.5%) 77 (30.6%) 538 (31.6%) Valvular heart disease, n (%) 372 (19.0%) 49 (19.4%) 323 (19.0%) Myocardiopathy, n (%) 272 (17.1%) 43 (17.1%) 229 (13.5%) Other, n (%) 84 (4.3%) 9 (3.6%) 75 (4.4%) Left main coronary artery diseased, n (%) 155 (7.9%) 21 (8.3%) 134 (7.9%) 0.803 Number of diseased vessels 0.359 One vessel, n (%) 634 (32.5%) 83 (32.9%) 551 (32.4%) Two vessels, n (%) 294 (15.1%) 32 (12.7%) 262 (15.4%) Three vessels, n (%) 234 (12.0%) 25 (9.9%) 209 (12.3%) Table 3 – Endpoints Total procedures (n = 1,953) One-catheter strategy (n = 252) Two-catheter strategy (n = 1,701) p-value Volume of contrast, (mL), median (IQR) 90 (62-118) 77 (60-105) 92 (64-120) < 0.001 Radial spasm, n (%) 176 (9.0%) 13 (5.2%) 163 (9.3%) 0.022 Access crossover, n (%) 92 (4.7%) 9 (3.6%) 83 (4.9%) 0.360 Supplemental catheters, n (%) 252 (12.9%) 40 (15.9%) 212 (12.5%) 0.132 Direct costs, (€/procedure), median (IQR) 169 (158-182) 149 (140-160) 171 (160-183) < 0.001 DAP, (mGy.m2), median (IQR) 3685 (2408-5695) 3488 (2556-5369) 3711 (2393-5762) 0.831 Air kerma, (mGy), median (IQR) 630 (420-964) 582 (407-917) 641 (424-974) 0.165 Fluoroscopy time, (min), median (IQR) 4.7 (2.8-8.3) 3.9 (2.2-8.0) 4.8 (2.9-8.3) 0.001 IQR: interquartile range; SD: standard deviation; DAP: dose-area product. These results are in line with three of the most recent randomized clinical trials, demonstrating a reduction in radial spasm by the one-catheter strategy. 7,18,19 Many factors, such as age, female gender, multiple radial punctures and radial diameter, are related with radial spasm. 4,14-16,20 Furthermore, exchange of catheters during transradial access has been linked to radial spasm induction, probably related to repeated stimulation of the radial artery. 4 As a result, radial spasm is not only associated with patient discomfort, procedural failure and morbidity and mortality, but also with high difficulty handling coronary catheters. This leads to more radiological tests to achieve cannulation of the coronary ostia and, therefore, to an increment in fluoroscopy time and total amount of iodinated contrast. Iodinated radiological agents are related with several complications, highlighting contrast induced nephropathy (CIN). CIN, affecting 1% to 33% of patients referred for invasive coronary angiography, is one of the most common causes of acquired renal failure in cardiology patients. 20-24 The development of CIN after an invasive coronary procedure is associated with long hospital stay, marked increase in morbidity and mortality, as well as an increase in health costs. 22,24 Classical studies have shown that iodinated contrast volume used in invasive coronary procedures is closely related to the onset of CIN. 21,23,26 To date, most studies on CIN prevention have not focused on specific techniques for reducing contrast administration. Only a recent observational study has shown reduction in CIN secondary to a specific technique for decreasing contrast administration by using rotational coronary angiography. 27 Therefore, savings with iodinated contrast by one-catheter strategy, as shown in our investigation and corroborated by multiple studies, 7-10,18,27 could reduce CIN. Studying the economic impact of medical interventions is crucial to assess the implementation of new diagnostic/ therapeutic techniques. A small observational study evaluated economic costs related to the use of TIG I catheter in a one‑catheter strategy compared with Judkins catheters in a two‑catheter strategy. 28 Nevertheless, that study only evaluated costs related to the consumption of coronary catheters. To our best knowledge, our investigation is the first one evaluating all direct economic costs attributable to the one-catheter strategy for diagnostic coronary interventions. Our results show that it is related to a significant reduction in economic cost per procedure. This fact is mediated fundamentally by three factors: a) use of fewer coronary catheters; b) reduction in radial 964