title: Percutaneous coronary intervention complications and guide catheter size: bigger is not better.
abstract: OBJECTIVE
  We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The association between guiding catheter size and complications of PCI in contemporary practice remains controversial.
  
  
  METHODS
  Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared.
  
  
  RESULTS
  Compared with 6-F guides, 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 use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR]: 1.18, p = 0.0004; 8-F OR: 1.44, p < 0.0001), vascular complications (7-F OR: 1.19, p = 0.0002, 8-F OR: 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR: 1.12, p < 0.0001, 8-F OR: 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR: 1.08, p = 0.03; 8-F OR: 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR: 1.06, p = 0.13; 8-F OR: 1.37, p < 0.0001) and in-hospital mortality (7-F OR: 1.11, p = 0.13; 8-F OR: 1.34, p = 0.03) were increased with 8-F but not 7-F guides.
  
  
  CONCLUSIONS
  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, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Hospitals and Health System and Veterans Administration Ann Arbor Health System, Ann Arbor, MI 48109-5869, USA. pagross@umich.edu
authors.forename: P Michael
authors.initials: PM
authors.lastname: Grossman
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: Richard
authors.initials: R
authors.lastname: McNamara
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
authors.forename: Hameem
authors.initials: H
authors.lastname: Changezi
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Chetcuti
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D001803:Blood Transfusion; D003287:Contrast Media / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D003287:Contrast Media