title: A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention.
abstract: OBJECTIVE
  Radial artery spasm may hinder completion of transradial angiography or PCI, leading to access site crossover, prolonged procedure times and complications. The aim of this study was to derive a radial artery spasm risk score in patients undergoing elective percutaneous coronary intervention (PCI), prospectively validate it, and apply it in a real-life clinical setting.
  
  
  METHODS
  The study population consisted of 3 cohorts of patients undergoing elective PCI with transradial access: the derivation cohort (N=1006), the validation cohort (N=576) and the intervention cohort (N=140), consisting of patients with high risk score, in whom intensified spasm-preventive measures were applied.
  
  
  RESULTS
  Multivariable analysis in the derivation cohort showed that 5 weighted factors could be used to construct a risk score for spasm: body-mass index, height, current smoking, hypertension and peripheral artery disease (c-statistic 0.945, with an optimal cut-off of 4). In the validation cohort, the cut-off of 4 predicted spasm with a sensitivity of 84.5% and a specificity of 74.7%. In the intervention cohort, which included only patients with a spasm-risk score of ≥4, the rate of spasm was drastically reduced (odds ratio 0.32, 95% confidence interval 0.17-0.61), compared to the corresponding high spasm risk subgroup of patients of the validation cohort.
  
  
  CONCLUSIONS
  A spasm risk score can be used to predict radial artery spasm during elective transradial PCI. Using this score, a high spasm risk patient subgroup can be identified, where intensive spasm-preventive measures can lead to a significant reduction in the frequency of spasm.
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: ggiann@med.uoa.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Synetos
authors.affiliation: Department of Cardiology, Patras University Medical School, Rio, Patras, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.affiliation: Department of Cardiology, Patras University Medical School, Rio, Patras, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Hahalis
authors.affiliation: Department of Cardiology, Patras University Medical School, Rio, Patras, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: 2nd Department of Cardiology, University of Athens Medical School, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D017534:Radial Artery / Q000503:physiopathology*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D013035:Spasm / Q000503:physiopathology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014655:Vascular Resistance
keywords: PCI; Risk score; Spasm; Transradial access; Vascular access