Achieving optimal outcomes in diagnostic and interventional coronary angiography requires the ability to make clinical decisions in an individualized manner. As such, some treatments may not be applicable to all patient populations, or, if applicable, may require modifications in their delivery. Although some prior studies have shown no overall reduction of vascular complications with arterial closure devices (ACDs) over mechanical compression in the management of arteriotomy, they must be credited for providing earlier hemostasis and patient mobilization.1–3 Whether ACDs benefit all patient populations equally remains to be determined. Currently, no practice guidelines exist regarding the management of arteriotomy. Therefore, clinicians must recognize those predictors that increase the risk of complications from ACDs in order to guide the appropriate delivery of these devices.
In this issue of the Journal, Aziz et al4 report the safety of ACDs in patients with renal dysfunction. A population of 610 patients who underwent diagnostic or interventional coronary angiography at a single center in New York City was retrospectively studied. Patients were stratified according to severity of renal dysfunction using the National Kidney Foundation Classification system and complications of bleeding, groin infections, vascular complications and device failures were the collectively defined in-hospital primary endpoints. A particularly high total rate of complications (10.8%) was reported in comparison to prior studies (3.5–8.4%).5 The authors attribute this difference to an underrepresentation of patients with renal dysfunction in previous studies (3.5%) compared to the current study (83% with estimated glomerular filtration rate (eGFR) From the University of California San Francisco, San Francisco, California.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Yerem Yeghiazarians, MD, University of California San Francisco, Division of Cardiology, 505 Parnassus Avenue, Box 0103, San Francisco, CA 94143-0103. E-mail: yeghiaza@medicine.ucsf.edu
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