Coronary Artery Disease Clinical Trial
Official title:
Randomized Comparison of JUDkins vs tiGEr Catheter in Coronary Angiography Via the Right Radial Artery: the JUDGE Study
The investigators aim to assess safety and efficiency of Tiger II (5Fr; Terumo Interventional Systems, Somerset, New Jersey) vs Judkins (5Fr; 3.5L/4R, Medtronic Co) catheters, in coronary angiography via the right transradial route. This is a prospective, randomized, two-centre, study of parallel design. Consecutive patients with acute coronary syndrome (ACS), eligible for non-urgent coronary angiography, are randomized after successful cannulation of right radial artery and informed consent to either Tigger II or Judkins 3.5L/4R catheters.
From the entrance of the first diagnostic catheter into the sheath and until the completion
of the diagnostic coronary angiography will be the measurement of the endpoints of the
study.
In case of failure to complete the coronary angiogram with the catheter study a crossover to
the other catheter of the study will take place except in cases of severe spasm, where
catheter choice will be at the discretion of the operator. In case of failure of the other
study's catheter, next catheter's selection will be at operator's discretion. Patients
included in the study, who do not process to adhoc PCI, will be monitored with baseline
creatinine and creatinine value at day 2 or 3 after coronary angiography.
In all angiography films will be conducted offline analysis by two experienced operators for
scoring opacification grade and coronary ostium contact with the catheters used.
DEFINITIONS Mild spasm Spasm causing well tolerated local pain Moderate spasm Spasm which
causes severe pain but the handling of catheters remains satisfactory Severe spasm Spasm
that leads to change diagnostic catheter or access site Duration of coronary angiogram Is
defined as the time from the insertion of the first diagnostic coronary catheter in the
sheath to the exit of the last diagnostic catheter from the sheath Radiation time Radiation
time from the insertion of the first diagnostic coronary catheter in the right radial sheath
to the exit of the last diagnostic catheter from the sheath Dose area product (DAP) DAP from
the insertion of the first diagnostic coronary catheter in the sheath to the exit of the
last diagnostic catheter from the sheath Contrast volume Contrast volume (ml) used from the
insertion of the first diagnostic coronary catheter in the sheath to the exit of the last
diagnostic catheter from the sheath Contrast induced nephropathy (CIN) Relative increase
≥25% from baseline or absolute increase ≥ 0.5mg/dl of serum creatinine within 48-72 hours of
intravenous contrast administration Opacification grade 0=poor/non-diagnostic
1. moderate opacification only in systole or diastole
2. moderate opacification throughout cardiac cycle
3. complete opacification but not throughout cardiac cycle
4. complete opacification throughout cardiac cycle Catheter contact with coronary ostium
0=none and non-diagnostic study
1=none but diagnostic study 2=non-coaxial contact 3=coaxial contact Catheter stability
within the coronary ostium 0=no catheter's steady engagement of the ostium throughout the
angiographic view
1=catheter's steady engagement of the ostium throughout the angiographic view Catheter
failure Completion of coronary angiogram after study catheter crossover with or without
right radial access site crossover Based on pilot data and previously published data we
hypothesized that Tiger catheter use will lead to an absolute decrease of at least 5 ml in
contrast volume compared with Judkins catheters (48 and 53 ml for Tiger και Judkins
catheters respectively, with estimated standard deviation of 17 for both). With a 2-sided
alpha of 0.05, group sample sizes of 316 and 316 will achieve 95% power to detect this
difference.
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