A PROSPECTIVE RANDOMIZED TRIAL COMPARING THE BENEFITS AND LIMITATIONSOF 6FR AND 8FR GUIDING CATHETERS IN ELECTIVE CORONARY ANGIOPLASTY - CLINICAL, PROCEDURAL, ANGIOGRAPHIC, AND ECONOMIC END-POINTS

Objectives: To determine the relation between guiding catheter size, p rocedural and angiographic details, and cost of coronary angioplasty. Background: Miniaturized angiographic equipment used during coronary a ngioplasty is proposed as a method to decrease the duration of supine bed rest, length of hospital stay, and cost of expensive inpatient hos pitalization. Methods: One hundred and sixty patients were randomized to undergo elective coronary angioplasty with a 6Fr (external diameter , 0.079-in; internal diameter 0.062-in) or 8Fr (external diameter, 0.1 05-in internal diameter, 0.078-0.079-in) guiding catheter. Standard ba lloon dilatation catheters were used. End points: 1 degrees peripheral vascular complications, 2 degrees technical and procedural outcomes; quantitative and qualitative quality of the coronary angiograms; and t he in-hospital (''bottom up'' cost accounting of equipment, supplies, support personnel, postcoronary angioplasty room), and physician cost (using Resource Based Relative Value Scale). Results: There was no dif ference in peripheral vascular complications between the two groups (6 Fr, 21%; 8Fr, 30%; P = NS). Less contrast medium was used with the 6Fr guiding catheters (6Fr, 178 +/- 102 mt; 8Fr, 257 +/- 147 mt; P = 0.00 01). The qualitative quality of the angiograms was better with 8Fr tha n with 6Fr guiding catheters. For the entire population, the total cos t of coronary angioplasty was less with 6Fr guiding catheters ($3,956 +/- $2,415) than with 8F guiding catheters ($5,073 +/- $3,985, P = 0.0 3). Excluding patients with either a coronary or peripheral vascular c omplication, there was less cost savings (6F, $3,720 +/- $1,338; 8F, $ 4,376 +/- 2,699, P = 0.05). Independent variables associated with incr eased cost included: large body mass index; hypercholesterolemia; noni onic contrast media; 8F guiding catheter; complex lesions; and duratio n of procedure. Conclusions: The use of smaller guiding catheters led to use of less contrast medium with a modest decrease in angiographic visualization. The cost savings seen with 6F guiding catheters is mult ifactorial due to smaller arteriotomy accompanying sheath insertion an d reduced rate of clinically significant coronary and peripheral vascu lar complications.