Graduation Thesis

Graduation Thesis

https://rpubs.com/alex_istrate/605846

1 General part

2 Special part

2.1 Introduction

2.1.1 Objectives

2.2 Methods

2.2.1 Statisitcal analysis of the data

To describe the quantitative variables, we used histograms and we calculated the arithmetic means ±standard deviation (SD) [with 95% confidence interval (CI)], as well as the extreme and median values. For the qualitative variables, we used pie or bar charts and calculated the absolute and percentual frequencies of the formed categories.

To study the relationships between quantitative and qualitative variables, we used the T or Mann-Whitney (MW) tests if they were binary, respectively ANOVA or Kruskal-Wallis (KW) if they had more categories. We presented the p values generated by these tests as well as the means ±SD of the groups and the difference of the means with associated 95% CI. We graphically presented the results in the form of box plots. To study the relationships between the quantitative variables we used the Spearman correlation coefficient (R), with the associated p-value and graphically presented the relations as scatter plots, on which we added the regression line. To describe the relationships between the qualitative variables we used the Chi² or Fisher test and the Cramer phi or V and Odds-Ratio (OR) / Relative Risk (RR) indicators with 95% CI. We graphically presented the results in the form of pie or bar charts.

We used Microsoft Excel 2016 for database management. For all statistical analyzes and subsequent graphs we used R 3.6.3 [1]. We considered p <0.05 to be statistically significant and p <0.10 to show only a tendency towards statistical significance.

2.3 Results

2.3.1 Demographics

A total of 283 patients were included din the study, of whom 86.8% had only one intervention yet, while 10.3% had 2 interventions, 2.9% had more (up to 5).

Among unique patients, 66.4% were men. At the time of each intervention, age had values between 40.2 and 94.2 years old (median = 70) with a mean of 69.65 ±10.6 years old. At the time of the first interention, women were significantly older then men (F:71.82 ±10.8 years old, M: 68.90 ±10.3 years old).

At the time of each intervention, BMI had values between 15.63 and 42.22 kg/m² (median = 25.83) with a mean of 26.77 ±4.72 kg/m². BMI had a statistically significant but weak negative correlation with age (-0.27, p<0.001).

Table 1: Demographic parameters of the sample.

Variable	Details	Total
N=		283
Sex	F	76 (33.6%)
	M	150 (66.4%)
Age (years)	μ ±SD	69.65 ±10.6
	M (min:max)	70 (40.2:94.2)
BMI (kg/m²)	μ ±SD	26.77 ±4.72
	M (min:max)	25.83 (15.63:42.22)
No. interventions	1	210 (86.8%)
	2	25 (10.3%)
	3+	7 (2.9%)
μ ±SD = Mean (standard deviation); M (min:max) = Median (min:max);

Figure 1: Sex distribution.

Figure 2: Number of visits.

Figure 3: Age distribution, at each intervention, colored by sex. (| mean, ¦ median).

Figure 4: BMI distribution, at each intervention, colored by sex. (| mean, ¦ median).

Figure 5: Correlation of BMI and age, colored by sex (Spearman’scorrelation coefficient).

2.3.2 Main

Most patients with an ACOMI diagnosis had stage IV (78.3%), or III (20.9%) and only 2 patients had stage IIb.

Most cases were registerd in 2019 (n=61, 23.0%) and the least were registerd in 2016 (n=18, 6.8%), 2014 (n=26, 9.8%).
264 (93.6%) interventions were successful.

Angiography was performed in 123 (46.4%) patients and coronarography in 16 (6.0%) patients. Elective or multivascular angioplasty was performed in 159 (56.2%) and 80 (28.3%) patients.

More than half of the patients (n=143, 50.5%) were not implanted stents. Only one stent was implanted in 100 patients (35.3%) and 2 or more were implanted in 40 patients (14.1%, up to 6 stents).

Table 2: Main parameters of the sample.

Variable	Details	Total
N=		283
ACOMI	ACOMI IIB	2 (0.8%)
	ACOMI III	51 (20.9%)
	ACOMI IV	191 (78.3%)
Angiography		123 (46.4%)
Coronarography		16 (6.0%)
Examination year	2014	26 (9.8%)
	2015	51 (19.2%)
	2016	18 (6.8%)
	2017	47 (17.7%)
	2018	62 (23.4%)
	2019	61 (23.0%)
Success of intervention		264 (93.6%)
Number of stents	0	143 (50.5%)
	1	100 (35.3%)
	2	25 (8.8%)
	3	6 (2.1%)
	4	5 (1.8%)
	5	2 (0.7%)
	6	2 (0.7%)
Elective angioplasty		159 (56.2%)
Multivascular angioplasty		80 (28.3%)
μ ±SD = Mean (standard deviation); M (min:max) = Median (min:max);

Figure 6: ACOMI diagnosis of the patients.

Figure 7: Year of examination.

Figure 8: Success of intervention.

Figure 9: Angiography and Coronarography.

Figure 9: Angiography and Coronarography.

Angiography and not having elective angiopasty were significantly correlated (OR = 0.13, p<0.001). Among patients with angiography, only 29.3% had elective angioplasty (compared to 76.8% among those without angiography) and among patients with elective angioplasty, only 24.8% had angiography (compaed to 72.5% of those without elective angioplasty).

vs. Coronarography
Angiography	yes	no	(total)
yes	11 (8.9% / 68.8%)	112 (91.1% / 45.0%)	123 (46.4%)
no	5 (3.5% / 31.2%)	137 (96.5% / 55.0%)	142 (53.6%)
(total)	16 (6.0%)	249 (94.0%)	265 (100%)
OR=2.69 [0.91, 7.97], phi=0.11 (p=0.074)

Table 3: Relația dintre Elective angioplasty și Angiography.

vs. Elective angioplasty
Angiography	yes	no	(total)
yes	36 (29.3% / 24.8%)	87 (70.7% / 72.5%)	123 (46.4%)
no	109 (76.8% / 75.2%)	33 (23.2% / 27.5%)	142 (53.6%)
(total)	159 (56.2%)	124 (43.8%)	265 (100%)
OR=0.13 [0.07, 0.22], phi=0.48 (p<0.001)

Table 3: Relația dintre Elective angioplasty și Angiography.

vs. Multivascular angioplasty
Angiography	yes	no	(total)
yes	30 (24.4% / 40.5%)	93 (75.6% / 48.7%)	123 (46.4%)
no	44 (31.0% / 59.5%)	98 (69.0% / 51.3%)	142 (53.6%)
(total)	80 (28.3%)	203 (71.7%)	265 (100%)
OR=0.72 [0.42, 1.24], phi=0.07 (p=0.273)

Table 4: Relația dintre Elective angioplasty și Coronarography.

vs. Elective angioplasty
Coronarography	yes	no	(total)
yes	7 (43.8% / 4.8%)	9 (56.2% / 7.5%)	16 (6.0%)
no	138 (55.4% / 95.2%)	111 (44.6% / 92.5%)	249 (94.0%)
(total)	159 (56.2%)	124 (43.8%)	265 (100%)
OR=0.63 [0.23, 1.73], phi=0.06 (p=0.441)

Table 4: Relația dintre Elective angioplasty și Coronarography.

vs. Multivascular angioplasty
Coronarography	yes	no	(total)
yes	3 (18.8% / 4.1%)	13 (81.2% / 6.8%)	16 (6.0%)
no	71 (28.5% / 95.9%)	178 (71.5% / 93.2%)	249 (94.0%)
(total)	80 (28.3%)	203 (71.7%)	265 (100%)
OR=0.58 [0.16, 2.09], phi=0.05 (p=0.568)

Table 5: Relația dintre Multivascular angioplasty și Elective angioplasty.

vs. Multivascular angioplasty
Elective angioplasty	yes	no	(total)
yes	51 (32.1% / 63.7%)	108 (67.9% / 53.2%)	159 (56.2%)
no	29 (23.4% / 36.2%)	95 (76.6% / 46.8%)	124 (43.8%)
(total)	80 (28.3%)	203 (71.7%)	283 (100%)
OR=1.55 [0.91, 2.64], phi=0.10 (p=0.113)

Figure 10: Number of stents.

Elective angioplasty was not significantly correlated to the number of stents (p=0.736) nor to having or not any stents (OR=0.91, p=0.720). 55.0% of the patients with stents had elective antioplasty and 48.4% of the patients with elective antioplasty had 1 or more stents.

vs. Elective angioplasty
Number of stents	yes	no	(total)
0	82 (57.3% / 51.6%)	61 (42.7% / 49.2%)	143 (50.5%)
1	54 (54.0% / 34.0%)	46 (46.0% / 37.1%)	100 (35.3%)
2	17 (68.0% / 10.7%)	8 (32.0% / 6.5%)	25 (8.8%)
3	2 (33.3% / 1.3%)	4 (66.7% / 3.2%)	6 (2.1%)
4	2 (40.0% / 1.3%)	3 (60.0% / 2.4%)	5 (1.8%)
5	1 (50.0% / 0.6%)	1 (50.0% / 0.8%)	2 (0.7%)
6	1 (50.0% / 0.6%)	1 (50.0% / 0.8%)	2 (0.7%)
(total)	159 (56.2%)	124 (43.8%)	283 (100%)
V=0.11 (p=0.736)

vs. Elective angioplasty
Number of stents	yes	no	(total)
0	82 (57.3% / 51.6%)	61 (42.7% / 49.2%)	143 (50.5%)
1	54 (54.0% / 34.0%)	46 (46.0% / 37.1%)	100 (35.3%)
2+	23 (57.5% / 14.5%)	17 (42.5% / 13.7%)	40 (14.1%)
(total)	159 (56.2%)	124 (43.8%)	283 (100%)
V=0.03 (p=0.861)

vs. Elective angioplasty
Number of stents	yes	no	(total)
1+	77 (55.0% / 48.4%)	63 (45.0% / 50.8%)	140 (49.5%)
0	82 (57.3% / 51.6%)	61 (42.7% / 49.2%)	143 (50.5%)
(total)	159 (56.2%)	124 (43.8%)	283 (100%)
OR=0.91 [0.57, 1.45], phi=0.02 (p=0.720)

Table 6: Relation between the number of stents and elective angioplasty (% by row and column).

Multivascular angioplasty was not significantly correlated to the number of stents (p=0.092) nor to having or not any stents (OR=1.36, p=0.291). 31.4% of the patients with stents had multivascular antioplasty and 55.0% of the patients with multivascular antioplasty had 1 or more stents.

vs. Multivascular angioplasty
Number of stents	yes	no	(total)
0	36 (25.2% / 45.0%)	107 (74.8% / 52.7%)	143 (50.5%)
1	27 (27.0% / 33.8%)	73 (73.0% / 36.0%)	100 (35.3%)
2	10 (40.0% / 12.5%)	15 (60.0% / 7.4%)	25 (8.8%)
3	2 (33.3% / 2.5%)	4 (66.7% / 2.0%)	6 (2.1%)
4	3 (60.0% / 3.8%)	2 (40.0% / 1.0%)	5 (1.8%)
5	2 (100% / 2.5%)	0	2 (0.7%)
6	0	2 (100% / 1.0%)	2 (0.7%)
(total)	80 (28.3%)	203 (71.7%)	283 (100%)
V=0.20 (p=0.092)

vs. Multivascular angioplasty
Number of stents	yes	no	(total)
0	36 (25.2% / 45.0%)	107 (74.8% / 52.7%)	143 (50.5%)
1	27 (27.0% / 33.8%)	73 (73.0% / 36.0%)	100 (35.3%)
2+	17 (42.5% / 21.2%)	23 (57.5% / 11.3%)	40 (14.1%)
(total)	80 (28.3%)	203 (71.7%)	283 (100%)
V=0.13 (p=0.093)

vs. Multivascular angioplasty
Number of stents	yes	no	(total)
1+	44 (31.4% / 55.0%)	96 (68.6% / 47.3%)	140 (49.5%)
0	36 (25.2% / 45.0%)	107 (74.8% / 52.7%)	143 (50.5%)
(total)	80 (28.3%)	203 (71.7%)	283 (100%)
OR=1.36 [0.81, 2.29], phi=0.07 (p=0.291)

Table 6: Relation between the number of stents and elective angioplasty (% by row and column).

2.3.3 PCI Arterial access

Table 7: PCI Arterial access.

PCI Arterial access	Total
	283
Brahial left	26 (9.2%)
Brahial right	12 (4.3%)
Femoral bilateral	2 (0.7%)
Femoral left	79 (28.0%)
Femoral left anterograde	2 (0.7%)
Femoral right	113 (40.1%)
Femoral right anterograde	1 (0.4%)
Femoral right, brahial left	1 (0.4%)
Popliteal right retrograde	1 (0.4%)
Radial left	38 (13.5%)
Radial left, femoral right	1 (0.4%)
Radial right	6 (2.1%)

Figure 11: .

2.3.4 Guidewire

Table 8: Guidewire.

Guidewire	Total
	283
Terumo hydrophyl guidewire	159 (64.6%)
Balance middle weight guidewire	55 (22.4%)
Others	32 (13.0%)

Table 9: Guidewire (complete list).

Guidewire (complete list)	Total
	283
Amplatz	3 (1.1%)
Asahi coronary guidewire	1 (0.4%)
Balance middle weight guidewire	55 (19.7%)
Cougar guidewire (fail BMW)	1 (0.4%)
Diagnostic guidewire	1 (0.4%)
EBU	6 (2.2%)
Fielder XT	1 (0.4%)
Fractured	1 (0.4%)
GAiA	1 (0.4%)
JR4	5 (1.8%)
Multipurpose	4 (1.4%)
no data	32 (11.5%)
none	1 (0.4%)
PT2	4 (1.4%)
Runthrough guidewire	1 (0.4%)
Steelcore	1 (0.4%)
Stiff	1 (0.4%)
Terumo hydrophyl guidewire	159 (57.0%)
Whisper extra support guidewire	1 (0.4%)

Figure 12: .

2.3.5 Amputations

Major aplutatons were performed in 8 patients (2.8%) and minor apmutations in 3 patients.

Table 10: Minor and major amputations.

Variable	Total
N=	283
Minor amputation	3 (1.1%)
Major amputation	8 (2.8%)

Figure 13: Amputations.

2.3.6 Other pathology

Table 11: Other pathology

Variable	Total
N=	283
Ischemic cardiomyopathy	18 (6.4%)
DM	81 (28.6%)
HBP	38 (13.4%)
Dyslipidemia	3 (1.1%)
COPD	2 (0.7%)
Heart insuffiency	5 (1.8%)
Chronic renal insufficieny	23 (8.1%)
Atrial fibrilation	13 (4.6%)
Cerebrovascular accident	9 (3.2%)

Figure 14: Other pathology.

2.3.7 Artery

Table 12: Arteries

Variable	Total
N=	283
Aorta	1 (0.4%)
Common iliac	57 (20.1%)
External iliac	66 (23.3%)
Common femoral	22 (7.8%)
Superficial femoral	114 (40.3%)
Tibial	26 (9.2%)
Popliteal	82 (29.0%)
Tibio-peroneal	29 (10.2%)
Peroneal	15 (5.3%)

Figure 15: Arteries.

3 References

1. R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.