Abstract 15179: Photoplethysmography Using a Smartphone Application for Assessment of Ulnar Patency Prior to Transradial Angiography
Introduction: The transradial approach for coronary angiography and percutaneous intervention is increasingly used due to a lower incidence of vascular complications, patient preference and a potential mortality benefit in patients with acute coronary syndromes. While the utility is debated, competency of the collateral circulation to the hand is routinely assessed prior to radial access with the modified Allen’s test (MAT). Smartphone technology allows assessment of circulation using dedicated applications. We assessed the hypothesis that a smartphone heart rate monitoring application (HRMA) would provide superior diagnostic accuracy over the MAT in assessing ulnar artery patency.
Methods: This study was a prospective randomized trial conducted in a single academic hospital. The participants’ arterial patency was assessed with three modalities: the MAT, the HRMA, and Doppler ultrasound imaging (DUS). Study subjects were randomly assigned via a computer generated algorithm to receive either the MAT or HRMA as the initial assessment modality, with DUS as the gold-standard assessment. The primary outcome was the diagnostic accuracy of the HRMA application in the subject’s primary potential access site.
Results: A total of 438 patients were enrolled between June 2015 and March 2016, with 219 participants randomized to each of the MAT and HRMA cohorts. Overall, the incidence of an occluded ulnar artery was low - with only 10 cases (2.3%) in the total cohort. The primary outcome, diagnostic accuracy was 81.7% (95% CI 76.0-86.6%) in the MAT cohort and 91.8% (95% CI 87.3-95.1%) in the HRMA group (p =0.002). This was primarily driven by an increased sensitivity of a patent ulnar artery (82.8% 95% CI 77.1-87.6% vs. 93.0% 95% CI 88.7-96.0%, p=0.001) with the HRMA. Similarly, assessment of either radial or ulnar patency in the homolateral and contralateral vessel had higher diagnostic accuracy using a HRMA than MAT (n=1472, p<0.01).
Conclusions: In conclusion, a smartphone HRMA used to assess ulnar patency prior to transradial access had superior diagnostic accuracy than the MAT. This proof of concept study demonstrates the accuracy and utility of smartphone based diagnostics over physical examination and the ability to impact point-of-care clinical decision making.
Author Disclosures: P. Di Santo: None. D.T. Harnett: None. T. Simard: None. F.D. Ramirez: None. A. Pourdjabbar: None. A. Yousef: None. R. Moreland: None. J. Bernick: None. G. Wells: None. A. Dick: None. M.R. Le May: None. M. Labinaz: None. D.Y. So: None. A. Chong: None. B. Hibbert: None.
- © 2016 by American Heart Association, Inc.