***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Radial artery spasm is one of the most common complications during coronary angiography via the transradial approach , causing patient discomfort or sometimes interrupting the procedure . This study was design ed to compare the spasmolytic effect between nicor and il and a cocktail during transradial coronary angiography . METHODS A r and omized study to compare 4 mg of nicor and il and a cocktail ( mixture of normal saline , 200 microg of verapamil ) was performed in 150 patients . We examined vasospasms of the radial artery that were expressed as stenosis of the radial artery vessel diameter after the procedure . RESULT The reductions of systolic and diastolic blood pressures showed no significant differences between the two groups ( 15.4+/-11.5/7.7+/-7.8 mmHg for nicor and il and 16.3+/-13.4/6.2 mmHg for cocktail ) . Both agents induced a significant radial artery vasodilation after transradial administration at proximal and mid segments ( P < 0.001 for all ) . Nicor and il showed a significant increase of the mean change of the radial artery diameter compared to the cocktail at mid-segment ( 0.32+/-0.23 mm for nicor and il and 0.24+/-0.15 mm for a cocktail , P < 0.05 ) . There was no statistically significant difference between the two groups in radial artery spasm ( 50.7 % vs. 52.0 % in nicor and il and a cocktail , respectively ) after catheterization . CONCLUSION Nicor and il with vasodilator effects by a dual mechanism was effective as the cocktail in preventing radial artery spasm during transradial coronary angiography Background Verapamil is traditionally applied prophylactically in transradial procedures to prevent radial artery spasm . However , verapamil may have side effects and is contraindicated in some clinical setting s. Methods and Results During an investigator‐initiated , r and omized , double‐blind trial , we evaluated the need for preventive verapamil administration . After vascular access was established , patients received either 5 mg verapamil ( n=297 ) or placebo ( n=294 ) . We compared the rate of access site conversions as primary end point using a superiority margin of 5 % . Occurrence of code breaks ( composite of conversions and unplanned use of verapamil ) , overall verapamil use , procedural and fluoroscopic times , contrast volume , and subjective pain were investigated as secondary end points . The rate of access site conversions was not different in the 2 arms ( placebo 1.7 % versus verapamil 0.7 % , P=0.28 , difference 1.0 % , 95 % CI for the difference −1.1 % to 3.3 % ) . Proportion of code breaks was similar in the 2 groups ( 3.4 % versus 1.3 % , P=0.11 ) , whereas overall verapamil use was markedly lower in the placebo arm ( 2.0 % versus 100 % , P<0.0001 ) . Procedural time ( median [ IQR ] 16.0 minutes [ 9.0 to 30.0 minutes ] versus 17.0 minutes [ 10.0 to 31.0 minutes ] , P=0.37 ) , fluoroscopic time ( 4.4 minutes [ 2.1 to 9.6 minutes ] versus 4.8 minutes [ 2.4 to 10.7 minutes ] , P=0.28 ) , contrast volume ( 72.5 mL [ 48.0 to 146.0 mL ] versus 75.5 mL [ 47.0 to 156.5 mL ] , P=0.74 ) , and pain score ( P for trend=0.12 ) were comparable in the 2 groups . Conclusions The preventive use of verapamil may be unnecessary for transradial procedures . The omission of prophylactic verapamil may not only reduce the rate of potential complications related to the drug but also allow the safe extension of the transradial method to those with contraindications to verapamil . Clinical Trial Registration URL : http://www . clinical trials.gov . Unique identifier : NCT01402427 OBJECTIVES This study sought to estimate the economic impact of same-day home discharge compared with overnight hospitalization after transradial percutaneous coronary intervention ( PCI ) . BACKGROUND Same-day home discharge after transradial PCI and a bolus-only abciximab regimen was found to be clinical ly noninferior to the abciximab st and ard therapy and overnight hospitalization in patients with various forms of acute coronary syndromes . METHODS In the EASY ( Early Discharge After Transradial Stenting of Coronary Arteries ) trial , 1,005 patients were r and omized after a bolus of abciximab and uncomplicated transradial coronary stenting  , either to same-day home discharge and no infusion ( outpatient group ) or to overnight hospitalization and 12-h abciximab infusion ( overnight-stay group ) . We estimated post-PCI health care cost ( in Canadian dollars ) of trial subjects and short-term economic impact of same-day home discharge . As r and omization was done after the procedure , outcomes were similar , and PCI re source use showed minimal and nonsignificant differences , a post-PCI cost-minimization analysis was conducted . Detailed per-patient information of health care re sources used immediately after PCI up to 30 days was collected . RESULTS Mean post-PCI hospital stay was 8.9 h for out patients versus 26.5 h for overnight-stay patients ( p < 0.001 ) . At 30-day follow-up , the mean cumulative medical cost per outpatient was $ 1,117 ± $ 1,554 versus $ 2,258 ± $ 1,328 for overnight-stay patients . The mean difference of $ 1,141 ( 95 % confidence interval : $ 962 to $ 1,320 ) was mainly due to the extra night for overnight hospital stay . CONCLUSIONS In a real-world setting , same-day home discharge after uncomplicated transradial PCI and a bolus-only abciximab regimen result ed in a 50 % relative reduction in medical costs . Extension of this outpatient strategy would be welcomed by the hospitals and reimbursement systems in a context of increasing dem and for health care cost reduction . ( Early Discharge After Transradial Stenting of Coronary Arteries [ EASY ] ; NCT00169819 ) We examined the response of the radial artery to vasoactive agents ( isosorbide dinitrate , ISDN , 1 mg , 3 mg , and 5 mg ; verapamil , 1 mg , 3 mg , and 5 mg ; and lidocaine , 10 mg , 30 mg , and 50 mg ) in 100 consecutive patients admitted for elective coronary angiography . The drug solutions were directly injected into the radial artery from the puncture site . As a result , 5 mg of ISDN  increased the diameter of the radial artery by 31 % and 28.8 % at the proximal and distal sites , respectively . Similarly , 5 mg of verapamil increased it by 9 % and 10.8 % at the proximal and distal site , respectively . But 10 mg of lidocaine decreased it by −15.6 % and −12.1 % at the proximal and distal site , respectively . At the doses utilized , ISDN was the most potent vasodilator for the radial artery and lidocaine  caused paradoxical vasoconstriction . Cathet . Cardiovasc . Intervent . 49:253–256 , 2000 . © 2000 Wiley‐Liss , OBJECTIVE Radial artery spasm remains a major complication of transradial coronary interventions . The aim of this study was to compare the efficacy of three different intra-arterial vasodilating cocktails in reducing the incidence of radial artery spasm in patients undergoing transradial coronary angiography . The secondary goal was to assess the predictors of arterial spasm in this large group of patients . METHODS A total of 379 patients undergoing the procedure were r and omly enrolled in 1 of 3 groups . Every patient in each of the 3 groups received intra-arterial heparin , lidocaine and diltiazem . Along with that , patients in Group A received nitroglycerin ; patients in Group B received nitroprusside instead of nitroglycerin ; and patients in Group C received both nitroglycerin and nitroprusside . A single experienced operator , blinded to the study drug , subjectively determined the presence of spasm . RESULTS Of 379 patients , a total of 44 patients ( 11.6 % ) experienced spasm . The occurrence of spasm was similar , independent of the vasodilator cocktail used ( Group A : 12.2 % , Group B : 13.4 % , Group C : 9.5 % ; p = 0.597 ) . After multivariate analysis , the following variables were found to be independent predictors of spasm : radial artery diameter (RD)/height index ( p = 0.005 ) , RD/BSA index ( p = 0.012 ) , and sheath outer diameter (OD)/RD index ( p = 0.024 ) . CONCLUSION In this prospect i ve , r and omized trial , the addition of a direct nitric oxide donor to nitroglycerin in an antispastic cocktail did not reduce the risk of spasm , and the use of nitroglycerin was found to be as effective as nitroprusside . Also , morphometric and mechanical factors play a significant role in predicting the occurrence of radial spasm . The sex of the patient , presence of diabetes , body surface area and smoking history appeared to play no role in predicting the occurrence of radial spasm OBJECTIVE To evaluate the impact of the use , prior to the procedure , of injectable diltiazem to prevent complications . METHODS Between September 2000 and July 2001 , 50 patients underwent transradial coronary angiography  and were r and omized to receive placebo ( GI ) or diltiazem ( GII ) through a catheter inserted into the radial artery . All patients received isosorbide mononitrate . Ultrasound analyses of the radial artery were performed before examination , 30 minutes afterwards , and 7 days afterwards to evaluate the flow , the diameter , and the artery output . RESULTS The radial artery diameter of GI was 2.4d + /- 0.5 mm before the procedure and 2.3 + /- 0.5 mm after 30 minutes ( NS ) , whereas in GII the diameter was 2.2 + /- 0.3 mm before the examination and + /- 2.5 0.4 mm 30 minutes after it ( P<0.001 ) . Radial artery output in group 1 was 7.3 + /- 5.l2 mL/min before the examination and 6.1 + /- 3.5 mL/min 30 minutes after the examination ( NS ) , and GII had an increase of 5.9 + /- 2.5 mL/min before examination to 9.05 + /- 7.78 mL/min after the examination ( P=0.04 ) . Complications ( spasm , occlusion , and partial obstruction ) occurred in 4 patients ( 17.4 % ) in GI and did not occur in GII ( P=0.04 ) . CONCLUSION The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug , result ing in the significant increase in the diameter of the radial artery and radial artery output OBJECTIVES This study sought to determine the relationships among access site practice , clinical presentation , and procedural outcomes in a large patient population . BACKGROUND Transradial access ( TRA ) has been associated with improved patient outcomes in selected population s in r and omized trials . It is unclear whether these outcomes are achievable in clinical practice . METHODS Using the BCIS ( British Cardiovascular Intervention Society ) data base , we investigated outcomes for  percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice . Patients were categorized as stable , non-ST-segment elevation acute coronary syndrome ( NSTEACS ) and ST-elevation acute coronary syndrome ( STEACS ) . The impact of access site on 30-day mortality , major adverse cardiac events , bleeding , and arterial access site complications was studied . RESULTS Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed . Following multivariate analysis , TRA was independently associated with a reduction in bleeding in all presenting syndromes ( stable odds ratio [ OR ] : 0.24 , p < 0.001 ; NSTEACS OR : 0.35 , p < 0.001 ; STEACS OR : 0.47 , p < 0.001 ) as well as access site complications ( stable OR : 0.21 , p < 0.001 ; NSTEACS OR : 0.19 ; STEACS OR : 0.16 , p < 0.001 ) . TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes ( stable OR : 1.08 , p = 0.25 ; NSTEACS OR : 0.72 , p < 0.001 ; STEACS OR : 0.70 , p < 0.001 ) 
    Output:
    
In this largest and up-to- date review on intra-arterial vasodilators use to reduce RAS , we have found that the verapamil at a dose of 5 mg or verapamil in combination with nitroglycerine are the best combinations to reduce RAS