Applegate Robert J, Sacrinty Matthew T, Kutcher Michael A, Baki Talal T, Gandhi Sanjay K, Santos Renato M, Little William C
Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
Catheter Cardiovasc Interv. 2006 Apr;67(4):556-62. doi: 10.1002/ccd.20677.
To evaluate the adjusted risk of vascular complications after manual compression and vascular closure devices for femoral artery access site management in a large contemporary cohort, using propensity score analysis.
Vascular closure devices (VCD) allow early ambulation after cardiac procedures involving femoral artery access, but whether the benefit of use of vascular closure devices (VCD) is offset by reduced safety in contemporary practice remains uncertain.
Twenty one thousand eight hundred and forty one consecutive diagnostic cardiac catheterization (n = 13,124) and percutaneous coronary intervention procedures (n = 8,717) performed via a femoral access at a single site (WFUBMC) between 1998 and 2003 were evaluated. VCD's were used based on operator preference. Propensity to receive a vascular closure device (VCD) was calculated. The relative incidence of vascular complications was evaluated by logistic regression models, using the propensity score as a covariate.
Overall, the unadjusted incidence of any vascular complication was 1.3% for VCD use and 1.4% for manual compression, p = NS. The propensity score-adjusted odds ratio for any vascular complication comparing VCD (n = 8,707) to manual compression (n = 13,034) was 0.86 (0.67-1.11) for all procedures, 0.80 (0.53-1.21) for diagnostic procedure, and 0.90 (0.65-1.26) for interventional procedures.
In this large single-center, contemporary observational study, the risk-adjusted occurrence of vascular complications following VCD use for femoral artery access management is not increased by VCD use. Thus, in the current era, the benefit of VCD use is not offset by reduced safety.
采用倾向评分分析方法，评估在一个大型当代队列中，手动压迫和血管闭合装置用于股动脉穿刺部位管理后血管并发症的校正风险。
血管闭合装置（VCD）可使涉及股动脉穿刺的心脏手术后早期活动，但在当代实践中，使用血管闭合装置（VCD）的益处是否会被安全性降低所抵消仍不确定。
对1998年至2003年期间在单一地点（WFUBMC）通过股动脉进行的21841例连续诊断性心导管检查（n = 13124）和经皮冠状动脉介入治疗手术（n = 8717）进行评估。血管闭合装置的使用基于操作者的偏好。计算接受血管闭合装置（VCD）的倾向。使用倾向评分作为协变量，通过逻辑回归模型评估血管并发症的相对发生率。
总体而言，使用血管闭合装置时任何血管并发症的未校正发生率为1.3%，手动压迫时为1.4%，p = 无显著性差异。在所有手术中，将使用血管闭合装置（n = 8707）与手动压迫（n = 13034）相比，任何血管并发症的倾向评分校正比值比为0.86（0.67 - 1.11）；诊断性手术为0.80（0.53 - 1.21）；介入性手术为0.90（0.65 - 1.26）。
在这项大型单中心当代观察性研究中，使用血管闭合装置进行股动脉穿刺部位管理后，经风险调整的血管并发症发生率并未因使用血管闭合装置而增加。因此，在当前时代，使用血管闭合装置的益处不会因安全性降低而被抵消。
