Coppola John, Patel Tejas, Kwan Tak, Sanghvi Kintur, Srivastava Sudhesh, Shah Sanjay, Staniloae Cezar
Cardiology Research Office, Saint Vincent Catholic Medical Center, New York, New York, USA.
J Invasive Cardiol. 2006 Apr;18(4):155-8.
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.
A total of 379 patients undergoing the procedure were randomly 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.
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).
In this prospective, randomized 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.
桡动脉痉挛仍然是经桡动脉冠状动脉介入治疗的主要并发症。本研究的目的是比较三种不同的动脉内血管扩张鸡尾酒在降低接受经桡动脉冠状动脉造影患者桡动脉痉挛发生率方面的疗效。次要目标是评估这一大组患者动脉痉挛的预测因素。
总共379例接受该手术的患者被随机纳入3组中的1组。3组中的每组患者均接受动脉内肝素、利多卡因和地尔硫䓬治疗。除此之外，A组患者接受硝酸甘油；B组患者接受硝普钠而非硝酸甘油；C组患者接受硝酸甘油和硝普钠。由一位对研究药物不知情的经验丰富的操作者主观判断痉挛的存在。
在379例患者中，共有44例患者（11.6%）发生痉挛。痉挛的发生率相似，与所使用的血管扩张鸡尾酒无关（A组：12.2%，B组：13.4%，C组：9.5%；p = 0.597）。多因素分析后，发现以下变量是痉挛的独立预测因素：桡动脉直径（RD）/身高指数（p = 0.005）、RD/体表面积指数（p = 0.012）和鞘外径（OD）/RD指数（p = 0.024）。
在这项前瞻性随机试验中，在抗痉挛鸡尾酒中向硝酸甘油添加直接一氧化氮供体并不能降低痉挛风险，且发现硝酸甘油的使用与硝普钠一样有效。此外，形态学和机械因素在预测桡动脉痉挛的发生中起重要作用。患者的性别、糖尿病的存在、体表面积和吸烟史似乎在预测桡动脉痉挛的发生中不起作用。
