心内科住院医师直接进行经皮左心导管插入术的安全性：一项队列分析。

Safety of percutaneous left heart catheterization directly performed by cardiology fellows: a cohort analysis.

作者信息

Agostoni Pierfrancesco, Anselmi Maurizio, Gasparini Gabriele, Morando Giorgio, Tosi Paolo, De Benedictis M Luisa, Quintarelli Silvia, Molinari Gionata, Zardini Piero, Turri Marco

机构信息

University of Verona, Italy.

出版信息

J Invasive Cardiol. 2006 Jun;18(6):248-52.

PMID:16751676

Abstract

BACKGROUND

No previous study has analyzed the possible responsibility of fellows-in-training in terms of the risk of complications during cardiac catheterization. Thus, we sought to identify possible risk factors for access site complications following cardiac catheterization procedures, with particular attention to the role of cardiology fellows.

METHODS

A total of 1,288 left heart catheterization procedures (both diagnostic and interventional), performed over a 1-year period at a university hospital, were retrospectively evaluated to determine the incidence of local complications (pseudoaneurysm, arterio-venous fistula, major hematoma or bleeding, vascular dissection). Several clinical (age, gender, previous coronary artery bypass surgery, indication to the exam) and procedural (procedure performed by the fellow, access site, type of procedure, urgent setting, use of glycoprotein IIb/IIIa inhibitors, simultaneous right heart catheterization, use of closure devices) covariables were considered. Major adverse cardiovascular and cerebrovascular events (MACCE: death, myocardial infarction, cerebrovascular event) were also assessed.

RESULTS

The overall access site complication rate was 2.6%. On multivariate regression analysis, the only two predictors of local complications were female gender (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.6-6.5) and femoral approach (OR 3.9, 95% CI 1.2-12.1). The rate of MACCE was 1.2%, mainly after percutaneous coronary interventions, with only 1 death overall (0.07%). Procedures performed by cardiology fellows were not associated with an increased incidence of either complication.

CONCLUSIONS

Cardiology fellows can safely perform cardiac catheterization procedures without an increase in the rate of local and major cardiovascular complications. Of course, the presence and watchful supervision of an attending physician is still essential to ensure both patient safety and optimal training.

摘要

背景

以往尚无研究分析住院医师在心脏导管插入术期间发生并发症风险方面的可能责任。因此，我们试图确定心脏导管插入术后穿刺部位并发症的可能危险因素，尤其关注心内科住院医师的作用。

方法

回顾性评估了在一所大学医院1年期间进行的总共1288例左心导管插入术（包括诊断性和介入性），以确定局部并发症（假性动脉瘤、动静脉瘘、大出血或出血、血管夹层）的发生率。考虑了几个临床变量（年龄、性别、既往冠状动脉搭桥手术、检查指征）和操作变量（由住院医师进行的操作、穿刺部位、操作类型、紧急情况、糖蛋白IIb/IIIa抑制剂的使用、同时进行的右心导管插入术、封堵装置的使用）。还评估了主要不良心血管和脑血管事件（MACCE：死亡、心肌梗死、脑血管事件）。

结果

总的穿刺部位并发症发生率为2.6%。多因素回归分析显示，局部并发症的仅有的两个预测因素是女性（比值比[OR]3.2，95%置信区间[CI]1.6 - 6.5）和股动脉入路（OR 3.9，95%CI 1.2 - 12.1）。MACCE发生率为1.2%，主要发生在经皮冠状动脉介入术后，总体仅1例死亡（0.07%）。心内科住院医师进行的操作与任何一种并发症的发生率增加均无关。