老年急性心肌梗死患者经桡动脉途径行直接经皮冠状动脉介入治疗的安全性与可行性

Safety and feasibility of transradial approach for primary percutaneous coronary intervention in elderly patients with acute myocardial infarction.

作者信息

Yan Zhen-xian, Zhou Yu-jie, Zhao Ying-xin, Liu Yu-yang, Shi Dong-mei, Guo Yong-he, Cheng Wan-jun

机构信息

Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Chin Med J (Engl). 2008 May 5;121(9):782-6.

PMID:18701040

Abstract

BACKGROUND

Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral approach. This study aimed to investigate the safety and feasibility of transradial approach for primary percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI).

METHODS

A total of 103 consecutive elderly patients (age = 65 years) who were diagnosed as having AMI were indicated for PCI. Among them, 57 patients received primary PCI via the transradial approach (transradial intervention, TRI group), and 46 underwent primary PCI via the transfemoral approach (transfemoral intervention, TFI group). The success rate of puncture, puncture time, cannulation time, reperfusion time, the total time for PCI, the success rate of PCI, the use rates of temporary pacemaker and intra-aortic balloon pump (IABP), and the total length of hospital stay of the patients in the two groups were compared. After the procedure, vascular access site complications and major adverse cardiovascular events (MACE) in the two groups in one month were observed.

RESULTS

The success rates of puncture (98.2% vs 100.0%) and PCI (96.5% vs 95.7%) for the patients in the TRI and TFI groups were not statistically significant (P > 0.05). The puncture time ((2.4 +/- 1.1) vs (2.0 +/- 0.9) minutes), cannulation time ((2.7 +/- 0.5) vs (2.6 +/- 0.5) minutes), reperfusion time ((16.2 +/- 4.5) vs (15.4 +/- 3.6) minutes), total time of the procedure ((44.1 +/- 6.8) vs (41.2 +/- 5.7) minutes), use rates of temporary pacemaker (1.8% vs 2.2%) and IABP (0 vs 2.2%) in the two groups were not statistically significant (P > 0.05), but the hospital stay of the TFI group was longer than that of the TRI group ((10.1 +/- 4.6) vs (7.2 +/- 2.6) days, P < 0.01). A radial occlusion was observed in the TRI group, but no ischemic syndrome in hand. In the TFI group, 4 patients had hematosis, 1 had pseudoaneurysm, and 1 had major bleeding. Statistical significance in vascular access site complications was seen in the two groups (1.8 % vs 13.1%, P < 0.05). Three patients died in the two groups respectively in one month, and there was no statistical significance in MACE in the two groups (5.3% vs 6.5%, P > 0.05).

CONCLUSION

The transradial approach for primary PCI is safe and feasible for elderly patients with AMI.

摘要

背景

与股动脉途径相比，经桡动脉冠状动脉介入治疗因其能降低血管穿刺部位并发症的发生率并提高患者满意度而被广泛应用。本研究旨在探讨经桡动脉途径在老年急性心肌梗死（AMI）患者行直接经皮冠状动脉介入治疗（PCI）中的安全性和可行性。

方法

连续纳入103例诊断为AMI且年龄≥65岁的老年患者行PCI治疗。其中，57例患者经桡动脉途径行直接PCI（经桡动脉介入治疗组，TRI组），46例经股动脉途径行直接PCI（经股动脉介入治疗组，TFI组）。比较两组患者的穿刺成功率、穿刺时间、置管时间、再灌注时间、PCI总时间、PCI成功率、临时起搏器及主动脉内球囊反搏（IABP）使用率以及患者住院总时长。术后观察两组患者1个月内血管穿刺部位并发症及主要不良心血管事件（MACE）。

结果

TRI组和TFI组患者的穿刺成功率（98.2%对100.0%）及PCI成功率（96.5%对95.7%）差异无统计学意义（P>0.05）。两组患者的穿刺时间（（2.4±1.1）对（2.0±0.9）分钟）、置管时间（（2.7±0.5）对（2.6±0.5）分钟）、再灌注时间（（16.2±4.5）对（15.4±3.6）分钟）、手术总时间（（44.1±6.8）对（41.2±5.7）分钟）、临时起搏器使用率（1.8%对2.2%）及IABP使用率（0对2.2%）差异均无统计学意义（P>0.05），但TFI组的住院时间长于TRI组（（10.1±4.6）对（7.2±2.6）天，P<0.01）。TRI组观察到桡动脉闭塞，但未出现手部缺血综合征。TFI组有4例发生血肿，1例发生假性动脉瘤，1例发生大出血。两组血管穿刺部位并发症差异有统计学意义（1.8%对13.1%，P<0.05）。两组分别有3例患者在1个月内死亡，两组MACE差异无统计学意义（5.3%对6.5%，P>0.05）。