De Carlo Marco, Borelli Gabriele, Gistri Roberto, Ciabatti Nicola, Mazzoni Alessandra, Arena Marco, Petronio A Sonia
Cardiothoracic and Vascular Department, Cardiology Unit, University of Pisa, Pisa, Italy.
Catheter Cardiovasc Interv. 2009 Sep 1;74(3):408-15. doi: 10.1002/ccd.22008.
To analyze the effectiveness of the transradial approach in reducing bleeding rates following urgent percutaneous coronary intervention (PCI) in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors (GPIs).
PCI and use of GPIs are recommended in acute coronary syndromes, but are strong predictors of severe hemorrhagic complications, which, in turn, are associated with reduced survival. The transradial approach represents a simple and effective solution to reduce vascular access site bleedings, particularly with GPIs.
All consecutive patients undergoing urgent transradial PCI under GPI treatment were enrolled in the registry. No patients were excluded. In addition, we performed a case-matched comparison of the transradial versus transfemoral approach using propensity analysis to adjust for known risk factors for bleeding. The primary end point was the rate of bleedings, graded according to the Thrombolysis in Myocardial Infarction (TIMI) classification.
Five hundred thirty-one consecutive patients were prospectively enrolled in the registry. TIMI major, minor, and minimal bleedings were 0.2%, 1.7%, and 6.4%, respectively. Transfusion rate was 0.8%. After propensity-matched analysis, the transradial approach was associated with significantly lower rates of all types of bleedings, while the transfemoral approach was the strongest predictor of TIMI major/minor bleedings (odds ratio 6.67; 95% confidence interval 1.72-25; P = 0.006).
The transradial approach dramatically reduces access site bleedings, including TIMI major and minor bleedings, and transfusion rate, while preserving procedural success and clinical outcome. The transradial approach is an attractive solution to reduce bleeding complications in patients treated with GPIs.
分析经桡动脉途径在接受糖蛋白IIb/IIIa抑制剂（GPI）治疗的急性冠脉综合征患者紧急经皮冠状动脉介入治疗（PCI）后降低出血率的有效性。
急性冠脉综合征推荐进行PCI并使用GPI，但这是严重出血并发症的强烈预测因素，而严重出血并发症又与生存率降低相关。经桡动脉途径是减少血管穿刺部位出血的一种简单有效的方法，尤其是在使用GPI时。
所有在GPI治疗下接受紧急经桡动脉PCI的连续患者均纳入登记研究。无患者被排除。此外，我们使用倾向分析对经桡动脉与经股动脉途径进行病例匹配比较，以调整已知的出血危险因素。主要终点是出血率，根据心肌梗死溶栓（TIMI）分类进行分级。
531例连续患者前瞻性纳入登记研究。TIMI大出血、小出血和微量出血发生率分别为0.2%、1.7%和6.4%。输血率为0.8%。倾向匹配分析后，经桡动脉途径与所有类型出血的发生率显著降低相关，而经股动脉途径是TIMI大出血/小出血的最强预测因素（比值比6.67；95%置信区间1.72 - 25；P = 0.006）。
经桡动脉途径可显著降低穿刺部位出血，包括TIMI大出血和小出血以及输血率，同时保持手术成功率和临床结局。经桡动脉途径是减少接受GPI治疗患者出血并发症的一种有吸引力的解决方案。
