Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
JACC Cardiovasc Interv. 2009 Nov;2(11):1057-64. doi: 10.1016/j.jcin.2009.07.014.
The study aimed to determine the mechanism and predictors of procedural failure in patients undergoing percutaneous coronary intervention (PCI) from the transradial approach (TR).
Transradial approach PCI reduces vascular complications compared with a transfemoral approach (TF). However, the mechanism and predictors of TR-PCI failure have not been well-characterized.
The study population consisted of patients undergoing TR-PCI by low-to-intermediate volume operators with traditional TF guide catheters. Baseline characteristics, procedure details, and clinical outcomes were prospectively collected. Univariate and multivariate analyses were performed to determine independent predictors of TR-PCI failure.
A total of 2,100 patients underwent TR-PCI and represented 38% of PCI volume. Mean age was 64 +/- 12 years, and 17% were female. Vascular complications occurred in 22 (1%), and TR-PCI failure was observed in 98 (4.7%) patients. The mechanism of TR-PCI failure included inability to advance guide catheter to ascending aorta in 50 (51%), inadequate guide catheter support in 35 (36%), and unsuccessful radial artery puncture in 13 (13%) patients. The PCI was successful in 94 (96%) patients with TR-PCI failure by switching to TF. On multivariate analysis, age >75 years (odds ratio [OR]: 3.86; 95% confidence interval [CI]: 2.33 to 6.40, p = 0.0006), prior coronary artery bypass graft surgery (OR: 7.47; 95% CI: 3.45 to 16.19, p = 0.0002), and height (OR: 0.97; 95% CI: 0.95 to 0.99, p = 0.02) were independent predictors of TR-PCI failure.
Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI.
本研究旨在探讨经桡动脉入路（TR）行经皮冠状动脉介入治疗（PCI）中程序失败的机制和预测因素。
与经股动脉入路（TF）相比，TR 可降低血管并发症的发生风险。然而，TR-PCI 失败的机制和预测因素尚未得到很好的描述。
本研究纳入了由低至中量手术量的操作者采用传统 TF 导引导管行经 TR-PCI 的患者。前瞻性收集了基线特征、手术细节和临床结局。采用单因素和多因素分析确定 TR-PCI 失败的独立预测因素。
共 2100 例患者接受了 TR-PCI，占 PCI 总例数的 38%。患者平均年龄为 64±12 岁，17%为女性。22 例（1%）发生血管并发症，98 例（4.7%）患者发生 TR-PCI 失败。TR-PCI 失败的机制包括 50 例（51%）导引导管无法进入升主动脉、35 例（36%）导引导管支持不足和 13 例（13%）桡动脉穿刺失败。94 例（96%）TR-PCI 失败患者通过转为 TF 成功完成 PCI。多因素分析显示，年龄＞75 岁（比值比 [OR]：3.86；95%置信区间 [CI]：2.33 至 6.40，p=0.0006）、既往冠状动脉旁路移植术（OR：7.47；95%CI：3.45 至 16.19，p=0.0002）和身高（OR：0.97；95%CI：0.95 至 0.99，p=0.02）是 TR-PCI 失败的独立预测因素。
低至中量手术量的操作者采用标准设备行经 TR-PCI 可获得较低的失败率。年龄＞75 岁、既往冠状动脉旁路移植术和身材矮小是 TR-PCI 失败的独立预测因素。需要进行适当的患者选择和仔细的风险评估，以最大限度地发挥 TR-PCI 的益处。
