经桡动脉与经股动脉途径行冠状动脉旁路移植术治疗无保护左主干病变的比较：手术操作及长期预后比较。
Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes.
机构信息
Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
JACC Cardiovasc Interv. 2010 Oct;3(10):1035-42. doi: 10.1016/j.jcin.2010.09.003.
OBJECTIVES
This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy.
BACKGROUND
The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared.
METHODS
Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method.
RESULTS
Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively.
CONCLUSIONS
In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.
目的
本研究旨在比较高危冠状动脉解剖结构患者中行经桡动脉（TR）和经股动脉（TF）经皮血运重建术的结局。
背景
经皮冠状动脉血运重建术治疗无保护左主干冠状动脉（UPLM）疾病时，TR 和 TF 两种方法的可行性、疗效和安全性尚未得到比较。
方法
在 821 例连续接受经皮血运重建术治疗的 UPLM 疾病患者中，根据血管入路方法比较了经桡动脉（n = 353）和经股动脉（n = 468）入路的手术结果、资源利用、住院期间出血和晚期临床事件。
结果
临床和血管造影特征在两组间相似，但 TR 患者较少出现不稳定型心绞痛，且 UPLM 分叉病变较少需要用 2 个支架治疗。TR 和 TF 方法在手术成功率（97%TF 与 96%TR，p = 0.57）或总手术时间方面无显著差异。然而，TR 组的住院时间和住院期间发生血栓形成心肌梗死（TIMI）大出血或小出血（0.6%与 2.8%，p = 0.02）的比例显著降低。使用倾向评分匹配模型（254 对匹配），在平均 17 个月的随访期间，TR 组心血管死亡（1.2%与 2.0%，p = 0.48）、非致死性心肌梗死（4.7%与 2.4%，p = 0.16）、支架血栓形成（0.8%与 2.8%，p = 0.10）和任何靶血管血运重建（6.0%与 6.7%，p = 0.72）的发生率在 TR 和 TF 组间无统计学差异。
结论
与 TF 血管入路相比，TR 经皮冠状动脉血运重建术治疗 UPLM 疾病是可行的，且与相似的手术成功率、缩短的住院时间、减少的出血以及可比的晚期临床安全性和疗效相关。
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