Mitchell Matthew D, Hong Jaekyoung A, Lee Bruce Y, Umscheid Craig A, Bartsch Sarah M, Don Creighton W
Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, USA.
Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):454-62. doi: 10.1161/CIRCOUTCOMES.112.965269. Epub 2012 Jun 26.
Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost-benefit analysis of radial catheterization based on results from a systematic review of published randomized controlled trials.
The systematic review added 5 additional randomized controlled trials to a prior review, for a total of 14 studies. Meta-analyses, following Cochrane procedures, suggested that radial catheterization significantly increased catheterization failure (OR, 4.92; 95% CI, 2.69-8.98), but reduced major complications (OR, 0.32; 95% CI, 0.24-0.42), major bleeding (OR, 0.39; 95% CI, 0.27-0.57), and hematoma (OR, 0.36; 95% CI, 0.27-0.48) compared with femoral catheterization. It added approximately 1.4 minutes to procedure time (95% CI, -0.22 to 2.97) and reduced hemostasis time by approximately 13 minutes (95% CI, -2.30 to -23.90). There were no differences in procedure success rates or major adverse cardiovascular events. A stochastic simulation model of per-case costs took into account procedure and hemostasis time, costs of repeating the catheterization at the alternate site if the first catheterization failed, and the inpatient hospital costs associated with complications from the procedure. Using base-case estimates based on our meta-analysis results, we found the radial approach cost $275 (95% CI, -$374 to -$183) less per patient from the hospital perspective. Radial catheterization was favored over femoral catheterization under all conditions tested.
Radial catheterization was favored over femoral catheterization in our cost-benefit analysis.
与股动脉入路相比，桡动脉入路用于冠状动脉造影和介入治疗已得到推广，因其可减少止血时间和血管并发症，但操作时间可能更长且并非总能成功，这引发了对其成本的担忧。我们基于对已发表的随机对照试验的系统评价结果，报告了桡动脉导管插入术的成本效益分析。
该系统评价在先前的综述基础上新增了5项随机对照试验，共计14项研究。按照Cochrane程序进行的荟萃分析表明，与股动脉导管插入术相比，桡动脉导管插入术显著增加了导管插入失败率（比值比[OR]，4.92；95%置信区间[CI]，2.69 - 8.98），但减少了主要并发症（OR，0.32；95% CI，0.24 - 0.42）、大出血（OR，0.39；95% CI，0.27 - 0.57）和血肿（OR，0.36；95% CI，0.27 - 0.48）。它使操作时间增加了约1.4分钟（95% CI， - 0.22至2.97），并使止血时间减少了约13分钟（95% CI， - 2.30至 - 23.90）。操作成功率或主要不良心血管事件方面无差异。一个逐例成本的随机模拟模型考虑了操作和止血时间、如果首次导管插入失败在备用部位重复导管插入的成本，以及与该操作并发症相关的住院费用。使用基于我们荟萃分析结果的基础病例估计值，从医院角度来看，我们发现桡动脉入路每位患者的成本少275美元（95% CI， - 374至 - 183美元）。在所有测试条件下，桡动脉导管插入术都优于股动脉导管插入术。
在我们的成本效益分析中，桡动脉导管插入术优于股动脉导管插入术。
