Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Am Heart J. 2013 Mar;165(3):280-5. doi: 10.1016/j.ahj.2012.08.011.
Use of the transradial approach (TRA) in percutaneous coronary intervention (PCI) has increased in recent years. TRA has a lower mortality rate than the transfemoral approach (TFA) in patients with acute coronary syndrome. Comparative studies have systematically excluded patients with cardiogenic shock (CS).
We performed a prospective, observational registry study of consecutive patients undergoing emergent revascularization between February 2007 and January 2012. An analysis of the clinical evolution of patients with CS during hospitalization was performed.
Of 1,400 emergency procedures, 122 had CS, of which 80 underwent PCI by TRA (65.6%) and 42 underwent PCI by TFA (34.3%). The main reason for choosing TFA was the absence of radial pulse (54.9%). Mortality (64.3% vs 32.5%, P = .001), serious access site complications (11.9% vs 2.5%, P = .03), access site complications requiring blood transfusion (7.1% vs 0%, P = .04), and major adverse cardiac events (death, infarction, stroke, serious bleeding, and postanoxic encephalopathy) (73.8% vs 43.8%, P = .001) were greater in patients treated by TFA. In the multivariate analysis, TRA was a predictor of mortality (odds ratio [OR] 0.39 [0.15-0.97]); other predictive factors were age ≥75 years (3.47 [1.35-8.92]), previous treatment with diuretics (3.67 [1.21-11.12]), and success of the procedure (0.07 [0.02-0.24]).
Transradial approach for PCI is possible and safe in up to two-thirds of patients with CS. Absence of radial pulse was the main factor preventing use of TRA. In multivariate analysis, TRA was associated with a lower risk of mortality.
近年来，经皮冠状动脉介入治疗（PCI）中经桡动脉入路（TRA）的应用有所增加。TRA 在急性冠状动脉综合征患者中的死亡率低于经股动脉入路（TFA）。比较研究系统地排除了心源性休克（CS）患者。
我们对 2007 年 2 月至 2012 年 1 月期间连续进行紧急血运重建的患者进行了前瞻性、观察性注册研究。对住院期间 CS 患者的临床转归进行了分析。
在 1400 例紧急手术中，有 122 例发生 CS，其中 80 例行 TRA 下 PCI（65.6%），42 例行 TFA 下 PCI（34.3%）。选择 TFA 的主要原因是桡动脉搏动消失（54.9%）。TFA 组死亡率（64.3%比 32.5%，P =.001）、严重入路部位并发症（11.9%比 2.5%，P =.03）、需要输血的入路部位并发症（7.1%比 0%，P =.04）和主要不良心脏事件（死亡、梗死、中风、严重出血和缺血性脑病后）（73.8%比 43.8%，P =.001）更高。多变量分析显示，TRA 是死亡率的预测因素（比值比 [OR] 0.39 [0.15-0.97]）；其他预测因素包括年龄≥75 岁（3.47 [1.35-8.92]）、利尿剂既往治疗（3.67 [1.21-11.12]）和手术成功（0.07 [0.02-0.24]）。
TRA 用于 PCI 在多达三分之二的 CS 患者中是可行且安全的。桡动脉搏动消失是阻止使用 TRA 的主要因素。多变量分析显示，TRA 与降低死亡率相关。
