University of Washington, Seattle, WA, USA.
Am Heart J. 2013 Mar;165(3):332-7. doi: 10.1016/j.ahj.2012.11.011. Epub 2012 Dec 29.
Transradial percutaneous coronary intervention (tPCI) as opposed to the femoral approach (fPCI) is associated with lower rates of bleeding. The purposes of this study were to describe the use of tPCI in the Washington State Clinical Outcomes Assessment Program, identify the predictors of bleeding, and determine whether tPCI was associated with less bleeding in women vs men, age <75 years vs ≥75 years, and baseline creatinine <2.0 mg/dL vs ≥2.0 mg/dL.
This study included 23,599 individuals who had a first tPCI or fPCI performed in 30 centers in Washington State in 2010 and 2011. Data were collected according to specifications from the American College of Cardiology National Cardiovascular Data Registry Cath-PCI version 4.3. The American College of Cardiology National Cardiovascular Data Registry bleeding model was used to calculate adjusted rates.
Transradial percutaneous coronary intervention was used in only 5% of procedures, and in just 3 centers, tPCI was used in >10% of cases. Patient demographics and medical histories were similar in tPCI and fPCI, although the percent of acute cases was higher in fPCI (68% vs 45%, P < .0001). The overall bleeding rate was 2.2%, and the 3 most important predictors of bleeding were acute procedure, women, and age ≥75 years. For women, unadjusted rates of bleeding were 1.4% for tPCI and 4.0% for fPCI (P = .013). Among women, adjusted rates were almost 20% lower for tPCI (3.3% vs 4.1%).
In Washington State, tPCI was used infrequently, although it was associated with lower bleeding rates in high-risk groups including women.
与股动脉入路（fPCI）相比，经桡动脉入路（tPCI）的出血率较低。本研究的目的是描述在华盛顿州临床结果评估计划中 tPCI 的使用情况，确定出血的预测因素，并确定 tPCI 是否与女性比男性、年龄<75 岁与≥75 岁、以及基线肌酐<2.0 mg/dL 与≥2.0 mg/dL 患者的出血减少有关。
本研究纳入了 2010 年和 2011 年在华盛顿州 30 个中心接受首次 tPCI 或 fPCI 的 23599 名患者。数据根据美国心脏病学会国家心血管数据注册中心 Cath-PCI 第 4.3 版的规定收集。使用美国心脏病学会国家心血管数据注册中心出血模型计算调整后的发生率。
仅 5%的手术采用经桡动脉入路，仅有 3 家中心采用经桡动脉入路的比例>10%。tPCI 和 fPCI 患者的人口统计学和病史相似，尽管 fPCI 的急性病例比例更高（68%比 45%，P<0.0001）。总的出血发生率为 2.2%，出血的 3 个最重要预测因素是急性手术、女性和年龄≥75 岁。对于女性，tPCI 的未调整出血率为 1.4%，fPCI 为 4.0%（P=0.013）。在女性中，tPCI 的调整后出血率几乎低 20%（3.3%比 4.1%）。
在华盛顿州，尽管经桡动脉入路与高危人群（包括女性）较低的出血率相关，但使用频率较低。
