Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
JACC Cardiovasc Interv. 2013 Jul;6(7):698-706. doi: 10.1016/j.jcin.2013.03.011. Epub 2013 Jun 14.
This study sought to investigate the influence of access site utilization on mortality, major adverse cardiac and cardiovascular events (MACCE), bleeding, and vascular complications in a large number of patients treated by primary percutaneous coronary intervention (PPCI) in the United Kingdom over a 5-year period, through analysis of the British Cardiovascular Intervention Society database.
Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing PPCI. A significant proportion of such bleeding complications are related to the access site, and adoption of radial access may reduce these complications. These benefits have not previously been studied in a large unselected national population of PPCI patients.
Mortality (30-day), MACCE (a composite of 30-day mortality and in-hospital myocardial re-infarction, target vessel revascularization, and cerebrovascular events), and bleeding and access site complications were studied based on transfemoral access (TFA) and transradial access (TRA) site utilization in PPCI STEMI patients. The influence of access site selection was studied in 46,128 PPCI patients; TFA was used in 28,091 patients and TRA in 18,037. Data were adjusted for potential confounders using Cox regression that accounted for the propensity to undergo radial or femoral approach.
TRA was independently associated with a lower 30-day mortality (hazard ratio [HR]: 0.71, 95% confidence interval [CI]: 0.52 to 0.97; p < 0.05), in-hospital MACCE (HR: 0.73, 95% CI: 0.57 to 0.93; p < 0.05), major bleeding (HR: 0.37, 95% CI: 0.18 to 0.74; p < 0.01), and access site complications (HR: 0.38, 95% CI: 0.19 to 0.75; p < 0.01).
This analysis of a large number of PPCI procedures demonstrates that utilization of TRA is independently associated with major reductions in mortality, MACCE, major bleeding, and vascular complication rates.
本研究通过分析英国心血管介入学会数据库，旨在探讨在英国超过 5 年的时间里，大量接受经皮冠状动脉介入治疗（PPCI）的患者中，入路选择对死亡率、主要不良心脏和心血管事件（MACCE）、出血和血管并发症的影响。
尽管抗栓和抗血小板治疗取得了进展，但急性 ST 段抬高型心肌梗死（STEMI）患者接受 PPCI 后出血并发症仍是发病率和死亡率的重要原因。此类出血并发症中有相当一部分与入路部位有关，采用桡动脉入路可能会减少这些并发症。这些益处以前尚未在接受 PPCI 的大型未选择的全国人群中进行研究。
根据经股动脉（TFA）和经桡动脉（TRA）入路在 STEMI 患者 PPCI 中的应用，研究死亡率（30 天）、MACCE（由 30 天死亡率和院内再梗死、靶血管血运重建和脑血管事件组成的复合终点）以及出血和入路部位并发症。在 46128 例 PPCI 患者中研究了入路选择的影响；28091 例患者采用 TFA，18037 例患者采用 TRA。使用 Cox 回归校正潜在混杂因素，该回归考虑了行桡动脉或股动脉入路的倾向性。
TRA 与 30 天死亡率降低独立相关（风险比 [HR]：0.71，95%置信区间 [CI]：0.52 至 0.97；p < 0.05），院内 MACCE（HR：0.73，95% CI：0.57 至 0.93；p < 0.05）、大出血（HR：0.37，95% CI：0.18 至 0.74；p < 0.01）和入路部位并发症（HR：0.38，95% CI：0.19 至 0.75；p < 0.01）。
对大量 PPCI 手术的分析表明，TRA 的应用与死亡率、MACCE、大出血和血管并发症发生率的显著降低独立相关。
