经桡动脉与股动脉入路行冠状动脉旁路移植血管造影和介入治疗的随机对比：RADIAL-CABG 试验（经桡动脉与股动脉入路行冠状动脉旁路移植血管造影和介入治疗的比较）。
A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention).
机构信息
VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
出版信息
JACC Cardiovasc Interv. 2013 Nov;6(11):1138-44. doi: 10.1016/j.jcin.2013.08.004. Epub 2013 Oct 16.
OBJECTIVES
This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery.
BACKGROUND
Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery.
METHODS
Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat.
RESULTS
Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%).
CONCLUSIONS
In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).
目的
本研究旨在比较经桡动脉与股动脉入路行冠状动脉旁路移植术（CABG）患者心导管检查时的使用情况和辐射暴露。
背景
有限的信息可用于比较经桡动脉与股动脉入路行 CABG 术后患者心导管检查的相对优势。
方法
连续入选的（N=128）行 CABG 术后并接受心导管检查的患者被随机分配至桡动脉或股动脉入路组。主要研究终点为对比剂用量。次要终点包括透视时间、手术时间、患者和术者的辐射暴露、血管并发症和主要不良心脏事件。分析采用意向治疗。
结果
与股动脉入路相比，桡动脉入路行诊断性冠状动脉造影时的平均对比剂用量更高（142±39 ml vs. 171±72 ml，p<0.01），手术时间更长（21.9±6.8 min vs. 34.2±14.7 min，p<0.01），患者体表空气比释动能（单位质量释放的动能）辐射暴露更大（1.08±0.54 Gy vs. 1.29±0.67 Gy，p=0.06），术者辐射剂量更高（第一术者：1.3±1.0 mrem vs. 2.6±1.7 mrem，p<0.01；第二术者：0.8±1.1 mrem vs. 1.8±2.1 mrem，p=0.01）。桡动脉组行择期经皮冠状动脉介入治疗（PCI）的患者更少（37.5% vs. 46.9%，p=0.28），桡动脉 PCI 操作更简单。在接受 PCI 的患者中，主要终点和次要终点的发生率在股动脉和桡动脉入路之间相似。桡动脉组的入路交叉更高（17.2% vs. 0.0%，p<0.01），两组血管入路部位并发症相似（3.1%）。
结论
与股动脉入路相比，CABG 术后患者行经桡动脉诊断性冠状动脉造影时，造影剂用量更大，手术时间更长，入路交叉和术者辐射暴露更大。（RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] 试验；NCT01446263）
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