De Maria Giovanni Luigi, Burzotta Francesco, Trani Carlo, Kassimis George, Pirozzolo Giancarlo, Patel Niket, Dato Ilaria, Porto Italo, Leone Antonio Maria, Niccoli Giampaolo, Kharbanda Rajeh, Crea Filippo, Banning Adrian P
Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Oxford OX39DU, United Kingdom.
J Invasive Cardiol. 2015 Jul;27(7):E125-36.
To analyze the immediate and long-term outcomes of transradial (TR) percutaneous coronary intervention (PCI) to unprotected left main stem (ULMS) bifurcation and to assess the main aspects affecting access-site choice in this specific PCI setting.
TR-PCI to the ULMS is feasible, but data specifically comparing TR and transfemoral (TF) approaches in ULMS-bifurcation PCI are limited.
We set up a two-center (Rome, Italy and Oxford, United Kingdom) retrospective registry aimed at comparing the immediate and 1-year outcomes of consecutive patients who underwent ULMS-bifurcation PCI with drug-eluting stent implantation from 2005 to 2013 using the TF or TR approach. Clinical endpoints were: total mortality; major adverse cardiac and cerebrovascular event (MACCE) rate; and net adverse clinical event (NACE) rate.
A total of 467 patients undergoing ULMS-bifurcation PCI were enrolled (221 TF and 244 TR). TR approach was increasingly adopted over time for both simple and complex procedures. No significant differences were observed between the TR and TF groups in terms of 1-year mortality (10.7% vs 9.8%; P=.79) and MACCE (18.2% vs 15.2%; P=.44). TR patients, as compared with TF, had significantly fewer access-site complications (2.0% vs 6.3% in TF; P=.02), resulting in a significant reduction of NACE rate (6.9% vs 15.7;%; P=.01).
In patients undergoing ULMS-bifurcation PCI, the selection of TR instead of TF approach is associated with similar early and long-term ischemic complications and with a significant reduction of access-site complications, resulting in lower NACE rate.
分析经桡动脉（TR）行经皮冠状动脉介入治疗（PCI）处理无保护左主干（ULMS）分叉病变的近期和长期疗效，并评估在这种特定PCI情况下影响入路选择的主要因素。
TR-PCI处理ULMS病变是可行的，但在ULMS分叉病变PCI中专门比较TR和经股动脉（TF）方法的数据有限。
我们建立了一个双中心（意大利罗马和英国牛津）回顾性注册研究，旨在比较2005年至2013年期间使用TF或TR方法行ULMS分叉病变PCI并植入药物洗脱支架的连续患者的近期和1年疗效。临床终点包括：全因死亡率；主要不良心脑血管事件（MACCE）发生率；以及净不良临床事件（NACE）发生率。
共纳入467例行ULMS分叉病变PCI的患者（221例采用TF方法，244例采用TR方法）。随着时间的推移，TR方法在简单和复杂手术中越来越多地被采用。TR组和TF组在1年死亡率（10.7%对9.8%；P = 0.79）和MACCE（18.2%对15.2%；P = 0.44）方面未观察到显著差异。与TF组相比，TR组患者的入路相关并发症明显更少（2.0%对TF组的6.3%；P = 0.02），导致NACE发生率显著降低（6.9%对15.7%；P = 0.01）。
在接受ULMS分叉病变PCI的患者中，选择TR而非TF方法与相似的早期和长期缺血性并发症相关，且入路相关并发症显著减少，导致NACE发生率更低。
