Jin Chen, Xu Yi, Qiao Shubin, Tang Xinran, Wu Yongjian, Yan Hongbing, Dou Kefei, Xu Bo, Yang Jingang, Xian Ying, Yang Yuejin
1 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
2 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Angiology. 2017 Oct;68(9):799-806. doi: 10.1177/0003319716685670. Epub 2017 Jan 5.
Despite increasing adoption of the transradial approach for percutaneous coronary intervention (PCI) in clinical practice, the role of transradial intervention (TRI) in women remains a significant debate. We identified 1392 women from a consecutive cohort of patients undergoing PCI in China in 2010 and compared the efficacy and hospital costs between TRI and transfemoral intervention. An inverse probability weighting (IPW) method was used to control for potential bias. After IPW adjustment, patients receiving TRI were less likely to experience post-PCI bleeding (adjusted odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.30-0.71) and major adverse cardiac events (adjusted OR 0.35, 95% CI 0.19-0.63) and more likely to have shorter length of stay in hospital (1.2 days difference, 95% CI: 0.6-1.7). Moreover, TRI was associated with a cost saving of ¥ (Yuan Renminbi) 7474 (approximately US$1150, 95% CI: ¥2993-¥11 624). More than 70% of this saving was driven by lower PCI-related costs. In conclusion, the use of TRI in women was associated with more favorable outcomes and lower hospital costs.
尽管在临床实践中经桡动脉途径用于经皮冠状动脉介入治疗(PCI)的应用越来越广泛,但经桡动脉介入治疗(TRI)在女性患者中的作用仍存在重大争议。我们从2010年在中国接受PCI治疗的连续队列患者中识别出1392名女性,并比较了TRI和经股动脉介入治疗的疗效及住院费用。采用逆概率加权(IPW)方法来控制潜在偏倚。经过IPW调整后,接受TRI的患者PCI术后出血的可能性较小(调整后的优势比[OR]:0.46,95%置信区间[CI]:0.30 - 0.71),发生主要不良心脏事件的可能性也较小(调整后的OR 0.35,95% CI 0.19 - 0.63),且住院时间更短的可能性更大(相差1.2天,95% CI:0.6 - 1.7)。此外,TRI可节省人民币7474元(约合1150美元,95% CI:2993元 - 11624元)。这一节省的70%以上是由较低的PCI相关成本驱动的。总之,女性使用TRI与更有利的结果和更低的住院费用相关。