Hulme William, Sperrin Matthew, Kontopantelis Evangelos, Ratib Karim, Ludman Peter, Sirker Alex, Kinnaird Tim, Curzen Nick, Kwok Chun Shing, De Belder Mark, Nolan James, Mamas Mamas A
From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.); Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.); University Hospital of Wales, Cardiff, United Kingdom (T.K.); Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.).
Circ Cardiovasc Interv. 2017 Feb;10(2):e004279. doi: 10.1161/CIRCINTERVENTIONS.116.004279.
The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach.
Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235 250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97-1.02; =0.472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; =0.869). The in-hospital vascular complication rate was 1.0%, and this outcome was not significantly associated with recent femoral proportion after risk-adjustment (odds ratio, 0.97; 95% confidence interval, 0.94-1.00; =0.060 per 0.1 increase in proportion).
The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.
由于患者偏好、较低的出血率、成本效益以及高危患者群体死亡率降低，桡动脉越来越多地被用作心脏导管插入术的主要穿刺部位。有人担心操作者/中心对经股动脉穿刺越来越不熟悉。本研究的目的是评估全国范围内穿刺部位实践向经桡动脉穿刺的转变是否导致经股动脉穿刺途径进行的经皮冠状动脉介入手术的结果变差。
利用英国心血管介入学会（BCIS）数据库，对2007年至2013年期间英格兰和威尔士所有92个中心的235250例经股动脉穿刺的经皮冠状动脉介入手术进行了回顾性分析。确定近期股动脉穿刺比例和近期股动脉穿刺量，并评估住院期间血管并发症和30天死亡率。在进行病例组合调整后，未观察到经股动脉穿刺病例的30天死亡率与中心股动脉穿刺比例之间存在独立关联，近期股动脉穿刺比例的风险调整优势比无统计学意义（优势比，0.99；95%置信区间，0.97 - 1.02；比例每增加0.1，P = 0.472），同样，近期股动脉穿刺量（每100例手术）也无统计学意义（优势比，1.00；95%置信区间，0.98 - 1.01；P = 0.869）。住院期间血管并发症发生率为1.0%，风险调整后该结果与近期股动脉穿刺比例无显著关联（优势比，0.97；95%置信区间，0.94 - 1.00；比例每增加0.1，P = 0.060）。
全国采用桡动脉穿刺所取得的结果改善与股动脉穿刺熟练程度的降低无关，应鼓励各中心继续根据当前最佳证据，尽可能将桡动脉穿刺作为经皮冠状动脉介入的默认穿刺部位。
