Wilson Simon J, Mitchell Andrew, Gray Timothy J M, Loh Hoe Jun, Cruden Nick L
British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom.
Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom.
Int J Cardiol. 2017 Aug 1;240:78-81. doi: 10.1016/j.ijcard.2017.03.041. Epub 2017 Mar 11.
A haemostatic technique that maintains radial artery flow ("patent haemostasis") following transradial catheterization reduces rates of radial artery occlusion (RAO) in patients with stable coronary disease. It is unclear whether this benefit extends to patients with an acute coronary syndrome (ACS).
Patients undergoing inpatient transradial catheterization for an ACS were prospectively enrolled in a consecutive cohort study (n=300). Radial haemostasis was obtained using standard radial compression (cohort 1; n=150) or patent haemostasis (cohort 2; n=150). An end-of-case activated clotting time (ACT) was recorded and radial artery patency assessed within 24 hours of sheath removal by reverse Barbeau's test.
The incidence of RAO was 16.0% following standard radial compression and 5.3% following patent haemostasis (p=0.003). Univariate predictors of RAO were patent haemostasis (OR 0.30; [0.13-0.68], p=0.004), hyperlipidaemia (OR 0.46; [0.21-0.98], p=0.04), history of current smoking (OR 2.86; [1.3-6.0], p=0.015) and longer procedure times (OR 1.03/additional minute; [1.01-1.05], p=0.003). There was no association between the end-of-case ACT and RAO (OR 1.00; [0.9-1.01] p=1.00). After adjusting for covariates, patent haemostasis reduced the risk of RAO by 70% compared to standard compression (OR 0.30; [0.12-0.77], p=0.12). The c-statistic for model discrimination was 0.79 (95% CI [0.71-0.86], p<0.001). Inverse probability treatment weighted analysis also confirmed patent haemostasis as an independent predictor of reduced RAO (OR 0.38 [0.15-0.95], p=0.039).
Patent haemostasis is highly effective in preventing early RAO in patients with ACS.
一种在经桡动脉导管插入术后维持桡动脉血流（“有效止血”）的止血技术可降低稳定性冠心病患者的桡动脉闭塞（RAO）发生率。目前尚不清楚这种益处是否也适用于急性冠状动脉综合征（ACS）患者。
将因ACS接受住院经桡动脉导管插入术的患者前瞻性纳入一项连续队列研究（n = 300）。使用标准桡动脉压迫法（队列1；n = 150）或有效止血法（队列2；n = 150）实现桡动脉止血。记录病例结束时的活化凝血时间（ACT），并在拔除鞘管后24小时内通过反向巴博试验评估桡动脉通畅情况。
标准桡动脉压迫后RAO发生率为16.0%，有效止血后为5.3%（p = 0.003）。RAO的单因素预测因素为有效止血（比值比0.30；[0.13 - 0.68]，p = 0.004）、高脂血症（比值比0.46；[0.21 - 0.98]，p = 0.04）、当前吸烟史（比值比2.86；[1.3 - 6.0]，p = 0.015）以及较长手术时间（比值比1.03/额外分钟；[1.01 - 1.05]，p = 0.003）。病例结束时的ACT与RAO之间无关联（比值比1.00；[0.9 - 1.01]，p = 1.00）。在对协变量进行调整后，与标准压迫相比，有效止血使RAO风险降低了70%（比值比0.30；[0.12 - 0.77]，p = 0.12）。模型判别能力的c统计量为0.79（95%可信区间[0.71 - 0.86]），p <0.001）。逆概率处理加权分析也证实有效止血是RAO降低的独立预测因素（比值比0.38 [0.15 - 0.95]，p = 0.039）。
有效止血在预防ACS患者早期RAO方面非常有效。
