Curtis Elizabeth, Fernandez Ritin, Lee Astin
1School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia 2Centre for Evidence based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence 3School of Nursing and Midwifery, University of Wollongong, Wollongong, Australia 4Department of Cardiology, the Wollongong Hospital, Wollongong, Australia 5Graduate School of Medicine, University of Wollongong, Wollongong, Australia.
JBI Database System Rev Implement Rep. 2017 Jul;15(7):1952-1967. doi: 10.11124/JBISRIR-2016-003039.
The uptake of percutaneous coronary procedures via the radial artery has increased internationally due to the decreased risk of complications and increased patient satisfaction. The increased susceptibility of the radial artery to spasm however presents a potential risk for procedural failure. Although most experts agree on the need for prophylactic medications to reduce radial artery spasm, currently there is inconsistency in literature regarding the most effective vasodilatory medication or combination of medications.
The objective of this study is to identify the effectiveness of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures.
This review considered studies that included participants aged 18 years and over undergoing non-emergent transradial percutaneous coronary artery procedures.
TYPES OF INTERVENTION(S): This review considered studies that used vasodilating intravenous and intra-arterial medications or combinations of medications prior to commencing and during transradial coronary approaches to reduce radial artery spasm.
The outcomes of interest were the incidence of radial artery spasm during percutaneous coronary procedure using objective and/or subjective measures and its effect on the successful completion of the procedure.
Randomized controlled trials published in the English language between 1989 to date were considered for inclusion.
The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies.
Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion.
Quantitative data was extracted from papers included in the review using the standardized data extraction tool from RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane).
Quantitative data, where possible, was pooled in statistical meta-analysis using RevMan5. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis.
Nine trials involving 3614 patients were included in the final review. Pooled data involving 992 patients on the effect of calcium channel blockers demonstrated a statistically significant reduction in the incidence of vasospasm in patients who received verapamil 5 mg compared to those who received a placebo (OR 0.33; 95%CI 0.19, 0.58). Similarly patients who received verapamil 2.5 mg or 1.25 mg had significantly fewer incidences of vasospasm when compared to those who received a placebo. Nitroglycerine 100mcg was demonstrated to be associated with a statistically significant reduction in the incidence of vasospasm.
The evidence demonstrates a benefit in the use of vasodilatory medications for the reduction of vasospasm in patients having radial coronary procedures. Further large-scale multi-center trials are needed to determine the preferred medication.
由于并发症风险降低以及患者满意度提高，经桡动脉进行经皮冠状动脉介入治疗在国际上的应用有所增加。然而，桡动脉对痉挛的易感性增加为手术失败带来了潜在风险。尽管大多数专家都认同需要使用预防性药物来减少桡动脉痉挛，但目前关于最有效的血管扩张药物或药物组合，文献中存在不一致的观点。
本研究的目的是确定血管扩张药物对接受经桡动脉冠状动脉介入治疗患者的桡动脉痉挛的有效性。
纳入标准 参与者类型：本综述纳入了包括18岁及以上接受非急诊经桡动脉经皮冠状动脉介入治疗的参与者的研究。
本综述纳入了在开始经桡动脉冠状动脉介入治疗之前和期间使用血管扩张静脉内和动脉内药物或药物组合以减少桡动脉痉挛的研究。
感兴趣的结局是使用客观和/或主观测量方法评估经皮冠状动脉介入治疗期间桡动脉痉挛的发生率及其对手术成功完成的影响。
纳入1989年至今以英文发表的随机对照试验。
检索策略旨在查找已发表和未发表的研究。本综述采用了三步检索策略。首先对MEDLINE、CINAHL和Scopus进行检索，然后查找未发表的研究。
在纳入综述之前，由两名独立的评审员使用标准化的批判性评估工具对选定用于检索的论文进行方法学有效性评估。评审员之间出现的任何分歧都通过讨论解决。
使用RevMan5（哥本哈根：北欧 Cochrane 中心，Cochrane）的标准化数据提取工具从综述中纳入的论文中提取定量数据。
在可能的情况下，使用RevMan5对定量数据进行统计荟萃分析。所有结果都进行了双数据录入。计算并分析以风险比（用于分类数据）和加权平均差（用于连续数据）表示的效应大小及其95%置信区间。
最终综述纳入了9项涉及3614名患者的试验。涉及992名患者的关于钙通道阻滞剂效果的汇总数据显示，与接受安慰剂的患者相比接受5mg维拉帕米的患者血管痉挛发生率有统计学意义的降低（OR 0.33；95%CI 0.19，0.58）。同样，与接受安慰剂的患者相比，接受2.5mg或1.25mg维拉帕米的患者血管痉挛发生率显著更低。已证明100mcg硝酸甘油与血管痉挛发生率的统计学显著降低相关。
证据表明使用血管扩张药物对减少接受桡动脉冠状动脉介入治疗患者的血管痉挛有益。需要进一步的大规模多中心试验来确定首选药物。
