Tröbs Monique, Achenbach Stephan, Plank Pia Maria, Marwan Mohamed, Röther Jens, Klinghammer Lutz, Blachutzik Florian, Schlundt Christian
Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Am J Cardiol. 2017 Nov 1;120(9):1508-1513. doi: 10.1016/j.amjcard.2017.07.049. Epub 2017 Jul 31.
Transradial access for coronary angiography and intervention is preferred over the femoral approach but can be technically challenging. Identification of predictors of transradial access failure is important, especially in the context of acute coronary syndromes. We therefore retrospectively analyzed 13,095 consecutive patients (66 ± 12 years, 64% male) in whom transradial access was attempted for coronary angiography or intervention to identify predictors of transradial access failure. Angiograms and patient files were systematically reviewed to analyze patient characteristics associated with failure. Transradial access failure rate was 6.8% (909 of 13,095). Patients with transradial access failure were more frequently female (9.5% vs 5.5%; p <0.001), significantly older (68 ± 12 vs 66 ± 12 years, p <0.001), and had a smaller body surface area (1.89 ± 0.21 vs 1.94 ± 0.2 m; p <0.001). Transradial failure was not significantly more frequent in ST-elevation myocardial infarction versus other patients (8.1% vs 6.9%, p = 0.195). After multivariable adjustment, only female sex (odds ratio [OR] 1.44, p <0.001), higher patient age (OR 1.01/year, p = 0.002), and lower height (OR 0.98/cm, p = 0.004) independently predicted transradial access failure. In conclusion, female sex, higher age, and smaller height independently predict transradial access failure in coronary angiography and intervention. Failure rate in ST-elevation myocardial infarction is not significantly increased.
冠状动脉造影和介入治疗采用经桡动脉途径优于股动脉途径，但在技术上可能具有挑战性。识别经桡动脉途径失败的预测因素很重要，尤其是在急性冠状动脉综合征的情况下。因此，我们回顾性分析了13095例连续患者（年龄66±12岁，男性占64%），这些患者尝试经桡动脉途径进行冠状动脉造影或介入治疗，以确定经桡动脉途径失败的预测因素。系统回顾血管造影和患者病历，以分析与失败相关的患者特征。经桡动脉途径失败率为6.8%（13095例中的909例）。经桡动脉途径失败的患者女性比例更高（9.5%对5.5%；p<0.001），年龄显著更大（68±12岁对66±12岁，p<0.001），且体表面积更小（1.89±0.21对1.94±0.2 m；p<0.001）。与其他患者相比，ST段抬高型心肌梗死患者经桡动脉途径失败的发生率并无显著更高（8.1%对6.9%，p=0.195）。多变量调整后，只有女性（比值比[OR]1.44，p<0.001）、患者年龄较大（OR 1.01/岁，p=0.002）和身高较低（OR 0.98/cm，p=0.004）独立预测经桡动脉途径失败。总之，女性、年龄较大和身高较低独立预测冠状动脉造影和介入治疗中经桡动脉途径失败。ST段抬高型心肌梗死的失败率并未显著增加。
