Téblick Arno, Vanderbruggen Wies, Vandendriessche Tom, Bosmans Johan, Haine Steven Els Frans, Miljoen Hielko, Segers Vincent, Wouters Kristien, Vrints Christiaan, Claeys Marc J
a Department of Cardiology , Antwerp University Hospital , Antwerp , Belgium.
b Department of Statistics , University Hospital of Antwerp , Antwerp , Belgium.
Acta Cardiol. 2018 Jun;73(3):241-247. doi: 10.1080/00015385.2017.1363947. Epub 2017 Aug 29.
Radial access (RA) and vascular closure devices (VCD) have been shown to be superior to transfemoral access (TFA) with regard to the prevention of vascular complications after percutaneous coronary intervention (PCI).
The present study evaluates whether RA is associated with less vascular complications and a lower mortality than VCD.
A total of 6999 consecutive PCI patients were studied through a single-centre prospective registry from January 2011 to August 2015. RA was applied in 1385 patients (20%), VCDs with Angio-Seal were implanted in 2145 patients (30%) and manual compression of TFA was performed in 3468 patients (50%).
RA and VCD patients had comparable baseline risk profiles. The overall vascular complication rate was 2.0% (n = 137) and was composed of false aneurysms (n = 85), clinically relevant haematomas (n = 27), arteriovenous fistulas (n = 12), arterial occlusions (n = 11) and local infections (n = 2). Vascular complications occurred in 0.6% of RA patients, 1.8% of VCD patients and 2.6% of TFA patients (p < .01). In-hospital mortality was 0.8% in RA patients, 0.8% in VCD patients and 3.8% in TFA patients (p < .01). In a multivariate logistic regression model, RA, compared to VCD, was found to be independently associated with a lower rate of vascular complications (OR: 0.34, 95% CI: 0.16-0.75), but not with lower mortality rates (OR: 1.20, 95% CI: 0.51-2.85).
In this large all-comers PCI population, the radial approach, compared to the femoral approach with VCD use (Angio-Seal), was independently associated with a reduction of vascular complications, but not with lower mortality rates.
在经皮冠状动脉介入治疗（PCI）后预防血管并发症方面，桡动脉入路（RA）和血管闭合装置（VCD）已被证明优于股动脉入路（TFA）。
本研究评估RA与VCD相比，是否血管并发症更少且死亡率更低。
2011年1月至2015年8月，通过单中心前瞻性登记研究了6999例连续接受PCI的患者。1385例患者（20%）采用RA，2145例患者（30%）植入带Angio-Seal的VCD，3468例患者（50%）采用TFA手动压迫止血。
RA组和VCD组患者的基线风险特征相当。总体血管并发症发生率为2.0%（n = 137），包括假性动脉瘤（n = 85）、临床相关血肿（n = 27）、动静脉瘘（n = 12）、动脉闭塞（n = 11）和局部感染（n = 2）。RA组患者血管并发症发生率为0.6%，VCD组为1.8%，TFA组为2.6%（p <.01）。RA组患者住院死亡率为0.8%，VCD组为0.8%，TFA组为3.8%（p <.01）。在多因素逻辑回归模型中，与VCD相比，RA与较低的血管并发症发生率独立相关（OR：0.34，95%CI：0.16 - 0.75），但与较低的死亡率无关（OR：1.20，95%CI：0.51 - 2.85）。
在这个大型的所有患者PCI人群中，与使用VCD（Angio-Seal）的股动脉入路相比，桡动脉入路与血管并发症的减少独立相关，但与较低的死亡率无关。
