Li Hu, Rha Seung-Woon, Choi Byoung Geol, Shim Min Suk, Choi Se Yeon, Choi Cheol Ung, Kim Eung Ju, Oh Dong Joo, Cho Byung Ryul, Kim Moo Hyun, Kim Doo-Il, Jeong Myung-Ho, Yoo Sang Yong, Jeong Sang-Sik, Kim Byung Ok, Hyun Min Su, Youn Young-Jin, Yoon Junghan
Department of Cardiovascular, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2018 Jul;33(4):716-726. doi: 10.3904/kjim.2016.316. Epub 2017 Jul 7.
BACKGROUND/AIMS: Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI).
A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%).
After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up.
In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.
背景/目的：经桡动脉介入治疗（TRI）正逐渐成为优于经股动脉介入治疗（TFI）的首选方法，因为TRI与较低的大出血和血管并发症发生率相关。然而，关于韩国ST段抬高型心肌梗死（STEMI）患者中TRI与TFI临床结局的已发表数据有限。
本研究纳入了2009年1月至12月在9家大学医院接受药物洗脱支架（DES）植入的直接经皮冠状动脉介入治疗（PCI）的689例连续STEMI患者。将TRI组（n = 220，31.9%）的中期血管造影结果和12个月累积临床结局与TFI组（n = 469，28.1%）进行比较。
倾向评分匹配后，两组的住院并发症和随访期间12个月的主要临床结局相似。然而，在12个月的随访期间，TFI组的再次血运重建发生率（6.4% 对0.5%，p = 0.003）、靶血管血运重建发生率（6.4% 对0.5%，p = 0.003）和主要不良心脏事件（MACE；11.6% 对4.6%，p = 0.018）高于TRI组。
在我们的研究中，与TFI相比，接受DES植入直接PCI的STEMI患者进行TRI与较低的穿刺部位血肿发生率、12个月再次血运重建率和MACE相关。因此，TRI在减少出血并发症同时改善接受DES植入直接PCI的STEMI患者主要临床结局方面可能发挥重要作用。
