Koshy Linda M, Aberle Laura H, Krucoff Mitchell W, Hess Connie N, Mazzaferri Ernest, Jolly Sanjit S, Jacobs Alice, Gibson C Michael, Mehran Roxana, Gilchrist Ian C, Rao Sunil V
Medical Education Program, Department of Medicine, Duke University Medical Center, DUMC Box 3182, Durham, NC 27710 USA.
J Invasive Cardiol. 2018 Jan;30(1):18-22. Epub 2017 Oct 15.
This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI).
Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown.
We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference.
Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound.
This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.
本研究旨在确定经皮冠状动脉介入治疗（PCI）后桡动脉入路、引导下股动脉入路和非引导下股动脉入路与术后出血及血管并发症之间的关联。
PCI后的出血事件和主要血管并发症与发病率、死亡率及费用增加相关。虽然桡动脉入路在减少出血和血管并发症方面已被证明优于股动脉入路，但使用微穿刺、透视或超声是否能减轻这些差异尚不清楚。
我们对女性安全PCI试验中接受PCI且明确入路方法的女性进行了事后分析（n = 643）。术后72小时内或出院时发生的出血或血管并发症的主要终点由独立临床事件委员会判定，并根据三类入路技术进行比较：桡动脉、引导下股动脉（透视、微穿刺、超声）或非引导下股动脉（上述均未使用）。以桡动脉入路为参照，采用多因素逻辑回归确定组间差异。
在PCI人群中，330例采用桡动脉入路，228例采用引导下股动脉入路，85例采用非引导下股动脉入路。与非引导下股动脉入路相比，桡动脉入路的主要终点发生率在统计学上显著较低；然而，桡动脉入路与透视、微穿刺或超声引导下的股动脉入路之间无显著差异。
这项事后分析表明，虽然桡动脉入路比非引导下股动脉入路更安全，但引导下股动脉入路似乎与桡动脉入路有相似的出血事件或血管并发症。
