Campelo-Parada Francisco, Carrié Didier, Bartorelli Antonio L, Namiki Atsuo, Hovasse Thomas, Kimura Takeshi, Serra-Peñaranda Antonio, Varenne Olivier, Lalmand Jacques, Kadota Kazushige, Ikari Yuji, Tobaru Tetsuya, Fujii Kenshi, Nakamura Shigeru, Saito Shigeru, Wijns William
Hôpital Rangueil, CHU Toulouse, 1 Avenue Jean Poulhès, 31059 Toulouse, France.
J Invasive Cardiol. 2018 Jul;30(7):262-268.
To compare the main outcomes of radial versus femoral access at long-term follow-up.
Little is known about the long-term major cardiovascular events and bleeding complications of patients undergoing percutaneous coronary intervention (PCI) with radial vs femoral approach.
A total of 1107 patients from the CENTURY II trial were included. To minimize baseline differences between radial and femoral groups, we applied propensity-score matching for this comparison.
In this multicenter study, the radial approach was used in 73.4% of patients. After propensity-score matching, baseline and procedural characteristics were comparable between both groups. Procedural success was high and similar in radial and femoral approaches (98.2% vs 97.5%; P=.47) while radial access was associated with a shorter hospital stay (1.69 ± 1.92 days vs 2.08 ± 1.98 days; P<.01). The short-term bleeding and vascular complication rates were significantly lower in the radial group (1.7% vs 6.2% [P<.001 in-hospital] and 2.7% vs 9.6% [P<.001 at 1-month follow-up]). At 3-year follow-up, radial access was associated with lower rates of all-cause mortality (3.9 vs 6.9%; P=.04) and cardiovascular death (2.1 vs 4.9%; P=.02). The composite of all-cause mortality, myocardial infarction, and revascularization showed no differences between groups (18.2 vs 21.1%; P=.29).
Compared to the femoral approach, the radial approach is associated with significantly lower long-term all-cause mortality rate as well as lower in-hospital and short-term bleeding rates. These results suggest additional long-term benefits of radial access for PCI, but should be interpreted within the context of the current study and further verified in future studies.
比较桡动脉入路与股动脉入路长期随访的主要结果。
对于接受经皮冠状动脉介入治疗（PCI）的患者，采用桡动脉入路与股动脉入路的长期主要心血管事件和出血并发症知之甚少。
纳入了来自CENTURY II试验的1107例患者。为尽量减少桡动脉组和股动脉组之间的基线差异，我们在此次比较中应用了倾向评分匹配法。
在这项多中心研究中，73.4%的患者采用了桡动脉入路。倾向评分匹配后，两组的基线和手术特征具有可比性。桡动脉入路和股动脉入路的手术成功率都很高且相似（分别为98.2%和97.5%；P = 0.47），而桡动脉入路与较短的住院时间相关（分别为1.69±1.92天和2.08±1.98天；P < 0.01）。桡动脉组的短期出血和血管并发症发生率显著更低（住院时分别为1.7%和6.2%[P < 0.001]，1个月随访时分别为2.7%和9.6%[P < 0.001]）。在3年随访时，桡动脉入路与较低的全因死亡率（分别为3.9%和6.9%；P = 0.04）和心血管死亡率（分别为2.1%和4.9%；P = 0.02）相关。全因死亡率、心肌梗死和血运重建的综合情况在两组之间无差异（分别为18.2%和21.1%；P = 0.29）。
与股动脉入路相比，桡动脉入路与显著更低的长期全因死亡率以及更低的住院和短期出血率相关。这些结果表明桡动脉入路用于PCI具有额外的长期益处，但应结合当前研究情况进行解读，并在未来研究中进一步验证。
