Januszek Rafał, Siudak Zbigniew, Malinowski Krzysztof Piotr, Wańha Wojciech, Wojakowski Wojciech, Gąsior Mariusz, Bartuś Stanisław, Dudek Dariusz
University of Physical Education, Department of Clinical Rehabilitation, 31-571 Kraków, Poland.
2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 31-501 Kraków, Poland.
J Clin Med. 2020 Mar 12;9(3):764. doi: 10.3390/jcm9030764.
The relationship between periprocedural complications and the type of vascular access in patients with prior history of coronary artery bypass grafting (CABG) and treated with percutaneous coronary interventions (PCIs) is less investigated than in the overall group of patients treated with PCI. The aim of the current study was to assess the relationship between the type of vascular access and selected periprocedural complications in a group of patients with prior history of CABG and treated with PCIs. Based on a Polish nationwide registry of interventional cardiology procedures called ORPKI, the authors analyzed 536,826 patients treated with PCI between 2014 and 2018. The authors extracted 32,225 cases with prior history of CABG. Then, patients with femoral and radial access as well as right and left radial access were compared. This comparison was proceeded by propensity score matching (PSM). After PSM, a multifactorial analysis revealed that patients treated with PCI from femoral access were significantly more often related to periprocedural deaths (odds ratio [OR]: 1.79; 95%, confidence interval [CI]: 1.1-3.0, = 0.02) and cardiac arrests (OR: 1.98; 95%, CI: 1.38-2.87, < 0.001). After inclusion of the Killip class grade and the occurrence of cardiac arrests before PCI into the PSM, the significance remained for procedural related cardiac arrests (OR: 1.55; 95%, CI: 1.07-2.28, = 0.022]). However, a comparison of right and left radial access showed no significant differences between procedure-related complications. It has been confirmed that there is a statistical association between femoral access (compared to radial access) and a higher rate of periprocedural cardiac arrests in patients with prior history of CABG treated with PCI.
与接受经皮冠状动脉介入治疗（PCI）的总体患者群体相比，既往有冠状动脉旁路移植术（CABG）病史且接受PCI治疗的患者围手术期并发症与血管入路类型之间的关系研究较少。本研究的目的是评估一组既往有CABG病史且接受PCI治疗的患者中血管入路类型与选定围手术期并发症之间的关系。作者基于波兰全国性的介入心脏病学手术登记处ORPKI，分析了2014年至2018年间接受PCI治疗的536,826例患者。作者提取了32,225例有CABG病史的病例。然后，对采用股动脉和桡动脉入路以及右桡动脉和左桡动脉入路的患者进行了比较。这种比较通过倾向评分匹配（PSM）进行。PSM后，多因素分析显示，采用股动脉入路进行PCI治疗的患者围手术期死亡（比值比[OR]：1.79；95%，置信区间[CI]：1.1 - 3.0，P = 0.02）和心脏骤停（OR：1.98；95%，CI：1.38 - 2.87，P < 0.001）的发生率明显更高。将Killip分级和PCI前心脏骤停的发生情况纳入PSM后，与手术相关的心脏骤停仍具有显著性（OR：1.55；95%，CI：1.07 - 2.28，P = 0.022）。然而，右桡动脉和左桡动脉入路的比较显示，手术相关并发症之间无显著差异。已证实，在既往有CABG病史且接受PCI治疗的患者中，股动脉入路（与桡动脉入路相比）与围手术期心脏骤停发生率较高之间存在统计学关联。
