University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America.
University of Tennessee Medical Center, Heart Lung Vascular Institute, Dept. of Cardiology, Knoxville, TN, United States of America.
Cardiovasc Revasc Med. 2022 Mar;36:107-112. doi: 10.1016/j.carrev.2021.05.023. Epub 2021 May 28.
Radial access is now considered the preferred approach for coronary angiography and percutaneous coronary intervention because of the low risk of vascular complications. However, radial access failure is not uncommon, leading to crossover to a different access site. The CHADS-VASc score is used to estimate stroke risk in patients with atrial fibrillation. Our study aimed to assess the CHADS-VASc score in predicting failure of the transradial approach, resulting in crossover to transfemoral access (TFA) for coronary angiography.
We performed a single-center, non-randomized, retrospective study. The study included 1775 patients who underwent coronary angiography with or without subsequent percutaneous intervention between July 2018 and October 2019. The study population was divided into three groups based on the CHADS-VASc score: low (≤2), intermediate (3-4), and high score (≥5) groups. The association between the CHADS-VASc score and radial access failure was evaluated and compared between the groups.
A total of 197 patients (11.1%) had crossover to the femoral artery. A large percentage of patients (19.2%) had radial access failure in the high CHADS-VASc score group (≥5) compared with 12.5% in the intermediate score group (3-4) and only 6.3% in the low score group (≤2). The highest crossover rate (42.9%) was observed in patients with a CHADS-VASc score of 8. Higher CHADS-VASc scores were also associated with increased fluoroscopy time, contrast administration, and radiation exposure.
The CHADS-VASc score can predict failure of the transradial approach, with a score of ≥5 having the highest correlation of failure requiring crossover to TFA.
由于血管并发症风险较低，桡动脉入路现在被认为是冠状动脉造影和经皮冠状动脉介入治疗的首选方法。然而，桡动脉入路失败并不少见，导致需要交叉到另一种入路。CHA2DS2-VASc 评分用于评估房颤患者的中风风险。我们的研究旨在评估 CHA2DS2-VASc 评分在预测经桡动脉入路失败中的作用，导致需要交叉到股动脉入路（TFA）进行冠状动脉造影。
我们进行了一项单中心、非随机、回顾性研究。该研究纳入了 2018 年 7 月至 2019 年 10 月期间接受冠状动脉造影术和（或）随后经皮介入治疗的 1775 例患者。根据 CHA2DS2-VASc 评分，研究人群分为三组：低危（≤2 分）、中危（3-4 分）和高危（≥5 分）组。评估并比较了 CHA2DS2-VASc 评分与桡动脉入路失败之间的关系。
共有 197 例患者（11.1%）交叉到股动脉。高危 CHA2DS2-VASc 评分组（≥5 分）中桡动脉入路失败的患者比例较大（19.2%），而中危评分组（3-4 分）为 12.5%，低危评分组（≤2 分）仅为 6.3%。CHA2DS2-VASc 评分为 8 分的患者交叉率最高（42.9%）。较高的 CHA2DS2-VASc 评分也与透视时间、造影剂用量和辐射暴露增加相关。
CHA2DS2-VASc 评分可预测经桡动脉入路失败，评分≥5 分与需要交叉到 TFA 的失败相关性最高。
