Cardiac Medical Unit Grantham Hospital Hong Kong SAR, China.
Department of Adult Intensive Care Queen Mary Hospital Hong Kong SAR, China.
J Am Heart Assoc. 2021 Aug 3;10(15):e021256. doi: 10.1161/JAHA.121.021256. Epub 2021 Jul 30.
Background Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long-term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory-wide retrospective cohort study including 26 022 patients who underwent first-ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all-cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all-cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63-0.78; <0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73-0.83, <0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70-0.87, <0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68-0.85, <0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82-1.13, =0.655). Conclusions Radial access was associated with a significant reduction in all-cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.
经桡动脉入路行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）与较少发生大出血有关。然而，关于经桡动脉或股动脉入路行 PCI 后的长期死亡率和主要不良心脏事件（major adverse cardiac events，MACE）的发表数据尚无定论。
这是一项全港范围的回顾性队列研究，纳入了 2010 年 1 月 1 日至 2017 年 12 月 31 日期间首次接受 PCI 的 26022 例患者。在通过倾向评分匹配的 14614 例患者中（每组 7307 例），桡动脉组和股动脉组分别有 558 例（7.6%）和 787 例（10.8%）患者在观察期间死亡，桡动脉组的年化全因死亡率为 2.69%，股动脉组为 3.87%。桡动脉组在 PCI 后 3 年内的全因死亡率风险低于股动脉组（风险比[HR]，0.70；95%CI，0.63-0.78；<0.001）。桡动脉入路与较低的 MACE 风险相关（HR，0.78；95%CI，0.73-0.83，<0.001）、出院后心肌梗死（HR，0.78；95%CI，0.70-0.87，<0.001）和计划性血运重建（HR，0.76；95%CI，0.68-0.85，<0.001）。两组间卒中风险相似（HR，0.96；95%CI，0.82-1.13，=0.655）。
与股动脉入路相比，桡动脉入路在 3 年内全因死亡率显著降低。桡动脉入路与降低心肌梗死和计划性血运重建风险相关，但与卒中无关。益处持续存在于术后早期之后。
