Section of Cardiology, Harry S. Truman VA Hospital, Columbia, Missouri, USA.
Division of Cardiovascular Disease, Department of Medicine, University of Missouri, Columbia, Missouri, USA.
Catheter Cardiovasc Interv. 2022 Feb;99(2):480-488. doi: 10.1002/ccd.30024. Epub 2021 Nov 30.
We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system.
TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied.
All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching.
A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding.
Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.
我们旨在比较经桡动脉（TRA）和经股动脉（TFA）途径行左主干经皮冠状动脉介入治疗（LM-PCI）的临床特征和手术结果。
经皮冠状动脉介入治疗（PCI）的 TRA 使用率稳步上升。然而，TRA 行 LM-PCI 的频率和疗效仍研究较少。
确定了 2008 年至 2018 年期间在退伍军人事务部医疗保健系统中进行的所有 LM-PCI。通过入路比较患者的基线特征和与手术相关的变量。采用倾向性评分匹配分析短期和长期临床结局。
2008 年至 2018 年期间，通过桡动脉或股动脉在退伍军人事务部共进行了 4004 例 LM-PCI。其中，596 例（14.9%）LM PCI 通过 TRA 进行。在研究期间，TRA 用于 LM-PCI 的比例从 2.2%增加到 31.5%。TRA 与 TFA 的倾向性匹配结果分析显示，手术成功率相似（TRA 为 98.4%，TFA 为 97.8%；RR：1.01[0.98，1.03]），1 年主要不良心血管事件（MACE）发生率相似（TRA 为 25.9%，TFA 为 26.8%；RR：0.96[0.74，1.25]）。次要结局分析中，包括大出血，均无统计学差异。
TRA 用于 LM-PCI 的使用率在退伍军人事务部医疗保健系统中稳步上升。这些发现表明，不同入路策略的手术成功率和 1 年 MACE 相似，表明有机会继续增加 TRA 用于 LM-PCI 的使用率。
