Stephan Tilman, Gierl Marie-Therese, Felbel Dominik, Rattka Manuel, Rottbauer Wolfgang, Gonska Birgid, Markovic Sinisa
University Hospital Ulm, Department of Cardiology, Angiology and Pneumology, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
J Invasive Cardiol. 2022 Mar;34(3):E237-E248. doi: 10.25270/jic/21.00022.
Transradial access for coronary angiography was observed to be superior to femoral access. Nevertheless, femoral artery access is still frequently used, especially in challenging subgroups with high procedural complexity, like patients with previous coronary artery bypass grafting (CABG).
We analyzed access-site choice and outcomes of CABG patients undergoing coronary catheterization in different clinical settings.
A total of 1206 consecutive CABG patients undergoing coronary angiography and intervention were included in this study. Procedural and clinical outcomes were compared between transradial and transfemoral access. Multivariate logistic regression analysis was performed to identify predictors of access-site choice.
Coronary catheterization was performed via radial access in 753 patients (63.1%) and via femoral access in 442 patients (36.9%). During the study period, femoral artery utilization dropped from 55.2% to a minimum of 28.2% per year (P<.01). Short stature (odds ratio [OR], 1.62; P<.01), peripheral artery disease (OR, 1.42; P=.04), cardiopulmonary resuscitation (CPR) (OR, 4.17; P<.001), ST-segment elevation myocardial infarction (STEMI) (OR, 2.56; P=.01), and coexisting left and right internal mammary artery (LIMA/RIMA) bypass grafts (OR, 2.67; P<.001) were independently associated with femoral access-site choice. Study outcomes including access-site complications (4.3% vs 1.6%; P<.01) as well as short- and long-term mortality (30-day mortality: 6.8% vs 2.0%; hazard ratio, 3.52; 95% confidence interval, 1.84-6.70; P<.001) were more likely to occur with femoral access. Length of stay was shorter in the radial cohort (3.7 ± 5.1 days vs 5.3 ± 7.2 days; P<.001).
Radial access appears to be favorable even in complex CABG patients. Although radial access was set as the standard vascular approach, femoral access was chosen in one-third of all patients. Independent predictors for femoral access were short stature, peripheral artery disease, acute settings like CPR and STEMI, as well as coexisting LIMA and RIMA grafts.
观察发现，冠状动脉造影经桡动脉途径优于经股动脉途径。然而，股动脉途径仍经常被使用，尤其是在手术复杂性高的具有挑战性的亚组患者中，如既往有冠状动脉旁路移植术（CABG）的患者。
我们分析了不同临床情况下接受冠状动脉导管插入术的CABG患者的入路部位选择及结果。
本研究共纳入1206例连续接受冠状动脉造影和介入治疗的CABG患者。比较经桡动脉和经股动脉入路的手术及临床结果。进行多因素逻辑回归分析以确定入路部位选择的预测因素。
753例患者（63.1%）通过桡动脉途径进行冠状动脉导管插入术，442例患者（36.9%）通过股动脉途径进行。在研究期间，股动脉的使用率从每年55.2%降至最低28.2%（P<0.01）。身材矮小（优势比[OR]，1.62；P<0.01）、外周动脉疾病（OR，1.42；P=0.04）、心肺复苏（CPR）（OR，4.17；P<0.001）、ST段抬高型心肌梗死（STEMI）（OR，2.56；P=0.01）以及同时存在左、右乳内动脉（LIMA/RIMA）旁路移植（OR，2.67；P<0.001）与股动脉入路部位选择独立相关。包括入路部位并发症（4.3%对1.6%；P<0.01）以及短期和长期死亡率（30天死亡率：6.8%对2.0%；风险比，3.52；95%置信区间，1.84 - 6.70；P<0.001）在内的研究结果在股动脉入路时更易发生。桡动脉组的住院时间更短（3.7±5.1天对5.3±7±2天；P<0.001）。
即使在复杂的CABG患者中，桡动脉入路似乎也更有利。尽管桡动脉入路被设定为标准血管入路，但仍有三分之一的患者选择股动脉入路。股动脉入路的独立预测因素为身材矮小、外周动脉疾病、CPR和STEMI等急性情况以及同时存在LIMA和RIMA移植。
