School of Nursing and Midwifery, Monash University, Melbourne, Vic, Australia; MonashHeart, Monash Health, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
School of Nursing and Midwifery, Monash University, Melbourne, Vic, Australia; Monash Emergency Research Collaborative, Monash Health, Melbourne, Vic, Australia.
Heart Lung Circ. 2022 Jul;31(7):985-992. doi: 10.1016/j.hlc.2022.01.016. Epub 2022 Mar 15.
Radial access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding, when compared to femoral access. However, radial access failure may be associated with an increased door-to-device (DTD) time.
To identify predictors of radial access failure requiring crossover to femoral artery access during primary PCI.
From 2013 to 2020, 2,256 consecutive patients treated for PPCI at a single tertiary hospital were prospectively recruited into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariable logistic regression was used to identify independent predictors of radial to femoral access crossover.
From 2,256 STEMI patients, primary radial access was used in 1,778 (78.8%), with 171 (9.6%) experiencing radial-to-femoral crossover. Patients with failed versus successful radial access experienced longer DTD times (67 mins, interquartile range [IQR] 46-99 vs 54 mins [IQR 39-78]; p<0.001). Independent predictors of radial-to-femoral access crossover included female sex (Adjusted Odds Ratio [AOR] 2.1, 95% Confidence Interval [CI] 1.4-3.0; p<0.001) and baseline hypertension (AOR 1.5, 95% CI 1.1-2.1; p=0.018).
In a real-world STEMI registry, almost 1 in 10 patients experienced access crossover from the radial to femoral artery which resulted in longer DTD times. Independent predictors of radial access failure included female sex and baseline hypertension. Knowing which patient characteristics are associated with increased risk of radial artery failure enables catheter laboratory staff to ensure equipment is readily available to maximise successful primary PCI are available.
与股动脉入路相比，经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）时采用桡动脉入路可降低死亡率和出血风险。然而，桡动脉入路失败可能与门到球囊（DTD）时间延长有关。
确定在直接经皮冠状动脉介入治疗（PPCI）中需要转为股动脉入路的桡动脉入路失败的预测因素。
从 2013 年至 2020 年，在一家三级医院接受 PPCI 治疗的 2256 例连续患者前瞻性地被纳入维多利亚心脏结局登记处，并随访 30 天。采用多变量逻辑回归分析确定桡动脉至股动脉入路交叉的独立预测因素。
在 2256 例 STEMI 患者中，1778 例（78.8%）采用了直接经皮冠状动脉介入治疗，其中 171 例（9.6%）出现桡动脉至股动脉交叉。与桡动脉入路成功的患者相比，桡动脉入路失败的患者 DTD 时间更长（67 分钟，四分位间距 [IQR] 46-99 比 54 分钟 [IQR 39-78]；p<0.001）。桡动脉至股动脉入路交叉的独立预测因素包括女性（校正优势比 [AOR] 2.1，95%置信区间 [CI] 1.4-3.0；p<0.001）和基线高血压（AOR 1.5，95%CI 1.1-2.1；p=0.018）。
在真实世界的 STEMI 登记中，近 10%的患者经历了从桡动脉到股动脉的入路交叉，导致 DTD 时间延长。桡动脉入路失败的独立预测因素包括女性和基线高血压。了解哪些患者特征与桡动脉失败风险增加相关，使导管实验室工作人员能够确保备有设备，以最大限度地提高初次经皮冠状动脉介入治疗的成功率。
