Feng Chunguang, Zong Bin, Liu Yi, Chen Mei, Li Shanshan, Xu Dujuan, Han Bing
Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221000, China.
Department of Ultrasound, Xuzhou Central Hospital, Xuzhou, 221000, China.
Heliyon. 2023 Jun 14;9(6):e17150. doi: 10.1016/j.heliyon.2023.e17150. eCollection 2023 Jun.
Compared with the conventional transradial approach (TRA), there are limited data on the efficacy and safety of the novel distal transradial approach (DTRA). This study aimed to verify the effectiveness and safety of the DTRA for percutaneous coronary angiography and intervention. Besides, we also try to highlight the potential of the DTRA in reducing radial artery occlusion (RAO), shorter time to hemostasis, and improved patient comfort.
This single-center prospective observational study enrolled patients treated with DTRA (n = 527) in the first 9 months and with TRA (n = 586) in the next 8 months from May 2020 to December 2021. The primary endpoint was the proximal RAO rate at 30 days.
Baseline data were similar between the two groups. The proximal radial artery occlusion rate at 30 days [2.3% vs. 7.0%], the success rate of puncture [86.4% vs. 96.7%], the Numeric Rating Scale score [1.97 ± 1.89 vs. 4.61 ± 2.68], and the incidence of postoperative subcutaneous hematoma and finger numbness [3.4% vs. 8.2%, 2.7% vs. 4.4%] were lower. The puncture time [6.93 ± 7.25 min vs. 3.18 ± 3.52 min] was longer, and the time until radial compression device removal was shorter [CAG: 138.61 ± 38.73 min vs. 191.6 ± 61.22 min, PCI:221.46 ± 62.45 min vs. 276.28 ± 76.39 min] in the DTRA group than TRA group (all P < 0.05). Multivariate logistic regression analysis revealed that the DTRA (OR 0.231, 95% confidence interval [CI] 0.088-0.769, P = 0.001),BMI<18.5 kg/m (OR 2.627, 95% CI 1.142-4.216, P = 0.004), Diabetes mellitus (OR 2.15, 95%CI1.212-3.475, P = 0.014), RCD removal time (CAG,min) (OR 1.091, 95% CI 1.013-1.441, P = 0.035) and RCD removal time (PCI,min) (OR 1.067, 95% CI 1.024-1.675, P = 0.022) were the independent risk factors of RAO 1 month after intervention procedure.
DTRA was found to a lower incidence of postoperative RAO and bleeding-related complications, shorter time to achieve hemostasis, and greater patient comfort.
与传统经桡动脉途径（TRA）相比，关于新型远端经桡动脉途径（DTRA）有效性和安全性的数据有限。本研究旨在验证DTRA在经皮冠状动脉造影和介入治疗中的有效性和安全性。此外，我们还试图突出DTRA在减少桡动脉闭塞（RAO）、缩短止血时间和提高患者舒适度方面的潜力。
本单中心前瞻性观察性研究纳入了2020年5月至2021年12月期间前9个月接受DTRA治疗的患者（n = 527）和后8个月接受TRA治疗的患者（n = 586）。主要终点是30天时的近端RAO率。
两组间基线数据相似。DTRA组30天时的近端桡动脉闭塞率[2.3%对7.0%]、穿刺成功率[86.4%对96.7%]、数字评分量表评分[1.97±1.89对4.61±2.68]以及术后皮下血肿和手指麻木的发生率[3.4%对8.2%，2.7%对4.4%]均较低。DTRA组的穿刺时间[6.93±7.25分钟对3.18±3.52分钟]较长，而拆除桡动脉压迫装置的时间较短[冠状动脉造影：138.61±38.73分钟对191.6±61.22分钟，经皮冠状动脉介入治疗：221.46±62.45分钟对276.28±76.39分钟]，均低于TRA组（所有P<0.05）。多因素逻辑回归分析显示，DTRA（比值比0.231，95%置信区间[CI]0.088 - 0.769，P = 0.001）、体重指数<18.5 kg/m²（比值比2.627，95%CI 1.142 - 4.216，P = 0.004）、糖尿病（比值比2.15，95%CI 1.212 - 3.475，P = 0.014）、拆除桡动脉压迫装置时间（冠状动脉造影，分钟）（比值比1.091，95%CI 1.013 - 1.441，P = 0.035）和拆除桡动脉压迫装置时间（经皮冠状动脉介入治疗，分钟）（比值比1.067，95%CI 1.024 - 1.675，P = 0.022）是介入治疗后1个月RAO的独立危险因素。
发现DTRA术后RAO和出血相关并发症的发生率较低，止血时间较短，患者舒适度更高。
