Chakravartti Jaidip, Feser William J, Plomondon Mary E, Valle Javier A, Rao Sunil V, Gutierrez J Antonio, Grunwald Gary K, Gunzburger Elise, Swaminathan Rajesh V
Department of Cardiology, Maine Medical Center, Portland, Maine.
Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 24;1(6):100440. doi: 10.1016/j.jscai.2022.100440. eCollection 2022 Nov-Dec.
There has been increasing use of transradial access (TRA) for non-chronic total occlusion (CTO) percutaneous coronary intervention (PCI). There are limited data on TRA for CTO PCI. The objectives of this study were to assess the temporal trends in the use of TRA versus transfemoral access (TFA), identify procedural and lesion characteristics associated with the use of TRA and TFA, and evaluate the association of access site with procedural complications and technical success among veterans undergoing attempted CTO PCI.
We performed a retrospective analysis of veteran patients who underwent attempted CTO PCI to compare outcomes between TRA and TFA. Patients who had undergone attempted PCI of at least 1 CTO were included. Propensity score matching was used to evaluate the composite primary outcome of major procedural complications, in-hospital bleeding, or 30-day mortality and the secondary outcome of procedural success.
In total, 4609 patients underwent attempted CTO PCI during 2010-2017. Rates of TRA for CTO PCI increased significantly, from 7% in 2010 to 38% in 2017 ( < .01). A greater percentage of CTO lesions in the TFA group was calcified and >20.0 mm in length. TRA was not associated with a reduction in the composite primary outcome (TRA 3.3% vs TFA 4.0%, = .47) or procedural success (TRA 66.6% vs TFA 65.7%, = .74) compared with TFA.
In this retrospective analysis of patients who underwent attempted CTO PCI, the proportion of TRA for CTO PCI has increased over time but was not associated with a greater safety or procedural success than TFA.
经桡动脉入路（TRA）在非慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中的应用日益增多。关于CTO PCI使用TRA的数据有限。本研究的目的是评估TRA与经股动脉入路（TFA）使用的时间趋势，确定与TRA和TFA使用相关的手术和病变特征，并评估在接受CTO PCI尝试的退伍军人中，入路部位与手术并发症和技术成功之间的关联。
我们对接受CTO PCI尝试的退伍军人患者进行了回顾性分析，以比较TRA和TFA之间的结果。纳入至少1次CTO PCI尝试的患者。倾向评分匹配用于评估主要手术并发症、院内出血或30天死亡率的复合主要结局以及手术成功的次要结局。
2010年至2017年期间，共有4609例患者接受了CTO PCI尝试。CTO PCI的TRA使用率显著增加，从2010年的7%增至2017年的38%（P<0.01）。TFA组中更大比例的CTO病变有钙化且长度>20.0 mm。与TFA相比，TRA与复合主要结局的降低（TRA为3.3% vs TFA为4.0%，P = 0.47）或手术成功（TRA为66.6% vs TFA为65.7%，P = 0.74）无关。
在这项对接受CTO PCI尝试患者的回顾性分析中，CTO PCI的TRA比例随时间增加，但与TFA相比，其安全性或手术成功率并未更高。
