Ahmad Fraz, Usman Ahmad, Osama Unknown, Afreen Aneela, Muhammad Farhan Hafiz Mian, Daniyal Shohaib, Jamil Sadiqa, Khan Fahad R
Cardiology, Shalamar Medical and Dental College, Lahore, PAK.
Cardiology, Army Cardiac Centre, Combined Military Hospital, Lahore, PAK.
Cureus. 2024 Oct 31;16(10):e72781. doi: 10.7759/cureus.72781. eCollection 2024 Oct.
Percutaneous coronary intervention (PCI) is a widely used therapeutic approach for complex coronary artery disease, especially in patients with ST-elevation myocardial infarction (STEMI). The choice of vascular access site, typically radial or femoral, can significantly impact patient outcomes due to varying complication rates associated with each approach.
This study aimed to compare access site complications between radial and femoral approaches in primary PCI for complex coronary lesions, providing insights into the safety and efficacy of these approaches.
A prospective cohort study was conducted from January 1, 2023, to December 31, 2023, at a tertiary care cardiovascular center. A total of 350 adult patients presenting with STEMI and requiring emergency PCI for complex coronary lesions were included and randomized equally to either radial (n = 175) or femoral (n = 175) access groups. Primary outcomes included access site complications, such as hematomas, pseudoaneurysms, arteriovenous fistulas, and major bleeding events. Secondary outcomes included procedural success, access site crossover, and hospital stay duration. Data were analyzed using chi-square tests, Student's t-tests, and multivariate logistic regression.
The incidence of access site complications was significantly lower in the radial group (11.4%) compared to the femoral group (22.9%) (p = 0.007). Major bleeding events were also notably reduced in the radial group (2.3% vs. 8.6%, p = 0.01). There was a significantly shorter median hospital stay for the radial group (three days vs. five days, p < 0.001), while procedural success rates were comparable between groups (97.1% vs. 94.3%, p = 0.31).
The radial approach for primary PCI in complex lesions is associated with fewer access site complications and shorter hospital stays compared to the femoral approach, supporting its use as the preferred access site.
经皮冠状动脉介入治疗（PCI）是治疗复杂冠状动脉疾病的一种广泛应用的方法，尤其是在ST段抬高型心肌梗死（STEMI）患者中。血管入路部位的选择，通常是桡动脉或股动脉，由于每种方法相关的并发症发生率不同，会对患者的预后产生显著影响。
本研究旨在比较复杂冠状动脉病变的直接PCI中桡动脉和股动脉入路的入路部位并发症，以深入了解这些方法的安全性和有效性。
2023年1月1日至2023年12月31日，在一家三级心血管护理中心进行了一项前瞻性队列研究。共有350例患有STEMI且因复杂冠状动脉病变需要紧急PCI的成年患者被纳入研究，并被平均随机分为桡动脉入路组（n = 175）和股动脉入路组（n = 175）。主要结局包括入路部位并发症，如血肿、假性动脉瘤、动静脉瘘和大出血事件。次要结局包括手术成功率、入路部位交叉和住院时间。使用卡方检验、学生t检验和多因素逻辑回归分析数据。
桡动脉组的入路部位并发症发生率（11.4%）显著低于股动脉组（22.9%）（p = 0.007）。桡动脉组的大出血事件也显著减少（2.3%对8.6%，p = 0.01）。桡动脉组的中位住院时间明显更短（3天对5天，p < 0.001），而两组之间的手术成功率相当（97.1%对94.3%，p = 0.31）。
与股动脉入路相比，复杂病变直接PCI的桡动脉入路与更少的入路部位并发症和更短的住院时间相关，支持将其作为首选的入路部位。
