介入操作时活化凝血时间峰值与股动脉入路经皮冠状动脉介入治疗后的全因死亡率相关。
Peak Procedural ACT Is Associated With All-Cause Mortality After Femoral Access PCI.
作者信息
Sampath-Kumar Revathy, Ben-Yehuda Ori, Al Khiami Belal, Ang Lawrence, Melendez Anna, Reeves Ryan, Mahmud Ehtisham
机构信息
Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, San Diego, California.
出版信息
J Soc Cardiovasc Angiogr Interv. 2024 Sep 23;3(12):102387. doi: 10.1016/j.jscai.2024.102387. eCollection 2024 Dec.
BACKGROUND
A minimum threshold activated clotting time (ACT) to guide heparin dosing during percutaneous coronary intervention (PCI) is associated with lower ischemic complications. However, data are variable regarding the risk of high ACT levels. The aim of this study was to assess the impact of peak procedural ACT on complications and mortality for transfemoral and transradial access PCI.
METHODS
The UC San Diego Health National Cardiovascular Data Registry CathPCI Registry was used to obtain data on patients who underwent native vessel PCI from January 2007 to September 2022. Coronary artery bypass graft patients and those who received bivalirudin were excluded. Complications and all-cause mortality at 30 days and 1-year post-PCI were assessed by ACT tertile.
RESULTS
A total of 2473 patients (age 65 ± 12 years; 74% male) undergoing PCI with 53% femoral and 47% radial access were included. The majority (82%) had 1-vessel coronary artery disease with heterogeneous clinical presentations (21.8% ST-elevation myocardial infarction, 25.4% non-ST-elevation myocardial infarction, 4.9% unstable angina, 33.8% stable angina, 3.4% atypical chest pain, 10.7% other indication for PCI). With femoral access, patients in the third tertile (ACT ≥ 275) had significantly higher all-cause mortality at 30 days (5.3% vs 2.7% vs 0.9%; < .001), 6 months (6.3% vs 4.0% vs 2.0%; = .007), and 1 year (9.0% vs 6.0% vs 2.7%; < .001) compared to the second (ACT 228-275) and first tertile (ACT ≤ 228), respectively. A 30-day landmark analysis revealed that there was no difference in all-cause mortality beyond 30 days (3.9% vs 3.4% vs 1.8%; = .176). There were increased bleeding complications in the highest tertile (12.8% vs 9.8% vs 7.5%; = .034) and a higher need for blood products (10.4% vs 6.7% vs 5.4%; = .014). There was no difference in ischemic major adverse cardiovascular events specifically periprocedural myocardial infarction or stroke between tertiles. There was no difference in clinical outcomes by peak ACT for patients who had radial access.
CONCLUSIONS
Higher ACT with transfemoral access PCI was associated with increased 30-day mortality, bleeding complications, and need for blood products post-PCI.
背景
在经皮冠状动脉介入治疗（PCI）期间，用于指导肝素剂量的最低激活凝血时间（ACT）阈值与较低的缺血性并发症相关。然而，关于ACT水平升高的风险，数据存在差异。本研究的目的是评估手术高峰ACT对经股动脉和经桡动脉途径PCI患者并发症和死亡率的影响。
方法
使用加州大学圣地亚哥分校健康国家心血管数据注册中心的CathPCI注册数据，获取2007年1月至2022年9月接受原位血管PCI患者的数据。排除冠状动脉旁路移植术患者和接受比伐卢定治疗的患者。通过ACT三分位数评估PCI术后30天和1年的并发症和全因死亡率。
结果
共纳入2473例接受PCI的患者（年龄65±12岁；74%为男性），其中53%经股动脉途径，47%经桡动脉途径。大多数患者（82%）患有单支冠状动脉疾病，临床表现各异（21.8%为ST段抬高型心肌梗死，25.4%为非ST段抬高型心肌梗死，4.9%为不稳定型心绞痛，33.8%为稳定型心绞痛，3.4%为非典型胸痛，10.7%为其他PCI适应证）。经股动脉途径时，第三三分位数（ACT≥275）的患者在30天（5.3%对2.7%对0.9%；P<0.001）、6个月（6.3%对4.0%对2.0%；P = 0.007）和1年（9.0%对6.0%对2.7%；P<0.001）时的全因死亡率分别显著高于第二三分位数（ACT 228 - 275）和第一三分位数（ACT≤228）。一项30天里程碑分析显示，30天后的全因死亡率无差异（3.9%对3.4%对1.8%；P = 0.176）。最高三分位数的出血并发症增加（12.8%对9.8%对7.5%；P = 0.034），对血液制品的需求更高（10.4%对6.7%对5.4%；P = 0.014）。三分位数之间在缺血性主要不良心血管事件，特别是围手术期心肌梗死或中风方面无差异。经桡动脉途径患者的临床结局在不同高峰ACT之间无差异。
结论
经股动脉途径PCI时较高的ACT与PCI术后30天死亡率增加、出血并发症及对血液制品的需求增加相关。
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