Davis K, Kennedy J W, Kemp H G, Judkins M P, Gosselin A J, Killip T
Circulation. 1979 Jun;59(6):1105-12. doi: 10.1161/01.cir.59.6.1105.
Data were collected prospectively on 7553 consecutive patients undergoing coronary arteriography. The studies were performed at 13 clinics of the Collaborative Study of Coronary Artery Surgery (CASS) using brachial and femoral techniques. There were eight deaths 0--24 hours and seven deaths 24--48 hours after arteriography (2/1000). There were 15 non-fatal myocardial infarctions (MIs) 0--24 hours and four MIs 24--48 hours after arteriography (2.5/1000). Of 657 cases with left main stenosis greater than or equal to 50%, five died and three had MI. Left main disease increased risk of death by 6.8 times (p less than 0.001). Other factors increasing risk were unstable angina, congestive heart failure, multiple premature ventricular contractions, and hypertension. Of the 1187 patients studied from the brachial artery, six died (0.51%) and five had MIs (0.42%). In 6328 patients studied from the femoral artery, nine died (0.14%) and 14 had MIs (0.22%). The brachial artery technique increased the risk of death 3.6 times compared with the femoral approach (p less than 0.05). This result did not apply when analysis was restricted to laboratories with 80% or more brachial procedures. Risk was not altered by heparin. Thus, a prospective, multicenter analysis of complications reveals low risk of coronary arteriography but significant difference between two techniques.
前瞻性收集了7553例连续接受冠状动脉造影的患者的数据。这些研究在冠状动脉外科协作研究（CASS）的13个诊所进行，采用肱动脉和股动脉技术。冠状动脉造影后0至24小时有8例死亡，24至48小时有7例死亡（2/1000）。冠状动脉造影后0至24小时有15例非致命性心肌梗死（MI），24至48小时有4例MI（2.5/1000）。在657例左主干狭窄大于或等于50%的病例中，5例死亡，3例发生MI。左主干病变使死亡风险增加6.8倍（p<0.001）。增加风险的其他因素包括不稳定型心绞痛、充血性心力衰竭、多次室性早搏和高血压。在1187例通过肱动脉进行研究的患者中，6例死亡（0.51%），5例发生MI（0.42%）。在6328例通过股动脉进行研究的患者中，9例死亡（0.14%），14例发生MI（0.22%）。与股动脉途径相比，肱动脉技术使死亡风险增加3.6倍（p<0.05）。当分析仅限于肱动脉操作比例达到或超过80%的实验室时，该结果不适用。肝素未改变风险。因此，一项关于并发症的前瞻性多中心分析显示冠状动脉造影风险较低，但两种技术之间存在显著差异。
