Popma J J, Satler L F, Pichard A D, Kent K M, Campbell A, Chuang Y C, Clark C, Merritt A J, Bucher T A, Leon M B
Department of Internal Medicine Cardiology Division, Washington Hospital Center, Washington, DC 20010.
Circulation. 1993 Oct;88(4 Pt 1):1569-78. doi: 10.1161/01.cir.88.4.1569.
Despite their potential advantages, new coronary angioplasty devices may be associated with more frequent vascular complications than noted after standard balloon angioplasty, theoretically due to the larger sheaths and prolonged periods of anticoagulation required by some of these devices. This study sought to identify the incidence, predictors, and clinical outcome of vascular complications after new device angioplasty.
The clinical course of 1413 patients was reviewed after balloon or new device angioplasty. Vascular complications were defined as formation of a pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, or groin hematoma associated with a > 15-point hematocrit drop or the need for surgical repair. Stepwise logistic regression was used to identify independent predictors for vascular complications. Vascular complications developed after 84 (5.9%) procedures; they occurred more frequently after intracoronary stenting (14.0%) and extraction atherectomy (12.5%) than after balloon angioplasty (3.2%) (odds ratios, 4.86; P < .001, and 4.26, P < .05, respectively). Independent predictors of vascular complications included the use of intraprocedural thrombolytic agents (P < .01), intracoronary stenting (P < .005), or extraction atherectomy (P < .05); high maximum creatinine level (P < .005); low nadir platelet count (P < .001); longer periods of excess anticoagulation (P < .05); and the need for repeat coronary angioplasty (P < .005). Vascular complications were not related to the size of the arterial sheath used.
Vascular complications developed more frequently after new device angioplasty than after balloon angioplasty, with the risk for vascular complications directly related to the degree of periprocedural anticoagulation.
尽管新型冠状动脉血管成形术器械具有潜在优势，但与标准球囊血管成形术后相比，其可能与更频繁的血管并发症相关，从理论上讲，这是由于其中一些器械需要更大的鞘管以及更长时间的抗凝。本研究旨在确定新型器械血管成形术后血管并发症的发生率、预测因素及临床结局。
回顾了1413例患者行球囊或新型器械血管成形术后的临床病程。血管并发症定义为假性动脉瘤、动静脉瘘、腹膜后血肿或腹股沟血肿形成，且伴有血细胞比容下降超过15个百分点或需要手术修复。采用逐步逻辑回归分析确定血管并发症的独立预测因素。84例（5.9%）手术发生了血管并发症；冠状动脉内支架置入术（14.0%）和旋切术（12.5%）后发生血管并发症的频率高于球囊血管成形术（3.2%）（优势比分别为4.86；P <.001和4.26，P <.05）。血管并发症的独立预测因素包括术中使用溶栓药物（P <.01）、冠状动脉内支架置入术（P <.005）或旋切术（P <.05）；最高肌酐水平升高（P <.005）；最低血小板计数降低（P <.001）；抗凝时间延长（P <.05）；以及需要再次行冠状动脉血管成形术（P <.005）。血管并发症与所使用动脉鞘管的大小无关。
新型器械血管成形术后血管并发症的发生频率高于球囊血管成形术，血管并发症的风险与围手术期抗凝程度直接相关。
