摘要
目的评价经桡动脉介入治疗冠心病的住院期间安全性和有效性及主要不良心脏事件的预测因素。方法人选阜外心血管病医院2004年5月至2009年5月16281例经桡动脉介入治疗冠心病患者（桡动脉组）和5388例经股动脉介入治疗冠心病患者（股动脉组）。比较桡动脉组与股动脉组患者临床特征、操作特点及住院期间临床疗效，并分析经桡动脉介入治疗患者住院期间发生主要不良心脏事件（包括死亡、心肌梗死和靶病变血运重建）的预测因素。结果与股动脉组比较，桡动脉组冠状动脉导管插入时间较长（P〈0．01），X线曝光时间、对比剂用量差异无统计学意义。桡动脉组与股动脉组操作成功率差异无统计学意义（95．5％比96．2％，P〉0．05）。血管径路并发症比例桡动脉组低于股动脉组（0．1％比1．3％，P〈0．01）。桡动脉组住院期间主要不良心脏事件发生率、死亡发生率均低于股动脉组（分别为1．6％比3．8％，P〈0．01；0．2％比0．4％，P〈0．01）。多因素logistic回归分析表明，经桡动脉介入治疗患者住院期间发生主要不良心脏事件的独立预测因素为年龄≥65岁（OR：1．98，95％可信区间：1．50～2．61，P〈0．01）、既往心肌梗死（OR：2．14，95％可信区间：1．63-2．82，P〈0．01）、置人药物洗脱支架（OR：0．68，95％可信区间：0．47～0．98，P=0．04）、冠状动脉夹层（OR：4．08，95％可信区间：2．28-7．33，P〈0．01）、左主干病变（OR：2．12，95％可信区间：1．09-4．13，P=0．03）、支架数（OR：1．25，95％可信区间：1．09-1．43，P〈0．01）、支架总长度（OR：1．01，95％可信区间：1．00～1．02，P=0．03）。结论经桡动脉介入治疗冠心病在住院期间具有良好的有效性和安全性。年龄t〉65岁、既往心肌梗死、置入药物洗脱支架、冠状动脉夹层、左主干病变、支架数、支架总长度是经桡动脉介入治疗住院期间发生主要不良心脏事件的独立预测因素。
Objective The purpose of this study is to evaluate the in-hospital clinical outcome of patients with coronary artery disease who underwent transradial intervention （TRI） and analyze the predictors of clinical outcome. Methods From May 2004 to May 2009, there were 16 281 patients who underwent transradial intervention, as well as 5388 patients who underwent transfemoral intervention （TFI） at our institution. The clinical characteristics, procedural characteristics, and in-hospital clinical adverse events were compared between TRI and TFI groups. Multivariable logistic regression analysis was performed to determine predictors of in-hospital major adverse cardiac events （ composite of death, myocardial infarction, or target lesion revascularization） of TRI. Results The annulations time was significantly longer for TRIthan TFI （P 〈0. 01 ）, fluoroscopy time, amount of contrast agent and procedural success rate （95. 5% for TRI and 96. 2% for TFI） were similar between the two groups. However, the rates of vascular complications （0. 1% for TRI group and 1.3% for TFI group, P 〈0.01） , incidence of in-hospital major adverse cardiac events （1.6% vs. 3.8%, P〈 0.01） and in-hospital death （0.2% vs. 0.4%, P〈0.01） were all significantly lower in TRI group compared with TFI group. The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events of TRI ： age 965 （ OR ： 1.98, 95% CI： 1.50 - 2. 61, P 〈 0. 01 ）, prior myocardial infarction （ OR：2. 14, 95% CI： 1.63 - 2. 82, P 〈 0. 01 ）, use of drug-eluting stent （DES） （ OR：O. 68, 95% CI：O. 47 - 0. 98, P = 0. 0d）, dissection during procedure （OR：4.08, 95%CI：2.28 -7.33, P 〈0.01） , left main lesion （OR：2. 12, 95% CI：1.09 - 4. 13, P =0. 03）, number of implanted stents （ OR： 1.25, 95% （21：1.09 - 1.43, P 〈 0. 01 ）, and total stented length （OR：I.01, 95%CI：1.00 -1.02, P=0.03）. Conclusions Ira this large single-centre patient cohort, the transradial intervention is superior to transfemoral intervention in terms of in-hospital safety and efficacy. Age 1〉 65, prior myocardial infarction, use of DES, dissection during procedure, left main lesion, number of implanted stents and total stented length were identified as independent multivariate predictors of in-hospital maior adverse cardiac events of TRI.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2011年第3期208-211,共4页
Chinese Journal of Cardiology
基金
科技部社会公益基金项目（2005DIBlJ084）
关键词
血管成形术
经腔
经皮冠状动脉
桡动脉
冠状动脉疾病
Angioplasty, transluminal, percutaneous coronary
Radial artery
Coronary disease
作者简介
通信作者：乔树宾，Email：qsbmail@tom．com
