80岁以上老年患者经桡动脉和股动脉途径行经皮冠状动脉介入治疗的对比研究

Comparison of Radial Versus Femoral Approach for Percutaneous Coronary Intervention in Octogenarian

目的:评价80岁以上老年患者经桡动脉途径行经皮冠状动脉介入治疗(PCI)的安全性和临床疗效。方法:2003-05至2007-05进行PCI 80岁以上的高龄患者268例,男性176例,年龄80～97岁;经股动脉途径PCI组156例(股动脉组),经桡动脉途径PCI组112例(桡动脉组)。对比两组的临床特点、PCI特点、住院期间主要的不良心脏事件(MACE,包括心脏性死亡、非致死性心肌梗死和靶病变再次重建率)。结果:桡动脉组与股动脉组相比,PCI的成功率相似,均在95%以上;桡动脉组需要更改途径的比率显著增高(P<0.05);冠状动脉导管插入时间(P<0.01)、X线曝光时间(P<0.05)均显著延长;造影剂用量有增多趋势(P>0.05),但两组差异未达统计学意义;术后卧床时间显著缩短(P<0.01),所有原因的穿刺部位血管并发症显著降低(P<0.01),其中,局部出血发生率(P<0.01)和局部血肿发生率(P<0.01)均显著减低。经多因素回归分析显示,桡动脉途径(OR=0.25,CI=0.09～0.75)是穿刺部位血管并发症独立的阴性预测因素。结论:80岁以上高龄患者的PCI,桡动脉途径可以降低穿刺血管局部并发症,与股动脉途径相比具有同样的临床效果和成功率,但是,穿刺失败率高,穿刺时间和曝光时间较长。

Objective ：To compare the safety and efficacy of the radial approach with femoral approach for percutaneous coronary intervention（PCI） in octogenarian. Methods ：268（ male 176,80-97 years old） octogenarians who underwent elective PCI from May 2003 to May 2007 in our hospital were studied, the results were compared between Radial approach group（ n = 156） and Femoral approach group（ n = 112） in terms of the clinical and procedural characteristics as well as the major adverse cardiovascular events during the hospitalization. Results：Procedural rate of success （both 〉 95 % ） were equivalent with both radial and femoral approaches. Radial approach was associated with longer annulations（3.0 ±2. 8 min vs. 2.0 ±1.9 min,P 〈0. 01 ） and fluoroscopy time（23 ±15 min vs. 19 ± 12 min, P = 0. 03 ）, greater utilization of contrast media （227 ± 48 ml vs. 205 ± 39 ml, P = 0. 06 ） and higher crossover rate （9. 8 % vs. 3.8%, P = 0. 02） to alternate access sites compared with the femoral approach. However, ambulation time （ 5 ± 2 h vs. 20 ± 4 h,P 〈0. 001 ） ,access site bleeding（2. 7% vs. 9. 6% ,P =0. 004） ,hecatomb（4. 5% vs. 10. 9% ,P =0. 006） or any vascular complications（7. 1% vs. 23.7% ,P 〈 0. 001 ） were significantly reduced in Radial approach group. Multivariate regression analysis identified radial approach（ OR = 0. 25, CI = 0.09 - 0. 75 ） as an independent negative predictor of post procedural vascular complications. Conclusion：Radial approach PCI in octogenarian significantly reduced the vascular complications in high-risk population,its efficacy and the rate of success in PCI were equivalent with femoral approach. However radial approach was associated with the longer cannulation and fluoroscopy time, and the higher puncture failure rate.