经桡动脉和经股动脉路径同期进行冠状动脉三支病变介入治疗患者住院期间及长期临床结果比较

Comparison of In-hospital and Long Term Clinical Outcomes Between Trans-radial and Trans-femoral Approaches in Patients of Triple Vessel Lesion CAD With Percutaneous Coronary Intervention

目的：通过与经股动脉（TF）径路比较，评价经桡动脉（TR）径路同期进行经皮冠状动脉（冠脉）介入治疗冠脉三支病变的安全性、可行性、住院期间及长期随访期间临床结果。方法：4974例冠脉造影诊断为左主干未受累的冠脉三支病变并接受单次经皮血运重建治疗的患者入选了本项研究。分为TR组3856例，TF组1118例。手术和临床结果通过数据库和随访获得。本研究应用倾向评分匹配方法得到基线资料均衡的930对患者来比较TR组和TF组的住院期间和长期随访期间临床结果，用Cox比例风险模型评估两组间所有临床结果的风险差异，用Kaplan-Meier法估算两组安全性和有效性相关事件的累积发生率，并用log-rank法进行比较。结果：倾向评分匹配后，两组的临床和血管造影特征无统计学意义。TR组较TF组住院时间更短[（7.49±4.46）天vs（8.63±6.23）天，P〈0.0001]、出血事件更少（1.1％vs 2.9%，P=0.003）外，其余手术结果差异无统计学意义。临床随访显示TR组全因死亡率明显降低（TR组1.8％，TF组4.2％，P=0.0014；风险比0.44，95%可信区间0.25-0.79），而两组间其他长期随访期间临床结果差异无统计学意义。结论：TR进行冠脉三支病变患者的同期介入治疗是安全、可行的，并具有与TF介入治疗相似的手术成功率，具更短的住院时间、更低的出血风险、更低的死亡率，长期疗效不亚于TF介入治疗。

Objectives： To evaluate the safety, feasibility, in-hospital and long-term follow-up period outcomes by trans-radial （TR） approach for treating the patients of triple vessel lesion coronary artery disease （CAD） with one-stage percutaneous coronary intervention （PCI） in comparison with trans-femoral （TF） access. Methods： A total of 4974 consecutive patients with triple vessel lesion CAD without LM disease who received one-stage PCI were enroll in this study. The patients were divided into 2 groups：TR group, n=3856 and TF group, n=1118. The procedural and clinical results were obtained from data base and follow-up study. There were 930 pairs of patients with comparable baseline data obtained from propensity score matching method served as control subjects for both TR and TF groups. The risk diversity between 2 groups was evaluated by Cox’s proportional-hazards model, the cumulative incidences for the safety and efifcacy were estimated by Kaplan-Meier method and meanwhile compare by log-rank test. Results： With propensity score matching, the clinical and angiographic characteristics were similar between 2 groups. TR group had the shorter in-hospital time than TF group （7.49 ± 4.46） days vs （8.63 ± 6.23） days, P〈0.0001 and less incidence of bleeding 1.1% vs 2.9%, P〈0.003; the other procedural feathers were similar between 2 group. The follow-up study presented that TR group had obviously lower all cause mortality than TF group （1.8% vs 4.2%,P=0.0014;HR=0.44, 95%CI 0.25-0.79）;the other longer term follow-up outcomes were similar between 2 groups. Conclusion： TR intervention is safe and feasible for treating the patients with triple vessel lesion CAD, the procedural success rate and long term outcomes are similar to TF intervention, while it has shorter in-hospital time, lower risks for bleeding and death.