Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(...Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.展开更多
Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients ag...Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.展开更多
Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA ve...Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.展开更多
Background：The risk of radial artery occlusion （RAO） needs particular attention in transradial intervention （TRI）.Therefore,reducing vascular occlusion has an important clinical significance.The aim of this study...Background：The risk of radial artery occlusion （RAO） needs particular attention in transradial intervention （TRI）.Therefore,reducing vascular occlusion has an important clinical significance.The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods：We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI.Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.Risk factors for RAO were evaluated using a multivariate model analysis.Results：Of the 606 patients,the RAO occurred in 56 patients.Compared with TRI at 2-5 cm away from the radius styloid process,the odds ratio （OR） for occlusion risk at 0 cm and 1 cm were 9.65 （P =0.033） and 8.90 （P =0.040）,respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 （OR =2.45,P =0.004）.Conclusion：Distal puncture sites （0-1 cm away from the radius styloid process） can lead to a higher rate of RAO.展开更多
目的系统评价经桡动脉行冠状动脉介入术患者术后早期下床活动的效果。方法检索1993年1月1日至2023年12月31日发表在Cochrane Library、PubMed、Web of Science、Embase、中国知网、中国生物医学文献数据库、维普资讯网、万方数据库和国...目的系统评价经桡动脉行冠状动脉介入术患者术后早期下床活动的效果。方法检索1993年1月1日至2023年12月31日发表在Cochrane Library、PubMed、Web of Science、Embase、中国知网、中国生物医学文献数据库、维普资讯网、万方数据库和国内外临床试验注册中心有关经桡动脉行冠状动脉介入术后早期下床活动的试验性研究,对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入12项研究,Meta分析结果显示,与常规康复相比,经桡动脉行冠状动脉介入术后早期下床活动有利于改善患者左室射血分数[MD=4.35,95%CI(1.96,6.74),P<0.01];能提高患者生活质量[SMD=2.56,95%CI(1.37,3.75),P<0.01];增强患者日常生活能力[MD=3.78,95%CI(1.87,5.69),P<0.01];降低心绞痛[OR=0.35,95%CI(0.16,0.79),P=0.01]、心律失常[OR=0.33,95%CI(0.15,0.70),P<0.01]和心力衰竭[OR=0.35,95%CI(0.13,0.91),P=0.03]发生率;对改善冠状动脉再狭窄[OR=0.28,95%CI(0.07,1.16),P=0.08],左室舒张末内径[MD=-1.53,95%CI(-4.58,1.53),P=0.33]和6分钟步行距离[MD=32.87,95%CI(-2.03,67.77),P=0.06]效果不显著。结论早期下床活动可以明显改善经桡动脉行冠状动脉介入术后患者的心功能,提高其生活质量和日常生活能力,减少并发症,促进患者的康复。展开更多
文摘Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.
文摘Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.
基金supported by the Wuzhou Science and Technology Project(No.202102094)。
文摘Background Distal radial artery access(DRA)has emerged as an alternative to conventional transradial access(TRA)for percutaneous coronary interventions(PCI).This study aims to compare the efficacy and safety of DRA versus TRA.Methods A total of 873 participants were enrolled,divided into the DRA group(n=236)and the TRA group(n=637).The primary endpoint was the success rate of access puncture.Secondary endpoints included procedural efficiency,patient comfort,and complication rates.Baseline characteristics,procedural data,and outcomes were analyzed and compared between the two groups.Results The success rates for access puncture showed no significant statistical difference between the DRA and TRA groups.However,the DRA group required more puncture attempts.DRA showed significant advantages,including shorter hemostasis times,reduced access puncture and postprocedural pain,and lower incidences of radial artery occlusion(2.1%vs.6.1%,P=0.043)and hematoma(1.7%vs.5.2%,P=0.037).Conclusions DRA is a viable alternative to TRA for performing PCI,offering comparable success rates and procedural efficiency with improved patient comfort and reduced complications.
文摘Background：The risk of radial artery occlusion （RAO） needs particular attention in transradial intervention （TRI）.Therefore,reducing vascular occlusion has an important clinical significance.The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods：We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI.Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.Risk factors for RAO were evaluated using a multivariate model analysis.Results：Of the 606 patients,the RAO occurred in 56 patients.Compared with TRI at 2-5 cm away from the radius styloid process,the odds ratio （OR） for occlusion risk at 0 cm and 1 cm were 9.65 （P =0.033） and 8.90 （P =0.040）,respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 （OR =2.45,P =0.004）.Conclusion：Distal puncture sites （0-1 cm away from the radius styloid process） can lead to a higher rate of RAO.
文摘目的系统评价经桡动脉行冠状动脉介入术患者术后早期下床活动的效果。方法检索1993年1月1日至2023年12月31日发表在Cochrane Library、PubMed、Web of Science、Embase、中国知网、中国生物医学文献数据库、维普资讯网、万方数据库和国内外临床试验注册中心有关经桡动脉行冠状动脉介入术后早期下床活动的试验性研究,对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入12项研究,Meta分析结果显示,与常规康复相比,经桡动脉行冠状动脉介入术后早期下床活动有利于改善患者左室射血分数[MD=4.35,95%CI(1.96,6.74),P<0.01];能提高患者生活质量[SMD=2.56,95%CI(1.37,3.75),P<0.01];增强患者日常生活能力[MD=3.78,95%CI(1.87,5.69),P<0.01];降低心绞痛[OR=0.35,95%CI(0.16,0.79),P=0.01]、心律失常[OR=0.33,95%CI(0.15,0.70),P<0.01]和心力衰竭[OR=0.35,95%CI(0.13,0.91),P=0.03]发生率;对改善冠状动脉再狭窄[OR=0.28,95%CI(0.07,1.16),P=0.08],左室舒张末内径[MD=-1.53,95%CI(-4.58,1.53),P=0.33]和6分钟步行距离[MD=32.87,95%CI(-2.03,67.77),P=0.06]效果不显著。结论早期下床活动可以明显改善经桡动脉行冠状动脉介入术后患者的心功能,提高其生活质量和日常生活能力,减少并发症,促进患者的康复。
