A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices
A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices
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DOI：
10.1016/j.ahj.2006.12.014
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发表时间：
2007-04-01
影响因子：
4.8
通讯作者：
Resnic, Frederic S.
中科院分区：
文献类型：
--
作者：
Arora, Nipun;Matheny, Michael E.;Resnic, Frederic S.
背景 血管通路并发症是冠状动脉造影和经皮冠状动脉介入治疗 (PCI) 后最常见的不良事件之一，据报道发生率为 1% 至 9%。关于血管并发症与血管闭合装置（VCD）的使用之间的关系存在相互矛盾的报道。本研究的目的是评估常规使用 VCD 的侵入性心脏病手术后与股动脉通路相关的血管结局。 方法 通过前瞻性登记，对 2002 年 1 月至 2005 年 12 月期间总共 12 937 名连续患者的院内结局进行研究。其中，6 913 名（53%）患者接受了 PCI，9 996 名（77%）患者接受了 VCD。使用单变量和多变量逻辑回归分析来确定血管并发症的预测因素。对 VCD 使用倾向进行分析，以解释使用此类设备的可能性的潜在偏差。结果 0.7% 的诊断性血管造影患者和 2.7% 的 PCI 患者发生血管并发症。在诊断性血管造影（0.5% vs 1.1%，P = 0.01（星号））和 PCI（2.4% vs 4.9%，P < 0.001（星号））组中，使用闭合装置的血管并发症风险显着降低。在考虑了使用此类设备的倾向后，多变量逻辑回归分析显示，在诊断性导管插入术中，使用 VCD 可使血管并发症的风险降低 58% (95% CI 19%-88%)，使 PCI 患者的血管并发症风险降低 42% (95% CI 17%-59%)。 结论 在当代实践中，在适当选择的接受诊断和治疗性心脏病的患者中，与手动压迫相比，VCD 可以降低血管并发症的风险。导管插入术。
Background Complications of vascular access are one of the most common adverse events after coronary angiography and percutaneous coronary intervention (PCI) and are reported to occur in 1% to 9% of cases. There are conflicting reports of the association of vascular complications with the use of vascular closure devices (VCDs). The purpose of this study was to assess femoral arterial access-related vascular outcomes after invasive cardiology procedures with the routine use of VCDs.Methods A total of 12 937 consecutive patients were studied for inhospital outcomes through a prospective registry from January 2002 to December 2005. Of these, 6913 (53%) patients underwent PCI and 9996 (77%) patients received VCDs. Univariate and multivariate logistic regression analyses were used to determine the predictors of vascular complications. A propensity analysis of VCD use was performed to account for potential bias in the likelihood of using such devices.Results Vascular complications occurred in 0.7% of diagnostic angiography and 2.7% of PCI patients. The risk of vascular complications was significantly lower with closure device use compared with manual compression in both diagnostic angiography (0.5% vs 1.1%, P = .01(star)) and PCI (2.4% vs 4.9%, P < .001(star)) groups. Multivariate logistic regression analysis, after accounting for the propensity to use such devices, revealed that VCD use was associated with a 58% (95% CI 19%-88%) reduction in the risk of vascular complications in diagnostic procedures catheterization and a 42% (95% CI 17%-59%) reduction in PCI patients.Conclusions In contemporary practice, VCDs offer reduced risk of vascular complications as compared with manual compression in appropriately selected patients undergoing diagnostic and therapeutic cardiac catheterizations.