Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry.
Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry.
复制标题
经桡动脉入路与经股动脉入路治疗 ST 段抬高型急性心肌梗死接受初次经皮冠状动脉介入治疗的患者：来自 CREDO-Kyoto AMI 登记处的见解。
DOI：
10.1007/s00380-017-1021-4
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Kimura T
中科院分区：
文献类型：
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作者：
Yamashita Y;Shiomi H;Morimoto T;Yaku H;Kaji S;Furukawa Y;Nakagawa Y;Ando K;Kadota K;Abe M;Akao M;Nagao K;Shizuta S;Ono K;Kimura T
近期随机临床试验表明，经桡动脉入路是ST段抬高急性心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）的首选入路。然而，经桡动脉入路治疗ST段抬高型心肌梗死的临床结局尚未在包括血流动力学不稳定高危患者的现实世界实践中得到充分评价。在CREDO-Kyoto AMI登记研究中，我们确定了3662例症状发作后24小时内接受直接PCI的STEMI患者，并通过经桡动脉（N= 471）或经股动脉（N= 3191）途径进行治疗。在当前的分析中，我们比较了经桡动脉入路和经股动脉入路治疗的2组患者的临床特征和长期结局。经桡动脉组血流动力学受损患者（Killip II-IV）的患病率显著低于经股动脉组（19 vs. 25%，P = 0.002）。经桡动脉组和经股动脉组之间死亡/MI/卒中和大出血的5年累积发生率无显著差异（分别为26.7 vs. 25.9%，对数秩P = 0.91和11.3 vs. 11.5%，对数秩P = 0.71）。校正混杂因素后，经桡动脉组相对于经股动脉组的死亡/MI/卒中风险[风险比（HR）1.15，95%CI 0.83- 1.59，P = 0.41]和大出血风险（HR 1.29，95%CI 0.77- 2.15，P = 0.34）均无显著性差异。在血流动力学受损患者亚组中，两组之间的死亡/MI/卒中和大出血风险也无显著差异。在真实世界实践中，经桡动脉入路与经股动脉入路行STEMI直接PCI的临床结局无差异。
Recent randomized clinical trials demonstrated that transradial approach was a preferred approach for primary percutaneous coronary intervention (PCI) in ST-elevation acute myocardial infarction (STEMI). However, clinical outcomes of transradial approach in STEMI have not been adequately evaluated yet in the real-world practice, which includes hemodynamically unstable high-risk patients. We identified 3662 STEMI patients who had primary PCI within 24 h after symptom onset and were treated by transradial (N= 471) or transfemoral (N= 3191) approach in the CREDO-Kyoto AMI registry. In the current analysis, we compared clinical characteristics and long-term outcomes between the 2 groups of patients treated by transradial approach and transfemoral approach. The prevalence of hemodynamically compromised patients (Killip II–IV) was significantly less in the transradial group than in the transfemoral group (19 vs. 25%,P= 0.002). Cumulative 5-year incidences of death/MI/stroke, and major bleeding were not significantly different between the transradial and transfemoral groups (26.7 vs. 25.9%, log-rankP= 0.91, and 11.3 vs. 11.5%, log-rankP= 0.71, respectively). After adjustment for confounders, the risks of the transradial group relative to the transfemoral group were not significant for both death/MI/stroke [Hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.83–1.59,P= 0.41] and major bleeding (HR 1.29, 95% CI 0.77–2.15,P= 0.34). In the subgroup of hemodynamically compromised patients, there were also no significant differences in the risks for death/MI/stroke and major bleeding between the 2 groups. Clinical outcomes of transradial approach were not different from those of transfemoral approach in primary PCI for STEMI in the real-world practice.