急诊经桡动脉冠状动脉介入治疗疗效和安全性评价

目的 评价急性ST段抬高心肌梗死(STEMI)急诊经桡动脉冠状动脉介入治疗(PCI)的安全性和有效性.方法 连续人选我院2004-2007年因STEMI行急诊PCI患者446例,其中经桡动脉介入242例,经股动脉介入204例.比较两组手术操作成功率、再灌注时间、手术时间、X线曝光量、造影剂用量、并发症和近远期预后.结果 与经股动脉介入比较,经桡动脉介入的急诊PCI完成时间延长[(62.1±23.4)rain比(56.8±16.7)min],X线曝光量增加[(2829.4±1365.2)mGY比(2352.3±903.1)mGY]、手术操作成功率下降(4%比0.9%),PCI再灌注时间＞60 min的比例升高(7.44%比2.94%),差异有统计学意义(P＜0.05).结论 经桡动脉行急诊PCI手术操作成功率低于经股动脉,影响急诊PCI再灌注时间,桡动脉介入操作困难时应果断更改手术人路.

Abstract：

Objectives To compare the safety and efficacy of radial artery access versus femoral artery access for percutaneous coronary intervention in acute myocardial infarction population. Methods From June 2004 to December 2006, 446 patients with acute myocardial infarction treated with percutaneous stenting were reviewed retrospectively. The radial artery approach was used in 242 patients, and the femoral artery approach in 204 patients. The success of the procedure, procedure duration, X-ray exposition, volume of contrast, incidence of major adverse cardiac events and complications were compared between the radial artery and femoral artery approach. Results Total procedure duration, X-ray exposition, the immediate success of the procedure and the proportion of patients with reperfusion time above 60min are higher in patients with radial artery acess than that with femoral artery access [(62. 1 ± 23. 4) min vs(56. 8 ± 16. 7)min,(2829. 4 ± 1365.2) mGY vs (2352. 3 ± 903.1) mGY, 4% vs 0.9% and 7.44% vs 2.94%respectively, all P ＜ 0. 05]. Conclusions In non-selected patients with acute myocardial infarction treated with primary stent implantation, the success rate of the radial artery approach is lower than the femoral artery approach and could prolong the reperfusion time. It is suitable to change artery access immediately if abnormality is found via radial artery access.

The efficacy and safety of transradial versus transfemoral approach for percutaneous coronary intervention in acute myocardial infarction

Objectives To compare the safety and efficacy of radial artery access versus femoral artery access for percutaneous coronary intervention in acute myocardial infarction population. Methods From June 2004 to December 2006, 446 patients with acute myocardial infarction treated with percutaneous stenting were reviewed retrospectively. The radial artery approach was used in 242 patients, and the femoral artery approach in 204 patients. The success of the procedure, procedure duration, X-ray exposition, volume of contrast, incidence of major adverse cardiac events and complications were compared between the radial artery and femoral artery approach. Results Total procedure duration, X-ray exposition, the immediate success of the procedure and the proportion of patients with reperfusion time above 60min are higher in patients with radial artery acess than that with femoral artery access [(62. 1 ± 23. 4) min vs(56. 8 ± 16. 7)min,(2829. 4 ± 1365.2) mGY vs (2352. 3 ± 903.1) mGY, 4% vs 0.9% and 7.44% vs 2.94%respectively, all P ＜ 0. 05]. Conclusions In non-selected patients with acute myocardial infarction treated with primary stent implantation, the success rate of the radial artery approach is lower than the femoral artery approach and could prolong the reperfusion time. It is suitable to change artery access immediately if abnormality is found via radial artery access.