Comparison of transradial vs. transfemoral approach in the treatment of acute myocardial infarction with primary angioplasty and abciximab.

Compared to the femoral approach, the use of radial arterial access has been demonstrated to reduce the incidence of access site bleeding complications in staged procedures. The purpose of this study was to evaluate clinical outcomes comparing radial and femoral approaches in the treatment of acute myocardial infarction with primary angioplasty and the GP IIb/IIIa inhibitor abciximab. Between 15 September 1999 and 15 September 2002, we prospectively enrolled 119 consecutive patients undergoing primary angioplasty with abciximab comparing radial (n = 64) and femoral (n = 55) access. In this nonrandomized study, freedom from major cardiac events at 1-month follow-up occurred in 62 (97%) and 52 (94.5%) patients in the radial and the femoral groups, respectively (P = 0.19). There were no major access site bleeding complications in the radial group, as opposed to three (5.5%) in the femoral group (P = 0.03), all requiring transfusions, with surgical repair necessary in two. Uncomplicated clinical course occurred in 62 (97%) of patients in the radial group and 49 (89%) in the femoral group (P = 0.04). Total hospital length of stay was significantly higher in the femoral group (5.9 +/- 2.1 vs. 4.5 +/- 1.2 days; P = 0.05). Cannulation time (from patient arrival at the catheterization laboratory to the effective placement of arterial sheath) and procedural time were not significantly different in the radial and the femoral group (respectively 8.5 +/- 5.2 vs. 9.0 +/- 5.8 min, P = 0.81, and 42 +/- 28 vs. 44 +/- 27 min, P = 0.74). Nevertheless, time of radiation (23.1 +/- 11 vs. 16.5 +/- 10.9 min; P = 0.01) and dose-area product (28,616 +/- 16,571 vs. 18,819 +/- 10,739 R. cm2; P = 0.01) were significantly higher in the radial group. In patients with acute myocardial infarction treated with primary angioplasty and abciximab, the transradial access is efficacious with fewer major access site complications than transfemoral access. Transradial approach produces a shorter length of stay, as compared to the transfemoral approach, although with longer times of radiation and higher dose-area product.     

急诊经桡动脉冠状动脉介入治疗疗效和安全性评价

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.     

急诊经桡动脉冠状动脉介入治疗疗效和安全性评价

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.     

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.     

急诊经桡动脉冠状动脉介入治疗疗效和安全性评价

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.     

Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial.

Transradial coronary intervention (TRI) can be performed in elective patients with low incidence of access site complications. However, the feasibility of primary stent implantation by TRI is still not clear in patients with acute myocardial infarction (AMI). We prospectively randomized 149 patients out of 213 patients with AMI within 12 hr from onset into two groups: 77 patients treated by TRI (TRI group) and 72 patients by transfemoral coronary intervention (TFI; TFI group). We compared the incidences of major adverse cardiac events (MACE; repeat MI, target lesion revascularization, and cardiac death) during the initial hospitalization and 9-month follow-up periods in both groups. There were one patient who crossed over to the opposite arm, and two patients with severe bleeding complications in the TFI group. Background characteristics of patients were similar between the two groups. The success rate of reperfusion and the incidence of in-hospital MACE were similar in both groups (96.1% and 5.2% vs. 97.1% and 8.3% in TRI and TFI groups, respectively). In selected patients with AMI, primary stent implantation by TRI is feasible as compared to TFI.     

老年急性心肌梗死患者经桡动脉和股动脉介入治疗的对比分析

目的分析老年急性心肌梗死患者经桡动脉直接PCI治疗的成功率、并发症以及应用经验。方法选择行直接PCI治疗的老年急性ST段抬高心肌梗死患者96例,根据PCI操作途径分为桡动脉组(50例)和股动脉组(46例),比较两组的手术成功率和手术结果,分析手术并发症以及住院期间预后。结果桡动脉组和股动脉组手术成功率相似(92.0%vs91.3%,P>0.05),桡动脉组有两例患者交叉到股动脉组手术成功,两组手术时间、穿刺时间和第一次球囊扩张时间均无显著差异(P>0.05),但桡动脉组透视时间显著延长(P<0.05),住院期间主要心血管不良事件两组无显著差异,桡动脉组穿刺局部出血并发症显著降低(2.0%vs10.8%,P<0.05)。结论经桡动脉直接PCI在老年急性心肌梗死患者中有较好的安全性和有效性。     

经桡动脉与股动脉入径直接经皮冠状动脉介入治疗急性心肌梗死的对比研究

目的　对经桡动脉与股动脉入径直接经皮冠状动脉介入 (TRA pPCI与TFA pPCI)治疗急性心肌梗死 (AMI)的临床可行性、安全性及其疗效进行对比研究。方法　 2 0 0 0年 9月至 2 0 0 2年 8月期间 ,2 0 8例 [男性 159例 ,女性 49例 ,平均年龄 (58 9± 11 9)岁 ]发病在 12h内的AMI患者 ,随机分为TRA pPCI组 10 6例 ,TFA pPCI组 10 2例。比较两种入径 pPCI各操作时程和疗效及术后出血、血栓 /栓塞和血管并发症 ;观察桡动脉痉挛发生率并评价药物预防和解痉效果。并随访比较TRA pPCI组术后 1个月双侧桡动脉内径和血流速度及桡动脉血管并发症。结果　TRA pPCI组和TFA pPCI组各 2例患者因入径血管困难而交叉调组。TRA pPCI组PCI处理病变血管 10 6支 ,其中完全闭塞病变 2 8支。TFA pPCI组PCI处理病变血管 10 2支 ,完全闭塞 3 4支。两组患者在桡 /股动脉穿刺时间、指引导管置入时间、病人到达医院至球囊开始扩张时间、总pPCI时程无明显差异 [(18 3± 3 3 )s比 (16 9± 4 2 )s ;(6 0± 1 6)min比 (5 8± 0 9)min ;(45 3± 19 6)min比 (42 8± 2 2 7)min ;(49 2± 2 4 1)min比 (46 5± 2 6 4)min ,P均 >0 0 5]。两组一次入径血管穿刺成功率、梗死相关动脉 (IRA)开通率和PCI成功率亦相似 (93 4%比 96 1% ;10 0 %比 1     

经导管血栓吸出术在处理急性心肌梗死冠脉内血栓中的应用

目的　本文介绍一种急性心肌梗死行急诊经皮血运重建术 (PCI)过程中处理冠脉内血栓的简单方法 ,并观察其近期临床疗效。方法　因急性心肌梗死入院 ,急诊冠状动脉造影显示冠状动脉近段病变及冠脉内血栓者。常规PTCA方法选择 7F指引导管 ,普通 0 0 14″冠脉导丝通过病变后 ,经导丝直接送入PercuSurge吸引导管至病变部位 ,反复抽吸至血栓消失 ,梗死部位恢复前向血流。然后直接置入冠脉内支架。造影观察病变扩张结果及梗死相关血管血流和心肌灌注情况。并随访住院期间心血管事件及心功能。结果　 12例急性心梗造影显示冠脉内大量血栓者接受了上述治疗。血栓吸引后即刻血栓影消失者 8例 ,血栓明显减少 4例。 8例完全闭塞者中经血栓吸引后 7例血管直接开通 ,前向血流明显改善。支架术后前向血流TIMI 3级和TMP 3级者 9例。 3例血流稍减慢 ,TMP 2级。住院期间无心绞痛、再梗及死亡等事件发生。出院前平均LVEF为 (6 4 1± 9 3) %。结论　经导管直接血栓吸出术是处理冠脉内血栓的一种简单有效的方法。     

经导管血栓吸出术在急性心肌梗死中的应用(附9例报道)

目的 冠脉内血栓是影响急性心肌梗死介入治疗效果的重要因素。本文介绍一种急性心肌梗死后经导管血栓吸出术的方法和疗效。方法 因急性心肌梗死入院，急诊冠状动脉造影显示冠状动脉近段病变及冠脉内血栓者。常规PTCA方法选择7F指引导管，导丝通过病变后，经导丝直接送入PercuSurg吸引导管至病变部位，反复抽吸至血栓消失，梗死部位恢复前向血流。然后直接置入冠脉内支架。造影观察病变扩张结果及梗死相关血管血流和心肌灌注情况。并随访住院期间心血管事件及心功能。结果 9例急性心梗造影显示冠脉内大量血栓者接受了上述治疗。8例吸引导管直接通过病变，1例使用了球囊预扩张。血栓吸引后即刻血栓影消失8例，血栓明显减少1例。支架术后残余狭窄均消失，前向血流完全正常者7例，2例血流稍减慢。梗死部位心肌组织的再灌注达TMP3级者7例．TMP2级2例。住院期间无心绞痛、再梗及死亡等事件发生。无心力衰竭发生，出院前超声心动图测定LVEF46％～72％。结论 经导管直接血栓吸出术可能是处理冠脉内血栓的一种简单有效的方法。     

老年急性心肌梗死患者经桡动脉与股动脉入径直接经皮冠脉介入治疗的对比研究

目的　探讨老年急性心肌梗死 (AMI)患者经桡动脉入径行直接冠脉介入治疗 (TRA pPCI)的可行性、安全性及疗效。 方法　 86例(男 60例 ,女 2 6例 ,平均年龄 68 9± 1 1 4岁 )发病在 1 2h内需接受 pPCI治疗的老年AMI患者 ,随机分为TRA pPCI组 46例 ,经股动脉入径 (TFA pPCI)组 40例 ,比较两种入径pPCI各操作时程、疗效及术中、术后可能出现的出血、血栓 /栓塞等血管并发症的发生率和预防处理措施。 结果　两组在处理病变血管支数、病变程度 ,以及在 pPCI各操作时程、疗效和成功率等均无明显差异。术后TFA pPCI组出血、血栓 /栓塞等血管并发症明显高于TRA pPCI组 (P <0 0 5)。TRA pPCI组术中有 4 3 %患者出现上肢动脉轻度痉挛 ,但经解痉治疗有效且不需中断PCI操作。术后随访TRA pPCI组Allen’s试验时间较前无明显变化 ,且双侧桡动脉内径及收缩期血流峰速无明显差别。结论　对血流动力学稳定的老年AMI患者 ,两种入径的pP CI治疗时程和效果相似 ,但TRA pPCI组出血、血栓 /栓塞等血管并发症少 ,且拔除鞘管时无须中断肝素抗凝治疗 ,可作为老年AMI患者PCI治疗时选择的血管途径之一     

老年急性心肌梗死患者经桡动脉途径直接PCI治疗的临床研究

目的 探讨老年急性心肌梗死(AMI)患者经桡动脉入径行直接冠脉介入治疗(TRA-pPCI)的可行性、安全性及疗效.方法 102例[男性73例,女性29例,平均年龄(68.5±11.6)岁]发病在12 h内需接受pPCI治疗的老年AMI患者,随机分为经桡动脉人径(TBA-pPCI)组52例,经股动脉入径(TFA-pPCI)组50例,观察两组的成功率、操作时间和并发症发生情况.术后随访3个月,评估术侧桡动脉、股动脉搏动情况及心脏事件发生情况.结果 两组在处理病变血管支数、病变程度,以及在操作时间、疗效和成功率等方面差异均无统计学意义.术后TFA-pPCI组出血等血管并发症明显高于TRA-pPCI组(P<0.05). TRA-pPCI组术中有5.8%的患者出现上肢动脉轻度痉挛,但经解痉治疗有效且不需中断PCI操作.术后3个月随访,TRA-pPCI组仅1例患者出现桡动脉搏动减弱,两组心脏事件发生率及心功能差异无统计学意义.结论 对血流动力学稳定的老年AMI患者,两种入径的pPCI治疗时程和效果相似,但TRA-pPCI组出血等血管并发症少,可作为老年AMI患者PCI治疗时选择的血管途径之一.     

Primary stenting for acute myocardial infarction via the transradial approach: a safe and useful alternative to the transfemoral approach

BACKGROUND: Primary stenting in acute myocardial infarction (AMI) has been demonstrated to reduce recurrent ischemic events. However, transradial stenting in AMI has not been well established. Therefore, we sought to investigate the feasibility and utility of transradial coronary stenting in patients with AMI. METHODS: From April 1998 to April 1999, 56 patients (43 male; mean age of 57 years) who arrived within 6 hours of pain onset with culprit vessel size > 2.5 mm constituted this study. The transradial approach (Group 1) was used in 30 patients with hemodynamically stable and palpable right radial pulse. The transfemoral approach (Group 2) was used for vascular access in the remainder of patients (26) who might have required a second vascular access site for intraaortic balloon pumping (in cardiogenic shock) and/or a transvenous temporary pacemaker. RESULTS: Overall success rate was achieved in 54 of 56 patients (96%). The success rate was 90% (27/30) in Group 1 and 96% (25/26) in Group 2. The cannulation time (from patient arrival at the catheterization room to the time of arterial cannulation) and the total procedure time (from patient arrival at the catheterization room to the completion of the procedure) were not significantly different between Group 1 and Group 2 (9.2+/-5.3 versus 8.9+/-5. 8 minutes, p>0.05; 53.7+/-19.4 versus 57.5 +/-26.8 minutes, p>0.05, respectively). In the Group 1 patients, there was no forearm ischemia or loss of radial pulse during the 30-day follow-up period. CONCLUSION: Primary coronary stenting for acute myocardial infarction via the transradial approach is a safe and feasible alternative to the conventional transfemoral approach, and is especially useful for hemodynamically stable patients who do not require a second vascular access site.     

血栓抽吸在急性心肌梗死治疗策略中价值的再评估

血栓抽吸处理急性ST段抬高型心肌梗死(STEMI)罪犯血管高负荷血栓简单实用,安全可靠。2000年以来,越来越多研究表明,血栓抽取可以有效提高STEMI患者心肌灌注,获得良好的短期临床预后,但对于长期临床预后结果不一致。本文复习了相关直接经皮冠状动脉介入(PPCI)术中应用血栓抽吸治疗的相关研究,有支持的,亦有反对的。我们将会分析这些研究结果的实际临床意义,包括技术层面、研究设计、统计学等方面存在的缺陷。通过对这些争论的分析,探讨血栓抽吸在STEMI中应用的前景。     

Impact of thrombus aspiration on angiographic and clinical outcomes in patients with ST-elevation myocardial infarction

BackgroundPrimary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) may be limited by thrombus embolization. Export aspiration catheter (EAC) is a thrombectomy device which may enhance angiographic results, but its impact on clinical outcomes is unclear. This trial objective was to assess the impact of EAC on angiographic and clinical outcomes in patients with STEMI.MethodsAll STEMI patients undergoing primary or rescue PCI in a tertiary care center were included. Patients were divided in two groups according to the use of the EAC. Patients were followed up prospectively for death, reinfarction, revascularization, or stroke. Thrombolysis In Myocardial Infarction (TIMI) flow in the culprit vessel was assessed before and after PCI.ResultsIncluded in the analysis were 535 patients. EAC was used in 165 patients before angioplasty (Group 1) and 370 patients underwent PCI without thrombus aspiration (Group 2). More patients in Group 1 had initial TIMI flow 0–1 compared to Group 2 (88% vs. 62%, P<.001). Proportion of patients with a final TIMI flow 3 was the same in both groups (89.1% vs. 87.6% for Groups 1 and 2, respectively; P=.67). An analysis restricted to patients with initial TIMI flow 0–1 yielded similar results. No difference in clinical outcomes was observed between the two groups (P=.70).ConclusionsSelective use of the EAC based on the judgment of operators results in excellent angiographic and clinical results. Further clinical investigation is needed to definitely answer whether thromboaspiration needs to be performed in all STEMI patients undergoing primary PCI.     

Feasibility and efficacy of transradial access for coronary interventions in patients with acute myocardial infarction.

Transradial coronary intervention is a relatively new technique that may lower morbidity and improve patient satisfaction. A retrospective analysis was performed on 41 consecutive patients who underwent transradial coronary interventions. Twenty-nine patients had ST elevation MI (group A) and 12 patients had non-Q-wave MI (group B). Mean time to arterial access from hospital admission was 15.6 min, and mean time to balloon inflation from arterial cannulation was 25.3 min. All patients underwent successful stenting of the infarct-related artery. Over 75% of patients received glycoprotein IIb/IIIa inhibitors. All patients received aspirin and either clopidogrel or ticlopidine. There were no procedure-related complications. Mean hospital stay was 3.9 days and 2.8 days for group A and group B, respectively. The transradial approach to coronary interventions is both feasible and safe in patients with acute myocardial infarction. This option may be most appealing in patients at high risk for developing vascular complications of arterial access.     

血栓抽吸对急性心肌梗死患者罪犯血管血流的影响

目的:分析血栓抽吸对急性心肌梗死(AMI)患者直接经皮冠状动脉介入术(PCI)罪犯血管血流的影响。方法:收集90例行PCI术的AMI患者的临床资料。按是否进行血栓抽吸分为对照组(单纯PCI术,40例)与研究组(血栓抽吸联合PCI术,50例),比较2组临床治疗结果、罪犯血管血流变化及术后1周与术后远期不良心血管事件发生率。结果:术后2组罪犯血管血流0~2级所占比例较术前明显降低(P0.05),且研究组明显低于对照组(P0.05)。研究组术后ST段回落良好所占比例为60.0%,略高于对照组,但差异无统计学意义(P0.05);研究组术后1周左室射血分数(LVEF)高于对照组,左室舒张末期内径(LVEDD)低于对照组(均P0.05)。研究组术后1周不良事件发生率与对照组比较差异无统计学意义(P0.05),其随访远期总不良事件发生率略低于对照组,但差异无统计学意义(P0.05)。结论:血栓抽吸可改善AMI患者PCI术后罪犯血管血流灌注,改善患者左室功能。     

急诊经桡动脉与股动脉入路介入治疗ST段抬高急性心肌梗死对比研究

目的观察经桡动脉入路行急诊ST段抬高急性心肌梗死直接经皮冠状动脉介入(PCI)治疗的有效性和安全性。方法选择沈阳军区总医院2005年1月至2006年10月连续607例ST段抬高性急性心肌梗死(STEMI)住院患者,分别接受经桡动脉入路(273例)或经股动脉入路(334例)途径行PCI治疗,观察两组手术成功率和并发症发生率。结果两组患者PCI成功率差异无统计学意义(97.07%对95.81%,P>0.05)。经桡动脉入路组局部血肿、假性动脉瘤、迷走反射发生率显著低于经股动脉入路组。结论行PCI治疗的STEMI患者经桡动脉入路途径是安全、有效和可行的方法,与经股动脉比较,经桡动脉途径可减少并发症的发生。