经桡动脉和股动脉两种途径行冠状动脉造影后即刻介入治疗的比较

目的比较经桡动脉和股动脉两种穿刺途径行冠状动脉造影术后即刻冠状动脉介入治疗的成功率、并发症以及近期疗效。方法选择因冠心病心绞痛入院行择期冠状动脉造影,且结果显示明确的冠状动脉病变,并选择即刻行冠状动脉介入治疗者。其中经桡动脉穿刺途径即桡动脉组134例,经股动脉穿刺途径即股动脉组427例。分析和比较两组靶血管病变特征、介入治疗成功率、疗效和并发症,并随访术后1月内主要心血管事件的发生率。结果桡动脉组男性患者和吸烟者所占的比例明显高于股动脉组(P<0.01)。桡动脉组PCI成功率为93.3%,与股动脉组(94.8%)相比差异无统计学意义。而桡动脉组病变血管的血运重建率为81.8%,低于股动脉组(93.4%),P<0.01。而且桡动脉组成功PCI者中慢性闭塞病变所占的比例(9.5%)也明显低于股动脉组(17.3%),P<0.05。但桡动脉组术后与穿刺有关的总的并发症发生率明显低于股动脉组,且术后平均卧床时间也明显短于股动脉组(P<0.01)。术后1个月期间主要心血管事件两组之间无明显差异。结论与经股动脉穿刺相比,经桡动脉穿刺冠状动脉造影后即刻行介入治疗的成功率和近期临床疗效基本相同,但术后与穿刺有关的并发症较少。对于复杂病变选择经股动脉PCI可能优于经桡动脉途径。

Transradial compared with transfemoral artery approach of direct percutanous coronary intervention immediately after coronary angiography

Objective To compare the differences of the success rate,complications,and clinical outcomes between transradial and transfemoral artery approach of percutanous coronary intervention(PCI) immediately after coronary angiography in angina patients.Methods Direct PCIs immediately after coronary angiography were done in total 561 angina patients from October 2000 to October 2005 in our hospital,which including trasradial artery approach in 134 patients(radial group) and transfemoral artery approach in 427 patients(femoral group).The characteristics of the target lesions,success rates,and complications were analyzed in two groups.The recurrent of angina,myocardial infarction and coronary death during one month follow-up were recorded in each group.Results The success rate of PCI was 93.3% in radial group compared with 94.8% in femoral group(P>0.05).There were no differences of clinical outcomes between two groups during one month follow-up.But in radial group,the revascularization rate of the lesion vessel was 81.8%,which was lower than that of femoral group(93.4%)(P<(0.01)),and the ratio of relatively complex lesions in the total target lesions in radial group was also lower than femoral group(P<0.05).Conclusions Direct PCI immediately after coronary angiography from transradial artery approach has the same success rate and recent clinical outcome,and less complication related to puncture compared with transfemoral approach.But transfemoral artery approach of PCI is still the better choice in patient with relatively complex coronary disease.