经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和介入治疗

目的探讨经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和介入治疗(PCI)的可行性和安全性。方法前瞻性单中心、随机对照研究,自2011年8月至12月,75例发病12h内的急性ST段抬高心肌梗死(STEMI)、拟行经桡动脉急诊PCI治疗的患者根据随机序号将患者按1:1比例随机分为MAC组和对照组:MAC组(37例)为直接应用MAC指引导管行冠状动脉造影和介入治疗,对照组(38例)为应用造影导管完成冠状动脉造影后再选择指引导管行介入治疗。比较两组患者血管穿刺成功率、导管室准备时间、鞘管置入时间、操作成功率、造影剂用量、操作时间、透视时间和导管室门-球囊(cathlab door to balloon,C2B)时间、穿刺部位并发症以及30天的主要心脏不良事件(死亡、非致死性心肌梗死和靶病变血运重建)发生率。结果 75例患者,其中男性57例,女性18例,年龄(61.5±12.2)岁。两组穿刺置管成功率均为100%,对照组1例患者因右桡尺动脉环而改股动脉路径完成手术。MAC组和对照组相比,两组患者的穿刺置管时间、PCI操作成功率和造影剂用量无明显差异[(1.73±1.08)min比(1.65±0.84)min,t=-0.398,P>0.05;89.2%比89.2%,χ2=0.140,P>0.05;(127±74)ml比(136±33)ml,t=1.159,P>0.05]。操作时间、C2B时间和透视时间MAC组均明显低于对照组[(27.27±6.97)min比(36.33±13.71)min,t=3.582,P<0.001;(15.11±4.77)min比(18.31±3.84)min,t=3.180,P=0.002;(7.61±3.04)min比(11.17±5.99)min,t=3.227,P=0.001]。穿刺部位并发症:局部血肿每组各2例。30天的主要心脏不良事件发生率两组相似(2.7%比2.7%)。结论经桡动脉应用单根MAC指引导管行急诊冠状动脉造影和PCI是安全和可行的,能明显减少操作时间、透视时间和C2B时间。

A single transradial MAC guiding catheter for coronary angiography and intervention in patients with ST elevation myocardial infarction

Objective To investigate the feasibility and safety of using a single guiding catheter(MAC 3.5) for left and right coronary angiography and intervention in patients with ST elevation myocardial infarction(STEMI).Methods This was a single-center,prospective,randomized study conducted from August 2011 to December 2011,75 patients with STEMI indicated for transradial primary PCI performed by an experienced transradial operator were randomized into two groups:MAC group(37 cases) consisted of patients who underwent coronary angiography and primary PCI by using a single guiding catheter(MAC 3.5).Control group(38 cases) included patients who first underwent coronary angiography with Tiger catheter followed by guiding catheter selection for intervention.Several parameters were evaluated:puncture success rate,sheath placement time,contrast consumption,procedure time,fluoroscopy time,cathlab door to balloon time(C2B),vascular access-site complications and 1-month major adverse cardiac events(MACE),including death,myocardial infarction,and target lesion revascularization.Results Radial artery was successfully accessed in all patients.One patient in control group required to crossover to the transfemoral access because of radial-ulnar artery loop.Baseline patient characteristics were similar between the MAC group and control group.The puncture success rate(100% vs.100%),the sheath placement time(1.73 ±1.08 min vs.1.65±0.84 min),the PCI procedural success rate(89.2% vs.89.2%) and contrast consumption(127±35 ml vs.137±33 ml) in the two groups were not statistically significant(P>0.05).Compare with the Control group,the total procedure time、C2B time and the overall fluoroscopy time were significantly lower in MAC Group(27.27±6.97 min vs.36.33±13.71 min,P<0.001;31.15±7.20 min vs.40.22±13.97 min,P=0.001;7.61 ±3.04min vs.11.17±5.99 min,P=0.002,respectively).Local hematoma occurred in 2 cases in each of the two groups that improved after physiotherapy and no radial artery occlusion was noted in the two groups.There were no differences in 1-month MACE(2.7% versus 2.7%).Conclusions A single transradial MAC guiding catheter for coronary angiography and intervention in STEMI patients is feasible and safe.It can shorten procedure time,fluoroscopy time and C2B time.