ABSTRACT
Abstract: Introduction: Octogenarian patients are usually excluded from studies in which the effectiveness of percutaneous coronary intervention (PCI) is compared. Objective: Our aim is to compare this procedure among octogenarians and those younger; in addition to comparing the radial access (RA) and femoral access (FA) in patients older than 80 years. Material and methods: This is a retrospective, observational, comparative, longitudinal, single-center study. Patients who have been referred for PCI, from 2010 to 2016 in Monterrey, Nuevo Leon, Mexico were included. The groups were divided into the octogenarians group (OG) and a group of younger than 80 years (YG). Results: A total of 1,282 patients were collected, of whom 92 were of the OG and 1,190 were of the YG. The FA was the most used. Similar levels of radiation time (RT), radiation dose (DR), and amount of administered contrast medium (CM), vascular complications (VC) and mortality between the two groups were found. However, the OG had more length of hospital stay (LHS). Comparing the FA against RA in the OG there were no differences in RT, RD, amount of CM, VC, death and LHS. Conclusion: The results are similar between the two groups, with a greater tendency to more LHS in the OG. There were not significant differences between the RA and FA in the OG, except that LHS in the FA.
Resumen: Introducción: Los pacientes octogenarios son usualmente excluidos de los estudios en los cuales se compara la efectividad de las intervenciones coronarias percutáneas. Objetivo: Nuestro objetivo es comparar este procedimiento entre los pacientes octogenarios y aquéllos más jóvenes; además se compara el abordaje radial y el abordaje femoral en los pacientes octogenarios. Material y métodos: Éste es un estudio retrospectivo, observacional, comparativo, longitudinal, unicéntrico. Se realizó con aquellos pacientes que se refirieron para realización de un intervencionismo coronario percutáneo, en Monterrey, Nuevo León, México del 2010 al 2016. Los grupos se dividieron en el grupo de pacientes octogenarios y el grupo de pacientes menores de 80 años. Resultados: Se recabó un total de 1,282 pacientes, de los cuales 92 eran pacientes octogenarios, mientras que 1,190 fueron más jóvenes. En ambos el abordaje femoral fue el más utilizado. Se encontraron valores similares de dosis de radiación, tiempo de radiación, cantidad de contraste administrado, complicaciones vasculares y mortalidad entre los dos grupos. Sin embargo, los pacientes octogenarios tuvieron más días de estancia hospitalaria. Al comparar el abordaje femoral y el radial en octogenarios no se encontraron diferencias en dosis de radiación, tiempo de radiación, cantidad de medio de contraste, complicaciones vasculares, muerte y días de estancia hospitalaria. Conclusiones: Los resultados fueron similares entre ambos grupos de edad, con una mayor tendencia de estancia hospitalaria en octogenarios. No se encontraron diferencias significativas entre ambos abordajes en pacientes octogenarios, a excepción de mayores días de estancia hospitalaria en el abordaje femoral.
ABSTRACT
Introducción: el acceso transradial ha surgido como una alternativa atractiva a la vía femoral para realizar coronariografías e intervenciones coronarias. Describimos nuestra experiencia, y comparamos el acceso radial con una cohorte de acceso femoral en un periodo de tiempo. Objetivo: identificar las complicaciones vasculares relacionadas con la coronariografía en pacientes de la unidad de dolor torácico de una institución de alta complejidad de la ciudad de Medellín. Materiales y métodos: estudio epidemiológico observacional, analítico, de una cohorte retrospectiva de pacientes mayores de 18 años que ingresaron a la unidad de dolor torácico del hospital Universitario San Vicente Fundación con diagnóstico de síndrome coronario agudo con y sin elevación del ST, y a los cuales se les realizó coronariografía por acceso radial y femoral. Resultados: se evaluaron 675 pacientes, de los cuales 59.6% (n=402) se les realizó acceso femoral y 40.4% (n=273) acceso radial con diferencias, en relación al sexo y aspectos personales como el tabaquismo y la enfermedad renal crónica. Respecto a las complicaciones según el tipo de acceso, se hallaron diferencias significativas en la presencia de hematoma femoral (OR= 5.6; IC 95%: 1.28; 24.63) y el espasmo radial (p<0.05). Conclusión: los accesos radial y femoral son seguros y efectivos, sin embargo la disminución significativa de las complicaciones vasculares puede ser una razón para preferir el acceso radial como técnica de elección en la mayoría de estos pacientes. (Acta Med Colomb 2015; 40: 209-217).
Introduction: the transradial access has emerged as an attractive alternative to the femoral access for coronary angiography and coronary interventions. We describe our experience, and compare the radial access with a cohort of femoral access in a time period. Objective: to identify vascular complications related to coronary angiography in patients of the chest pain unit of a high complexity institution of the city of Medellin. Materials and Methods: epidemiological, observational, analytical study of a retrospective cohort of patients over 18 years admitted to the chest pain unit of the University Hospital San Vicente Foundation with diagnosis of acute coronary syndrome with and without ST elevation in which coronary angiography by radial and femoral access was performed. Results: 675 patients were evaluated. 59.6% (n = 402) underwent femoral access, and 40.4% (n = 273) radial access with differences in relation to sex and personal aspects such as smoking and chronic kidney disease. Regarding complications according to the type of access, significant differences were found in regard to the presence of femoral hematoma (OR = 5.6; 95% CI: 1.28; 24.63) and radial artery spasm (p <0.05). Conclusion: the radial and femoral accesses are safe and effective; however, the significant decrease in vascular complications may be a reason to prefer the radial access as technique of choice in most of these patients. (Acta Med Colomb 2015; 40: 209-217).
Subject(s)
Humans , Male , Female , Adult , Radial Artery , Acute Coronary Syndrome , Universities , Coronary Angiography , Percutaneous Coronary Intervention , HematomaABSTRACT
Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access. .
Fundamento: Menos complicações hemorrágicas e deambulação precoce fazem do acesso radial uma via privilegiada para cateterismo cardíaco. Entretanto, a abordagem transradial (TR) nem sempre é bem-sucedida, sendo necessária a sua conversão em acesso femoral. Objetivo: Avaliar a taxa de conversão do acesso radial em femoral no cateterismo cardíaco e identificar seus fatores preditivos. Métodos: Registro prospectivo de dois centros, incluindo 7.632 pacientes consecutivos submetidos a cateterização via acesso radial entre janeiro de 2009 e outubro de 2012. Avaliou-se a incidência de conversão em acesso femoral e seus fatores preditivos através de análise de regressão logística. Resultados: A idade média dos pacientes foi de 66 ± 11 anos, sendo 32% deles mulheres. Houve 2.969 (38.4%) intervenções coronarianas percutâneas (ICP),sendo a artéria radial direita a primeira escolha mais usada (97,6%). A taxa de insucesso do acesso radial foi de 5,8%. Fatores preditivos independentes da conversão do acesso radial em femoral foram o uso de bainhas introdutoras curtas (OR 3,047; IC: 2,380-3,902; p < 0,001), ICP (OR 1,729; IC: 1,375-2,173; p < 0,001), sexo feminino (OR 1,569;IC: 1,234-1,996; p < 0,001), doença multiarterial (OR 1,457; IC: 1,167-1,819; p = 0,001), área de superfície corporal(ASC) ≤ 1,938 (OR 1,448; IC: 1,120-1,871; p = 0,005) e idade > 66 anos (OR 1,354; IC: 1,088-1,684; p = 0,007). Conclusão: A abordagem transradial para cateterismo cardíaco tem alta taxa de sucesso e a necessidade de sua conversão em acesso femoral nesta coorte foi baixa. Os fatores preditivos independentes de sua conversão em acesso femoral foram: sexo feminino; idade mais avançada; menor ASC; uso de bainhas introdutoras curtas; doença multiarterial; e ICP. .