RESUMO
BACKGROUND: The transradial approach has not been evaluated for "rescue" percutaneous coronary intervention (PCI) with glycoprotein (GP) IIb/IIIa inhibitor following failed thrombolysis. OBJECTIVES: To compare the safety and procedural outcomes of the transradial and transfemoral approaches to rescue PCI. METHODS: Rescue PCI cases with adjuvant GP IIb/IIIa inhibitor performed at two centres were reviewed retrospectively, and the bleeding rates, equipment use and procedure times for the femoral and the radial approach were compared. RESULTS: Radial access was attempted in 47 of 111 cases (42%) and crossover to femoral access was required in two cases (4%). Major bleeding occurred in three patients in the radial group (6%) and in 12 patients in the femoral group (19%; P=0.06). Radial access was associated with less access site-related major bleeding (0% versus 9%; P=0.04) and fewer transfusions (4% versus 19%; P=0.02). After excluding patients with intra-aortic balloon pump, this difference was no longer statistically significant (4% versus 8%; P=0.7). Fluoroscopy times and contrast use were similar, and the time to first balloon inflation was slightly longer with radial access (33 min versus 30 min; P=0.07). CONCLUSIONS: In selected patients, the transradial approach for rescue PCI is safe and effective. The present findings warrant further study in a prospective, randomized trial.
Assuntos
Angioplastia Coronária com Balão/métodos , Cateterismo Cardíaco/métodos , Artéria Femoral , Infarto do Miocárdio/terapia , Artéria Radial , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angiografia Coronária , Serviços Médicos de Emergência/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Inibidores da Agregação Plaquetária/administração & dosagem , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Probabilidade , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Falha de Tratamento , Resultado do TratamentoRESUMO
BACKGROUND: Percutaneous coronary interventions (PCIs) are often complicated by postprocedural myocardial necrosis as manifested by elevated cardiac markers. PURPOSE: To assess the incidence and risk factors of elevated troponin-I (TnI) after PCI. METHODS AND RESULTS: We performed a retrospective analysis on 522 PCI cases over a 1-year period at a single center. An elevated postprocedural TnI (>1.0 ng/ml) occurred in 213 patients (40.8%). Overall, glycoprotein (GP) IIb/IIIa inhibitors were used in 52% of cases. Baseline clinical characteristics were similar between the positive and the negative TnI groups. A univariate analysis revealed that patients with elevated TnI post-PCI had significantly more multivessel (28% vs. 15%, P = .001) and multilesion interventions (44% vs. 27%, P<.0001). The lesions were longer, more often angulated and involving bifurcations, and more complex in the TnI-positive group. Stent use and number of stents was higher in the TnI-positive group, and longer inflation times (>30 s) or higher inflation pressures (>14 atm) were used more often in the TnI-positive group. GP IIb/IIIa inhibitor use was higher in the TnI-positive group (61% vs. 45%, P = .0007). After multivariable analysis, independent predictors of elevated TnI after PCI included multilesion intervention, lesion length, lesion angulation, and GP IIb/IIIa inhibitor use. CONCLUSION: TnI is elevated in approximately 40% of cases after PCI. TnI is more likely to be elevated after intervention on multiple lesions, angulated or long lesions.