动脉穿刺路径在冠状动脉介入治疗中的应用现状及对预后的影响:单中心10557例患者经验  

Current Application Status of Artery Access in Percutaneous Coronary Intervention and Their Impact on Long-term Prognosis in Relevant Patients: A single Center Experience in 10577 Patients

作　　者：许连军[1] 宋莹[1] 许晶晶[1] 高展[1] 唐晓芳[1] 王欢欢[1] 刘如[1] 蒋萍[1] 姜琳[1] 高立建[1] 张茵[1] 宋雷[1] 赵雪燕[1] 陈珏[1] 高润霖[1] 乔树宾[1] 杨跃进[1] 徐波[1] 袁晋青[1] XU Lian-jun SONG Ying XU Jing-jing GAO Zhan TANG Xiao-fang WANG Huan-huan LIU Ru JIANG Ping JIANG Lin GAO Li-jian ZHANG Yin SONG Lei ZHAO Xue-yan CHEN Jue GAO Run-lin QIAO Shu-bin YANG Yue-jin XU Bo YUAN Jin-qing.(Department of Cardiology, National Center of Cardiovascular Disease and Fu Wai Hospital, CAMS and PUMC, Beijing （100037）, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2017年第10期965-969,共5页Chinese Circulation Journal

基　　金："十二五"国家科技支撑计划项目(2011BAI11B07);国家自然科学基金(81470486)

摘　　要：目的:通过对单中心大样本经皮冠状动脉(冠脉)介入治疗(PCI)患者2年随访结果的分析,探讨经股动脉路径患者的临床特点,比较股动脉路径、桡动脉路径的安全性和对预后的影响。方法:在2013年阜外医院10 557例经股动脉路径和桡动脉路径穿刺的PCI患者中,比较桡动脉路径组(n=9 745)和股动脉路径组(n=812)患者的临床特点,分析不同动脉路径对预后的影响。结果:经桡动脉路径患者9 745例(90.9%);经股动脉路径患者812例(7.6%),股动脉路径组患者中,高龄、女性、糖尿病、陈旧性心肌梗死、PCI史、冠脉旁路移植术(CABG)史患者比例更高,差异均有统计学意义(P<0.001);股动脉路径组患者冠脉左主干病变、左主干或三支病变更多见,差异均有统计学意义(P<0.001)。Logistic回归分析:女性、年龄、陈旧性心肌梗死、PCI史、CABG史,左主干病变均是选择股动脉路径的预测因素。倾向性评分匹配后,股动脉路径组住院期间死亡率较桡动脉路径组高,差异均有统计学意义(P<0.05)。2年随访Kaplan-Meier生存分析所有终点事件均没有显著性差异。Cox多因素回归分析发现,股动脉路径是出血学术研究联合会(BARC)分级2型以上出血的独立危险因素(HR=2.210,P=0.013),不是主要心脏终点事件的独立危险因素。结论:(1)女性,高龄,陈旧性心肌梗死,PCI史,CABG史,左主干病变均是股动脉路径的预测因素;(2)经股动脉路径患者住院期间死亡率较桡动脉路径患者高;(3)股动脉路径是BARC分级2型以上出血的独立危险因素,但对PCI治疗患者的长期预后无明显影响。Objective： To explore the application status of trans-femoral route （TFR） and trans-radial route （TRR） percutaneous coronary intervention （PCI） via a single center large sample 2-year follow-up study and to evaluate their impact on long-term prognosis in relevant patients. Methods： A total of 10577 patients received PCI by TFR or TRR in our hospital during 2013 were analyzed. The patients were divided into two groups： TRR group, n=9745 （90.9%） and the TFR group, n=812 （7.6%）. Clinical features were compared between 2 groups and their impacts on prognosis were studied. Results： Compared with TRR group, TFR group had more patients with elder age, more female, diabetes, more with the histories of myocardial infarction （MI）, PCI or CABG, all P〈0.001; more patients with left main disease or 3-vessel lesions, all P〈0.001. Logistic regression analysis indicated that female, age, histories of MI, PCI or CABG and left main disease were the predictors for choosing TFR. With propensity score matching, TFR group had the higher in-hospital mortality than TRR group, P〈0.05. 2-year follow-up Kaplan-Meier survival analysis showed that the end point events were similar between 2 groups. Cox multivariate analysis found that TFR was an independent risk factor of BARC ≥ 2 bleeding （HR=2.210, P=0.013）, while not an independent risk factor for main cardiac end point events. Conclusion： ① Female, elder age, histories of MI, PCI or CABG and left main disease were the predictors for choosing TFR. ② The in-hospital mortality was higher in TFR PCI. ③ TFR was an independent risk factor of BARC≥2 bleeding, while it had no impact on long-term prognosis in PCI patients.

关 键 词：血管成形术 经腔 经皮冠状动脉 桡动脉 股动脉 

分 类 号：R54[医药卫生—心血管疾病]