经远端桡动脉入路在复杂冠状动脉病变患者中行介入治疗的有效性和安全性分析  

Efficacy and Safety Analysis of the Interventional Treatment Through the Distal Transradial Access in Patients With Complex Coronary Lesions

作　　者：于伟 崔成 刘明浩 宋莹 邹同强 陈珏 刘海波 宋雷 高展 王欢欢 高立建 YU Wei;CUI Cheng;LIU Minghao;SONG Ying;ZOU Tongqiang;CHEN Jue;LIU Haibo;SONG Lei;GAO Zhan;WANG Huanhuan;GAO Lijian(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,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、阜外医院冠心病中心,北京100037 [2]秦皇岛市第三医院心内科,秦皇岛066000

出　　处：《中国循环杂志》2024年第8期775-780,共6页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(2022-I2M-C&T-B-048);首都卫生发展科研专项(CFH2024-2-2054)。

摘　　要：目的:分析经远端桡动脉入路(dTRA)在复杂冠状动脉病变患者中行介入治疗的有效性和安全性。方法:回顾性纳入2021年6月至2022年5月期间在中国医学科学院阜外医院经dTRA或常规桡动脉入路(TRA)行经皮冠状动脉介入治疗(PCI)的10033例复杂冠状动脉病变(B2型及C型病变)患者,其中TRA组9625例、dTRA组408例;经倾向性评分匹配后,两组各纳入391例患者。比较倾向性评分匹配前后两组患者的基线资料、PCI术中资料(包括病变特点、介入操作成功率等)、入路相关大出血事件发生情况。结果:倾向性评分匹配前,dTRA组中合并高血压、高脂血症、冠心病家族史、心肌梗死病史、冠状动脉旁路移植术史的患者比例均明显高于TRA组(P均<0.05);经倾向性评分匹配后,两组的基线资料相似(P均>0.05)。倾向性评分匹配前,与TRA组相比,dTRA组中B2型病变患者比例较高,而C型病变、应用血管内超声(IVUS)的患者比例较低(P均<0.05),两组的慢性完全闭塞病变患者比例差异无统计学意义(P>0.05)。经倾向性评分匹配后,与TRA组相比,dTRA组中应用IVUS的患者比例较低,而支架置入数量较多(P均<0.05),两组在SYNTAX积分、指引导管大小、靶病变分布、应用主动脉内球囊反搏的患者比例、介入操作成功率、入路相关大出血事件发生率方面的差异均无统计学意义(P均>0.05)。结论:与TRA相比,经dTRA对复杂冠状动脉病变行介入治疗同样安全、有效。Objectives:Present study analyzed the efficacy and safety of percutaneous coronary intervention(PCI)using the distal transradial access(dTRA)for patients with complex coronary lesions.Methods:A total of 10033 patients with complex coronary artery lesions(type B2 and type C lesions)who underwent percutaneous coronary intervention(PCI)via dTRA or conventional transradial access(TRA)at Fuwai Hospital between June 2021 and May 2022 were included(9625 patients in the TRA group and 408 patients in the dTRA group).After propensity score matching,391 patients were included in each group.Baseline data,PCI intraoperative data(including lesion characteristics,intervention success rate,etc.),and incidence of major bleeding related to the access were compared between the two groups before and after propensity score matching.Results:Before propensity score matching,the proportions of patients with hypertension,hyperlipidemia,family history of coronary heart disease,history of myocardial infarction,and history of coronary artery bypass grafting were significantly higher in the dTRA group than in the TRA group(all P<0.05).After propensity score matching,the baseline data of the two groups were similar(all P>0.05).Before propensity score matching,compared with the TRA group,patients in the dTRA group had a higher proportion of patients with type B2 lesions,while the proportions of patients with type C lesions and those using intravascular ultrasound(IVUS)were lower(all P<0.05).The proportion of patients with chronic complete occlusion was similar between the two groups(P>0.05).After propensity score matching,compared with the TRA group,patients in the dTRA group had a lower proportion using IVUS and had a higher percent of stent implantation(both P<0.05).There was no statistically significant difference between the two groups in terms of SYNTAX score,guide catheter size,target lesion distribution,proportion of patients using intra-aortic balloon counterpulsation,success rate of intervention procedures,and incidence of major bleed

关 键 词：远端桡动脉入路 经皮冠状动脉介入治疗 复杂病变 

分 类 号：R54[医药卫生—心血管疾病]