AM HEART J：经桡动脉PCI未增神经系统并发症风险

　　英国学者的一项研究表明，与常规经股动脉冠状动脉介入（PCI）相比，经桡动脉PCI未升高神经系统并发症风险。论文于2012年12月26日在线发表于《美国心脏杂志》（American Heart Journal）。

　　此项回顾性研究从英国心血管介入学会数据库中分别纳入124,616和223,476例接受经桡动脉和经股动脉PCI的患者。经桡动脉组患者较为年轻，糖尿病患病率较低，并且更有可能既往罹患心血管疾病和外周血管病。经股动脉组患者则更有可能伴CABG手术和肾损伤病史。

　　结果显示，经桡动脉和经股动脉组患者分别出现139（0.11%）和247（0.11%）例次神经系统并发症。多变量校正风险模型显示，与常规PCI相比，经桡动脉PCI与神经系统并发症风险升高无相关性。主动脉内球囊反搏应用、既往心血管事件、PCI前休克以及因急性冠脉综合征行PCI为神经系统并发症的最显著预测因素。

Influence of access site choice on incidence of neurologic complications after percutaneous coronary intervention

Background

Neurologic complications (NCs) are a rare but potentially devastating complication that may follow percutaneous coronary intervention (PCI). In recent years, there has been an increase in use of transradial access, driven by a developing body of evidence that favors its use over femoral access. Concerns have been raised, however, that transradial access may increase the risk of NC compared with transfemoral access. We aimed to investigate the influence of access site selection on the occurrence of NCs through a period of transition during which transradial access became the dominant route for PCI procedures performed in the United Kingdom.

Methods

We performed a retrospective analysis of the British Cardiovascular Intervention Society database between January 2006 and December 2010. The data were split into 2 cohorts based on access site.

An NC was defined as a periprocedural ischemic stroke, hemorrhagic stroke, or transient ischemic attack occurring before hospital discharge. Binary logistic multivariate analysis was used to investigate the influence of access site utilization on NCs and adjust for measured confounding factors.

Results

Between 2006 and 2010, the use of radial access increased from 17.2% to 50.8% of all PCI procedures. A total of 124,616 radial procedures and 223,476 femoral procedures were studied with a NC rate of 0.11% in each cohort. In univariate (odds ratio 1.01, 95% CI 0.82-1.24, P = .93) and multivariate analysis (odds ratio 0.99, 95% CI 0.79-1.23, P = .91), there was no significant association between the use of radial access and the occurrence of NCs.

Conclusion

These results suggest that radial access is not associated with an increased risk of clinically detected NCs, even during a period when there was a rapid evolution in the preferred access site for PCI in the United Kingdom. These are reassuring results, particularly for operators embarking on a change to radial access for PCI.