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Propensity matched analysis of bleeding and vascular complications associated with vascular closure devices vs
Ali F Iqtidar1, Dadong Li, Jeffrey Mather
1Henry Low Heart Center, Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06107, USA. aiqtidar@harthosp.org
Insights
Vascular closure devices (VCDs) are safe for femoral artery hemostasis after percutaneous coronary intervention (PCI). The Perclose device demonstrated the lowest complication rates compared to other VCDs and manual compression.
Area of Science:
- Cardiovascular Interventions
- Medical Device Safety
- Vascular Access Management
Background:
- Debate persists regarding the impact of vascular closure devices (VCDs) on bleeding and vascular complications in percutaneous coronary intervention (PCI) patients.
- Limited comparative data exists for different VCD subtypes.
Purpose of the Study:
- To compare the safety and efficacy of VCDs versus manual compression (MC) for achieving femoral artery hemostasis post-PCI.
- To analyze complication rates among different VCD subtypes.
Main Methods:
- Propensity score matching created comparable groups: MC (n=1,407) and VCD (n=2,814).
- Patients undergoing PCI over an eight-year period were analyzed.
- Bleeding and vascular complications were compared between groups, with subgroup analysis for VCD types.
Main Results:
- VCD use was associated with significantly lower rates of large hematomas (1.1% vs 2.1%, P < 0.01) compared to MC.
- Angioseal use correlated with the highest need for surgical repair.
- Perclose showed the lowest bleeding and composite vascular/bleeding complication rates (5.6%) versus Angioseal (9.2%) and Starclose (10.2%).
Conclusions:
- Vascular closure devices are a safe and effective method for achieving hemostasis in PCI patients.
- The Perclose device is associated with the lowest incidence of vascular and bleeding complications.
Background:
In patients undergoing percutaneous coronary intervention (PCI), controversy exists regarding the effect of vascular closure device (VCD) use on bleeding and vascular complications with limited data available for comparison of the different devices.
Methods:
We developed propensity score matched groups, manual compression (MC) (n = 1,407) and VCD (n = 2,814), who underwent PCI in an eight-year period and compared their bleeding and vascular complications. Vascular closure device subtype analysis was also done.
Results:
Compared to MC, the VCD group had lower rates of hematoma > or = 10 cm (1.1% vs 2.1%, P < 0.01). Angioseal use was associated with the highest rate of surgical repair. Perclose had the lowest rates of bleeding and the lowest composite outcome of all vascular and bleeding complications at 5.6% vs 9.2% forAngiosealand 10.2% for Starclose (P < 0.001).
Conclusion:
In patients undergoing PCI, VCD use is a safe method for achieving femoral artery hemostasis. Perclose use is associated with the least complications.
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