慢性全闭塞皮肤冠状动脉干预的访问地点选择和结果:VA CART计划的见解
Jaidip Chakravartti1, William J Feser2,3, Mary E Plomondon2,4
1Department of Cardiology, Maine Medical Center, Portland, Maine.
概括
通过皮肤冠状动脉干预 (PCI) 的慢性全闭症 (CTO) 的超射线接入 (TRA) 使用显著增加,但与输血门接入 (TFA) 相比,没有提高安全性或成功率. 需要进一步的研究来理解TRA.
科学领域:
- 心血管干预 心血管干预
- 干预心脏病学 干预心脏病学
- 血管接入技术 血管接入技术
背景情况:
- 透射接入 (TRA) 越来越多地用于皮肤穿冠状动脉干预 (PCI),但关于其用于慢性全闭性 (CTO) PCI的数据有限.
- 关于TRA与TFA的安全性和有效性的数据有限,特别针对CTO PCI程序.
- 了解CTO PCI中不同访问站点的趋势和结果对于优化患者护理至关重要.
研究的目的:
- 评估退伍军人中CTO PCI的TRA与TFA使用的时间趋势.
- 在CTO PCI中识别与TRA和TFA使用相关的患者和病变特征.
- 评估访问站点 (TRA与TFA) 与CTO PCI中的程序性并发症和技术成功之间的关联.
主要方法:
- 在2010年至2017年期间,经过试图CTO PCI的资深患者的回顾性分析.
- 使用倾向性得分匹配对TRA和TFA之间的结果进行比较.
- 综合初级结局 (主要并发症,出血,死亡率) 和手术成功的评估.
主要成果:
- 在2010年至2017年期间,TRA对CTO PCI的使用从7%增加到38% (P < .01).
- 与TFA相比,TRA与重大手术并发症,出血或30天死亡率的减少无关 (3.3%对4.0%,P = .47).
- 在TRA和TFA之间,程序成功率相似 (66.6%对65.7%,P = .74).
结论:
- 尽管使用率增加,但在退伍军人中,CTO PCI的TRA与TFA相比没有显示出更高的安全性或有效性.
- 这些发现表明,TFA仍然是CTO PCI的可行和可比的访问策略.
- 可能需要进一步调查以确定特定的患者亚组或技术修改,这些修改可能会提高CTO PCI中的TRA结果.
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