Prediction and impact of failure of transradial approach for primary percutaneous coronary intervention.

Autor:	Abdelaal E; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., MacHaalany J; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Plourde G; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Barria Perez A; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Bouchard MP; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Roy M; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Déry JP; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Déry U; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Barbeau G; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Larose É; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Gleeton O; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Noël B; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Rodés-Cabau J; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Roy L; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Costerousse O; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada., Bertrand OF; Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2016 Jun 15; Vol. 102 (12), pp. 919-25. Date of Electronic Publication: 2016 Mar 30.
DOI:	10.1136/heartjnl-2015-308371
Abstrakt:	Objectives: To determine predictors of failure of transradial approach (TRA) in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and develop a novel score specific for this population. Methods: Consecutive patients with STEMI undergoing primary PCI in a tertiary care high-volume radial centre were included. TRA-PCI failure was categorised as primary (primary transfemoral approach (TFA)) or crossover (from TRA to TFA). Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed. Clinical outcomes up to 1 year were assessed. Results: From January 2006 to January 2011, 2020 patients were studied. Primary TRA-PCI failure occurred in 111 (5%) patients and crossover to TFA in 44 (2.2%) patients. Independent predictors of TRA-PCI failure were: weight ≤65 kg (OR: 3.0; 95% CI 1.9 to 4.8, p<0.0001), physician with ≤5% TFA conversion (OR: 0.45; 95% CI 0.2 to 0.9, p=0.033), and physician with ≥10% conversion to TFA (OR: 2.2; 95% CI 1.2 to 3.7, p=0.005), intra-aortic balloon pump (OR: 2.0; 95% CI 0.9 to 4.3, p=0.066), cardiogenic shock (OR: 2.8; 95% CI 1.4 to 5.6, p=0.0035), endotracheal intubation (OR: 107; 95% CI 42 to 339, p<0.0001), creatinine >133 μmol/L (OR: 3.6; 95% CI 1.9 to 6.8, p<0.0001), age ≥75 (OR: 1.7; 95% CI 1.0 to 2.9, p=0.031), prior PCI (OR: 2.6; 95% CI 1.5 to 4.5, p=0.0009), hypertension (OR: 1.8; 95% CI 1.2 to 2.9, p=0.009). An integer risk score ranging from -1 to 12 was developed, and predicted TRA-PCI failure from 0% to 100% (c-statistic of 0.868; 95% CI 0.866 to 0.869). Mortality at 1 year remained significantly higher after TRA-PCI failure (adjusted OR 2.2; 95% CI 1.2 to 3.9, p=0.011). Conclusions: In a high-volume radial centre, the incidence of TRA-PCI failure is low and can be accurately predicted using a 9-variables risk score. Since outcomes after TRA-PCI failure remained inferior, further effort to maximise the use of radial approach for primary PCI should be investigated. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
Databáze:	MEDLINE
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