Transradial Primary Percutaneous Coronary Intervention is Associated with Low Rates of Clinical and Cardiovascular Events in Patients with Acute ST Elevation Myocardial Infarction

Yıl 2014, Cilt: 17 Sayı: 1, 46 - 53, 01.01.2013

Mustafa Yurtdaş Yüksel Kaya Nesim Aladağ Mahmut Özdemir Mustafa Tuncer

https://doi.org/10.4274/khj.6309

Öz

OBJECTIVE: The transradial (TR) approach has been increasingly employed as an alternative approach to the transfemoral (TF) approach in percutaneous coronary intervention (PCI). We aimed to investigate the impact of TR approach on clinical outcomes in 1st and 6th months compared with a TF approach in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI.METHODS: Three hundred fifteen patients who underwent primary PCI for STEMI were evaluated retrospectively. TR approach group consisted of 55 patients (19 females, mean age: 55±10 years), and TF approach group consisted of 74 patients (21 females, mean-age 53±9 years). Endpoints included the rates of major adverse cardiovascular events (MACE: death, recurrent MI, target lesion revascularization and stroke) and net adverse clinical events (NACE: MACE and bleeding) at the first and six-months.RESULTS: The two groups were similar in terms of baseline clinical characteristics. Arterial cannulation, door-to-balloon and total-procedure times, and access-site crossover rates were not significantly different between TR approach and TF approach groups (p=0.966, p=0.139, p=0.393, and p=0.197; respectively). While infarction localizations and the numbers of treated vessel were similar in both groups, the use of tirofiban was higher (p=0.025) and hospital stay was lower (p=0.017) in TR approach. The 30-day rate of MACE was lower in TR approach than that in TF approach, but not statistically significant (p=0.119). The 30-day rate of NACE was significantly lower in TF approach (p=0.006). At the 6th month, the TR approach had significantly lower rates of MACE (p=0.039) and NACE (p=0.002) as compared to TF approach. CONCLUSION: TR approach had similar procedural times and was associated with lower clinical and cardiovascular events in patients with STEMI undergoing primary PCI as compared to those of TF approach.

Anahtar Kelimeler

Transradial approach, acute myocardial infarction; primary percutaneous coronary intervention; clinical outcomes

Akut ST Yükselmeli Miyokard İnfarktüslü Hastalarda Transradiyal Primer Perkütan Koroner Girişim Düşük Klinik ve Kardiyovasküler Olaylar ile İlişkilidir

Öz

AMAÇ: Son yıllarda perkütan koroner girişim (PKG)'e alternatif bir yaklaşım olarak transradiyal (TR) yöntem artan bir şekilde kullanılmaktadır. Biz bu çalışmada, primer PKG'ye alınan ST yükselmeli miyokard infarktüs (STYMİ)'lü hastalarda transfemoral (TF) yöntem ile kıyaslandığında TR yöntemin birinci ve altıncı aydaki klinik sonuçlar üzerindeki etkisini araştırmayı amaçladık.YÖNTEMLER: STYMİ için primer PKG'ye alınan 315 hasta geriye-dönük olarak değerlendirildi. Dışlama kriterleri belirlendikten sonra, TR yöntemi uygulanan grup 55 hasta (19 kadın, ortalama yaş 55±10 yıl), TF yöntemi uygulanan grup ise 74 hastadan (21 kadın, ortalama yaş 53±9 yıl) oluştu. Sonlanım noktası; birinci ve altıncı aylardaki majör istenmeyen kardiyak olay (MKO: ölüm, tekrarlayan Mİ, hedef lezyon revaskülarizasyonu ve inme) ve net istenmeyen klinik olay (NKO: MKO ve kanama) oranlarından oluştu. BULGULAR: Her iki grup bazal klinik özellikler bakımından benzerdi. Artere giriş, kapı-balon ve toplam işlem süreleri gruplar arasında önemli bir farklılık göstermedi (sırasıyla; p=0,966, p=0,139 ve p=0,393). Her iki grup benzer arter-giriş yeri değiştirme oranlarına sahipti (p=0,197). İnfarktüs yerleşimi ve tedavi edilen damar sayıları gruplar arasında benzer iken, TR yönteminde tirofiban kullanımı daha fazla (p=0,025) ve hastanede kalış süresi daha kısa (p=0,017) idi. Otuz günlük MKO oranı, TR yönteminde TF yöntemine göre daha düşük olmasına rağmen istatistiksel olarak önemli değildi (p=0,119). Otuz günlük NKO oranı TR yönteminde anlamlı olarak daha düşüktü (p=0,006). Altıncı ayda, TF yaklaşımı ile karşılaştırıldığında TR yaklaşımı daha düşük MKO (p=0,039) ve NKO (p=0,002) oranlarına sahipti. SONUÇ: Çalışmamızın bulguları primer PKG'ye alınan STYMİ hastalarında TF yaklaşımı ile karşılaştırıldığında TR yaklaşımının benzer işlemsel sürelere sahip olup, daha düşük klinik ve kardiyovasküler olaylar ile ilişkili olduğunu gösterdi.

Anahtar Kelimeler

Transradiyal yaklaşım, akut miyokard infarktüsü; primer perkütan koroner girişim; klinik sonuçlar

Kaynakça

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