Vascular Access Site Complications Associated With PCI
What is the association between trends in primary and secondary vascular access sites and vascular access site complications (VASCs) among patients who underwent percutaneous coronary intervention (PCI) in Michigan?
The investigators queried data from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry to evaluate the use of transradial and transfemoral PCI and their associated VASCs. Authors evaluated the association between operator transradial experience and the occurrence of either radial or femoral VASCs using Bayesian hierarchical models adjusting for patient characteristics including age, sex, weight, PCI indication, coronary artery disease presentation, preprocedural hemoglobin value, cardiogenic shock, cardiac arrest, and procedural use of an intra-aortic balloon pump or other mechanical ventricular support device, and including an operator random intercept term. An analogous analysis was completed categorizing hospitals into tertiles of radial access use.
From 2013 to 2017, transradial PCI increased from 25.9% to 45.2% and the overall use of secondary vascular access increased from 4.9% to 8.7% with minimal change in overall VASCs (1.2% to 1.4%). The use of secondary vascular access was associated with increased VASCs (odds ratio [OR], 5.82; 95% confidence interval [CI], 5.26-6.43). Although, patients treated by operators in the highest tertile of radial use were more likely to experience femoral VASCs (adjusted OR, 1.51; 95% CI, 1.08-2.13), treatment by these operators was associated with an overall reduction in all VASCs (adjusted OR, 0.62; 95% CI, 0.46-0.83).
The authors concluded that despite increased use of transradial PCI, there has been no significant decrease in VASCs.
This registry study reports that despite increased adoption of the use of transradial PCI, overall VASCs have failed to improve, in part due to increased femoral access complications. Only the highest tertile of transradial operators have a significantly lower rate of VASCs compared with the middle and lowest tertile. Of note, the use of a secondary vascular access site during PCI is also increasing and is associated with significantly increased risk of VASCs. Additional research is needed to identify and implement strategies to further mitigate and minimize VASCs associated with femoral access in the transradial era.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Interventions and Coronary Artery Disease
Keywords: Blue Cross Blue Shield Insurance Plans, Coronary Artery Disease, Heart Arrest, Hemoglobins, Intra-Aortic Balloon Pumping, Percutaneous Coronary Intervention, Risk, Shock, Cardiogenic, Secondary Prevention, Vascular Access Devices, Vascular Diseases
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