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Transradial
Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis- Affiliations：
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
- Author bio：
† These authors contributed equally to this work.
*Corresponding author Tel: 86-10-88398760, Fax: 86-10-68331730, E-mail: yangyjfw@126.com
- Funds：
DOI：10.24920/J1001-9294.2017.023
CLC：Received：07 December 2016，
Published Online：26 September 2017，
Published：2017-09
- Accepted：
Scan QR Code
Jin Chen, Xu Yi, Qiao Shu-bin, et al. Transradial
Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis[J]. Chinese medical sciences journal, 2017, 32(3): 161-170.Jin Chen, Xu Yi, Qiao Shu-bin, et al. Transradial
Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis[J]. Chinese medical sciences journal, 2017, 32(3): 161-170. DOI： 10.24920/J1001-9294.2017.023.
摘要
目的
从院内费用和临床结果两方面对65岁以上老年患者经桡动脉与股动脉路径行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）进行比较和评价，为老年患者介入路径选择提供临床和卫生经济学依据。
方法
本研究为回顾性研究，共纳入阜外医院2010年1月1日至2010年12月31日收治的1229例年龄
>
65岁的PCI病例。其中，经桡动脉路径介入治疗（transradial intervention，TRI）1033例，经股动脉路径介入治疗（transfemoral intervention，TFI）196例。研究使用倾向性评分的逆概率加权法（inverse probability weighting，IPW）对两种路径的患者院内费用和临床结局进行了比较。依据出血学术研究联合会标准，对出血并发症及主要不良心血管事件（包括院内全因死亡、心肌梗死、住院期间再次血运重建及BARC分级≥3）进行了比较。
结果
与TFI组相比，TRI组患者平均年龄较低，女性患者所占比例较低，且既往心肌梗死、既往冠状动脉旁路移植术史、既往PCI及既往卒中病史均较少。造影结果提示TRI组患者单支病变比例较高，而开口病变比例则较低。IPW调整后，TRI组患者的院内费用明显低于TFI组，差值为CNY7495（95%CI：4419-10420，P
<
0.0001），造成住院费用差异的主要原因是TRI组患者PCI术中花费较低。IPW调整后TRI组患者住院时间较短（差值=1.9 d，95%CI：1.1-2.7，P
<
0.0001），且主要不良心血管事件较少（OR=0.47，95%CI：0.31-0.73，P
<
0.001）。IPW调整前后，两组患者出血并发症的差异在无统计学意义（P
>
0.05）。
结论
与股动脉路径PCI相比，桡动脉路径可降低65岁以上老年患者院内费用，缩短住院时间，减少主要不良心血管事件的发生。
Abstract
Objective
2
To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years.
Methods
2
We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital
Beijing
China
between January 1 and December 31
2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases.
Results
2
Patients who underwent TRI were younger
less often female
more likely to receive PCI for single-vessel lesions
and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%
CI
: CNY4419-10 420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days
95%
CI
: 1.1-2.7 days)
shorter post-procedural stay (0.7 days
95%
CI
: 0.3-1.1 days)
and fewer major adverse cardiac events (adjusted odds ratio = 0.47
95%
CI
: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (
P
>
0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction
acute coronary syndrome
and stable angina.
Conclusion
2
The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.
关键词
Keywords
references
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