Impacto da utilização do acesso radial na ocorrência de sangramento grave entre idosos submetidos a intervenção coronária percutânea

Abstract

Background: The development of major bleeding after percutaneous coronary intervention (PCI) is associated with higher morbidity and mortality, and advanced age is one of its main predictors. This analysis aimed to evaluate the impact of the use of the transradial approach on the incidence of bleeding complications in elderly patients undergoing PCI. Methods: This was a consecutive and controlled registry of patients ≥ 60 years of age undergoing PCI by the transradial approach. Angiographic procedure success, technical failure, and the incidence of ischaemic adverse events and major bleeding were evaluated. Results: Between May of 2008 and December of 2010, 707 elderly patients underwent PCI; in 635 patients (89.8%), the transradial approach was used. The mean age was 69.9 ± 7.2 years, and 11.5% were > 80 years of age. 39.7% of the patients female, and 30.9% had diabetes mellitus. Acute ischaemic syndrome accounted for 72% of the clinical indications. The angiographic success rate was 96.8%, with a crossover rate of 2.8%. The in-hospital mortality rate was 2.4%: myocardial infarction occurred in 0.9%, stroke occurred in 0.3%, and stent thrombosis occurred in 0.9%. Hematomas were reported in 1.6% of the procedures, with a major bleeding rate of 0.8%. Conclusions: In elderly patients undergoing PCI, representative of contemporary practice and with high risk of bleeding, the use of the transradial approach, was associated with a low major bleeding rate.

Intervenção coronária percutânea por acesso transradial em pacientes idosos vs. não-idosos

“…The fluoroscopy and procedure time, as well as rates of vascular complications, cardiac death, and procedural success did not differ between groups in the present study. These results are consistent with those reported by Cao et al 10 In the study by Andrade et al, 11 despite the mean age of 70 years and the prevalence of procedures in the presence of acute coronary syndrome, including 22% primary PCI, a high success rate and low prevalence of angiographic complications were attained, requiring access-site crossover in less than 3% of cases, with no need for excess time for its performance or increased use of materials.…”

Radial vs. Femoral Artery Access in Elderly Patients Undergoing Percutaneous Coronary Intervention

“…18 In a national series, of a group with extensive experien ce in radial access, there was no comparison with a control group of patients treated via femoral approach. 20 Thus, the data of this study's population corroborate the fact that the greater the potential for bleeding and vascular complications of a patient, the greater the benefit of considering the radial access as a priority when performing PCI.…”

Intervenção coronária percutânea pela via radial: incorporação da técnica e resultados de um centro de formação em cardiologia intervencionista

“…24 Review of major bleeding after PCI has become increasingly important, as the occurrence of such events related to the punc ture site is directly associated with increased morbidity and mortality, 811 in addition to reduced adherence to antiplatelet therapy, an important predictor of stent thrombosis. 12 A reduction of bleeding along the access route brings even greater benefits to highrisk subgroups, such as elderly patients, 3,13 females, 3 or those with acute coronary syndrome. 14 Specifically, in the treatment of acute coronary syndrome with and without STsegment elevation, Romagnoli et al 5 demonstrated that the use of radial access reduced the 30day cardiovascular mortality rate, the incidence of bleeding, and the length of hospital stay.…”