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

Abstract

background: Radial access is the object of increasing interest for interventional cardiologists, providing several advantages, including a reduction of bleeding and major adverse cardiovascular event (MACE) rates. However, even though elderly patients have a greater risk of access site bleedings, the use of the radial approach is controversial, due to the greater anatomical complexity of these patients. Methods: Retrospective study including patients undergoing percutaneous coronary intervention (PCIs) using the radial access divided into an elderly (> 65 years) and a non-elderly (< 65 years) group. Clinical, angiographic and procedural characteristics as well as early and late follow-up outcomes were analyzed. results: The elderly group included 131 patients (145 PCIs) and the non-elderly group, 149 patients (176 PCIs). The elderly group presented lower body mass index and fewer smokers and higher rates of chronic renal failure, peripheral arterial disease, stable coronary artery disease, multivessel disease and calcified lesions. There was no difference in the rate of access-site crossover (4.8% vs. 3.4%), fluoroscopy time (15.3 ± 10.3 minutes vs. 16.1 ± 10.3 minutes), procedure time (40.6 ± 26.4 minutes vs 46.4 ± 53.6 minutes), angiographic (96.3% vs 97.5%) and clinical (94.5% vs 95.4%) success, MACE (3.4% vs 3.4%) and bleedings (0.21% vs 0.6%) during hospitalization. In the late follow-up there was no difference in the MACE rates (9.6% vs 11%). Conclusions: Despite the greater clinical and angiographic complexity, PCI using the radial access is safe and effective, with a high procedural success rate and low in-hospital and late follow-up complication rates.

Perfil dos pacientes submetidos ao cateterismo cardí­aco

“…A escolha da via se justifica pela maior facilidade para manipulação do profissional e por exigir menor treinamento do mesmo e maior rapidez no procedimento (26) . Entretanto, foi evidenciado por outros estudos (27,28) que o acesso radial tem benefícios mais expressivos que o femoral, incluindo menor tempo de internação hospitalar, ausência de restrição da deambulação, menor ocorrência de complicações vasculares e menor custo.…”