RESUMEN
BACKGROUND: Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF. METHODS: The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions. RESULTS: A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P < 0.0001) and at 1 year (37.6% vs 5.0%, P < 0.0001). Shock and MB were highly predictive of 30 day and 12 month mortality. CONCLUSION: In a default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group.
Asunto(s)
Cateterismo Periférico , Enfermedad Coronaria/cirugía , Arteria Femoral/cirugía , Intervención Coronaria Percutánea , Hemorragia Posoperatoria , Arteria Radial/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Transfusión Sanguínea/estadística & datos numéricos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/métodos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Hemorragia Posoperatoria/diagnóstico , Hemorragia Posoperatoria/mortalidad , Hemorragia Posoperatoria/terapia , Reoperación , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Reino UnidoRESUMEN
Coronary intramural hematoma can present with acute coronary syndrome. We present a 39-year-old man with post-assault stress-induced left main intramural hematoma. We used computed tomography coronary angiogram with lesion characterization and suspected the diagnosis of intramural hematoma despite its limited spatial resolution; computed tomography was used for follow-up imaging and proper monitoring of therapeutic measures. (Level of Difficulty: Advanced.).