Percutaneous coronary intervention complications and guide catheter size: bigger is not better.
JACC Cardiovasc Interv
; 2(7): 636-44, 2009 Jul.
Article
en En
| MEDLINE
| ID: mdl-19628187
ABSTRACT
OBJECTIVES:
We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI).BACKGROUND:
The association between guiding catheter size and complications of PCI in contemporary practice remains controversial.METHODS:
Procedure and outcome variables from 103,070 consecutive patients that underwent PCI with 6-F (n = 64,335), 7-F (n = 32,676), and 8-F (n = 6,059) guide catheters were compared.RESULTS:
Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with incrementally more contrast agent use, and more post-PCI complications including contrast-induced nephropathy, vascular access site complications, bleeding, transfusion, major adverse cardiac event, and death. After multivariate analysis, the use of larger guides were associated with a higher risk of contrast-induced nephropathy (7-F odds ratio [OR] 1.18, p = 0.0004; 8-F OR 1.44, p < 0.0001), vascular complications (7-F OR 1.19, p = 0.0002, 8-F OR 1.68, p < 0.0001), decline in hemoglobin >3 g/dl (7-F OR 1.12, p < 0.0001, 8-F OR 1.72, p < 0.0001), and post-procedure blood transfusion (7-F OR 1.08, p = 0.03; 8-F OR 1.80, p < 0.0001), whereas major adverse cardiac events (7-F OR 1.06, p = 0.13; 8-F OR 1.37, p < 0.0001) and in-hospital mortality (7-F OR 1.11, p = 0.13; 8-F OR 1.34, p = 0.03) were increased with 8-F but not 7-F guides.CONCLUSIONS:
Compared with 6-F guides, PCIs performed with 7- and 8-F guides were associated with more contrast medium use, renal complications, bleeding, vascular access site complications, greater need for post-procedure transfusion, and 8-F guides with increased nephropathy requiring dialysis, in-hospital major adverse cardiac events, and mortality. These data suggest that selection of smaller guide catheters may result in improved clinical outcome in patients undergoing contemporary PCI.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Angioplastia Coronaria con Balón
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Risk_factors_studies
Aspecto:
Equity_inequality
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JACC Cardiovasc Interv
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2009
Tipo del documento:
Article
País de afiliación:
Estados Unidos