Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial.
EuroIntervention
; 15(6): e522-e530, 2019 Aug 09.
Article
em En
| MEDLINE
| ID: mdl-31113763
ABSTRACT
AIMS:
This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. METHODS ANDRESULTS:
This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Transradial access reduced the primary outcome (RR 0.37, 95% CI 0.17-0.81; p=0.013), mostly driven by ACUITY major bleeding (RR 0.343, 95% CI 0.123-0.959; p=0.041) when compared with the transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance (p=0.76). Ultrasound guidance, however, reduced mean access time (93 sec vs. 111 sec; p=0.009), attempts (1.47 vs. 1.9; p<0.0001), difficult accesses (4.5% vs. 9.2%; p=0.0007), venepuncture (4.1% vs. 9.2%; p<0.0001) and improved first-pass success (73% vs. 59.7%; p<0.0001).CONCLUSIONS:
Transradial access significantly reduced the composite outcome compared to transfemoral access. Ultrasound guidance did not reduce the primary outcome compared to the standard technique, but significantly improved the efficiency and overall success rate of arterial access.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Cateterismo Cardíaco
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Angiografia Coronária
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Artéria Radial
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Artéria Femoral
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Intervenção Coronária Percutânea
Tipo de estudo:
Clinical_trials
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Observational_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article