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Periprocedural vascular access site complications during coronary angioplasty are independently associated with adverse short and long-term mortality
  1. TD Kinnaird1,
  2. RA Anderson1,
  3. Z Xue2,
  4. R Waksman2,
  5. JM Lindsay2
  1. 1University Hospital of Wales, Cardiff, UK,
  2. 2Washington Hospital Centre, Washington, USA

Abstract

Introduction Studies have linked bleeding during percutaneous coronary intervention (PCI) with adverse short and long-term outcomes. However, the specific impact of vascular access complications after contemporary PCI and outcomes is less well established.

Methods A retrospective database analysis of 7314 consecutive patients undergoing PCI via the femoral route at the Washington Hospital Centre was performed. Vascular complications were defined as femoral haematoma greater than 5 cm in diameter, retroperitoneal bleeding, arteriovenous fistula, pseudoaneurysm and any surgical repair of a vascular access site.

Results A vascular access site complication occurred in 405 patients (5.9%) and their occurrence was independently associated with age, low body mass index, female sex, shock, glycoprotein receptor antagonist use and chronic renal impairment. The use of bivalirudin was associated with a lower incidence of access site complications. Length of stay was more prolonged (6.3 days vs 2.9 days, p<0.001) and stent thrombosis more common (1.2% vs 0.1%, p<0.001) in patients with access site complications. Mortality at 30 days (7.7% vs 2.4%, p<0.001) and at 1 year (14.9% vs 6.6%, p<0.001) was significantly higher in those patients with a vascular access site complication. Independent predictors of 1-year death were age (odds ratio (OR) 1.1 for every year), periprocedural stroke (OR 7.7), blood transfusion (OR 3.1), chronic renal insufficiency (OR 2.5), diabetes (OR 1.8) and vascular access site complications (OR 1.4). The occurrence of a femoral haematoma was an independent predictor of inhospital and 30-day mortality, with a stepwise increase in the association as the haematoma size increased (as assessed by observed haematocrit drop).

Conclusions Periprocedural vascular access site complications are independently associated with poor patient outcomes after PCI. Of importance, isolated femoral artery haematomas also appear to infer an adverse outcome. These data highlight the importance of careful access route choice and selective adjunctive pharmacotherapy utilisation during PCI.

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