AIMS:We sought to evaluate bleeding complications and periprocedural outcomes of the radial approach (RA) as compared to the femoral approach (FA) during percutaneous coronary intervention (PCI) in "real-world" patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS:The study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centres in Poland (the ORPKI Polish National Registry). Patients treated using the RA and FA were compared using a propensity score analysis to avoid possible selection bias. The analysis was carried out in an "as-treated" manner. The FA was used in 9,334 (40.9%) and the RA in 13,478 (59.1%) patients. After propensity score matching, a higher total amount of contrast (191.8±8.0 vs. 174.8±68.8 ml; p=0.001) and lower radiation doses (1,279.5±1,346.3 vs. 1,182.6±887 mGy; p=0.02) were reported in FA. More access-site-related bleeding complications after both angiography (0.17% vs. 0.02%; p=0.004) and PCI (0.23% vs. 0.09%; p=0.049) were reported in the FA group. Periprocedural death (1.94% vs. 0.93%; p=0.001) was more common after PCI performed with the FA. CONCLUSIONS:The radial approach was associated with a lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at the access site.

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目的:我们试图评估“现实” ST段抬高型心肌梗死(STEMI)患者在经皮冠状动脉介入治疗(PCI)期间与股动脉入路(FA)相比,bleeding动脉入路(RA)的出血并发症和围手术期结局)。
方法与结果:该研究小组于2014年1月至2015年6月在波兰的151个三级侵入性心脏病学中心(ORPKI波兰国家注册中心)对22,812例连续的STEMI患者进行了PCI和支架植入治疗。使用倾向评分分析比较使用RA和FA治疗的患者,以避免可能的选择偏倚。该分析以“处理后”的方式进行。 FA用于9,334(40.9%),RA用于13,478(59.1%)患者。倾向得分匹配后,FA中的造影剂总量较高(191.8±8.0 vs. 174.8±68.8 ml; p = 0.001)和较低的放射剂量(1,279.5±1,346.3 vs.1,182.6±887 mGy; p = 0.02)。在FA组中,血管造影后(0.17%vs. 0.02%; p = 0.004)和PCI(0.23%vs. 0.09%; p = 0.049)出现更多的与出入部位相关的出血并发症。在FA进行PCI后,围手术期死亡(1.94%vs. 0.93%; p = 0.001)更为常见。
结论:radial动脉入路与STEMI患者围手术期死亡的发生率较低,以及进入部位出血并发症的发生率显着降低有关。

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