Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention

The role of vascular closure devices (VCDs) in patients having percutaneous coronary intervention (PCI) is controversial, and recommendations for use vary. To examine the use of and outcomes associated with VCDs in real-world practice. Observational cohort study. 32 hospitals in Michigan that partic...

Celý popis

Uložené v:
Podrobná bibliografia
Vydané v:Annals of internal medicine Ročník 159; číslo 10; s. 660
Hlavní autori: Gurm, Hitinder S, Hosman, Carrie, Share, David, Moscucci, Mauro, Hansen, Ben B
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 19.11.2013
Predmet:
Aged
Aneurysm, False - etiology
Aneurysm, False - prevention & control
Blood Transfusion
Body Mass Index
Female
Femoral Artery
Hematoma - etiology
Hematoma - prevention & control
Hospital Mortality
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - instrumentation
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - prevention & control
Retroperitoneal Space
Risk Factors
Wound Closure Techniques - adverse effects
ISSN:1539-3704, 1539-3704
On-line prístup:Zistit podrobnosti o prístupe
Tagy: Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
Popis
Shrnutí:The role of vascular closure devices (VCDs) in patients having percutaneous coronary intervention (PCI) is controversial, and recommendations for use vary. To examine the use of and outcomes associated with VCDs in real-world practice. Observational cohort study. 32 hospitals in Michigan that participate in a large multicenter quality improvement collaborative. Consecutive patients having emergent and nonemergent PCI from 2007 to 2009. Vascular complications and the need for transfusion. Of the 85 048 PCIs performed during the study that met the inclusion criteria, 28 528 (37%) procedures used VCDs. In propensity score-matched analysis, VCDs were associated with reductions in vascular complications (odds ratio [OR], 0.78 [95% CI, 0.67 to 0.90]; P = 0.001) and postprocedure transfusions (OR, 0.85 [CI, 0.74 to 0.96]; P = 0.011). These findings were consistent across many prespecified subgroups except for patients with a body mass index (BMI) less than 25 kg/m2 and those treated with platelet glycoprotein (GP) IIb/IIIa inhibitors, in whom the benefit of VCDs over manual closure was attenuated. When the specific subtypes of vascular complications were evaluated, VCDs were associated with fewer hematomas (OR, 0.69 [CI, 0.58 to 0.83]; P < 0.001) or pseudoaneurysms (OR, 0.54 [CI, 0.38 to 0.76]; P < 0.001) but an increase in the odds of retroperitoneal bleeding (OR, 1.57 [CI, 1.12 to 2.20]; P = 0.009). Unmeasured confounding cannot be excluded despite the study having measured and balanced many confounders. Vascular closure devices were associated with a significant reduction in vascular complications and need for transfusion in this large cohort of patients having transfemoral PCI. This benefit was lost in patients receiving GP IIb/IIIa inhibitors and those with normal or lean BMI and was counterbalanced by a small increase in the more serious risk for retroperitoneal bleeding.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ObjectType-Undefined-3
ISSN:1539-3704
1539-3704
DOI:10.7326/0003-4819-159-10-201311190-00004