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RES14
Factors Associated With Percutaneous Coronary Intervention (PCI) Access Complications
By: Hoke, L., Ratcliffe, S., Kimmel, S. & Kolansky, D.; Hospital Of The University Of Pennsylvania, Philadelphia, PA
For further information, please contact: linda.hoke@uphs.upenn.edu
Purpose: To determine what method for sheath removal produces the fewest complications and what factors are associated with access site complications.
Background/Significance: Complex antiplatelet and antithrombotic regimens used in conjunction with percutaneous coronary intervention (PCI) may increase the risk of vascular complications. This study investigated concurrent factors associated with access site complications for patients undergoing PCI. Methods: This prospective cohort study enrolled 413 patients during a prospective 7-month period. Intervention variables studied included: pharmacologic agents, method and duration of sheath removal procedure. Outcome variables included: hematoma formation, bleeding occurrence, pseudoaneurysm prevalence, incidence of arteriovenous (AV) fistula formation, and thrombosis.
Results: Of the 413 patients 68 (16.5%) had a complication. There were a total of 64 (15.5%) hematomas with 35 (8.5%) 1-5 cm and 29 (7.0%) greater than 5 cm, bleeding occurrence 6 (1.5%), AV fistula 4 (1%) and pseudoaneurysm 3 (.7%). There were no significant differences for complications using manual, C-clamp or arterial vascular closure device. Patients who had higher systolic BPs (135 vs. 129; df=410, p=.025) or were older (66 vs. 63, df=411, p=.016), were significantly more likely to have complications.
Conclusions: This study found that clinically significant major complications were low. Arterial vascular closure devices, mechanical C-clamp, and manual compression all provide low and comparable complication risks following sheath removal in the era of antiplatelet and antithrombotic therapies. Older patients and patients with elevated blood pressure should have their groin closely monitored and observed for vascular complications.
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