Premium
Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal
Author(s) -
Cantor Warren J.,
Mahaffey Kenneth W.,
Huang Zhen,
Das Pranab,
Gulba Dietrich C.,
Glezer Stanislav,
Gallo Richard,
Ducas John,
Cohen Marc,
Antman Elliott M.,
Langer Anatoly,
Kleiman Neal S.,
White Harvey D.,
Chisholm Robert J.,
Harrington Robert A.,
Ferguson James J.,
Califf Robert M.,
Goodman Shaun G.
Publication year - 2007
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20897
Subject(s) - medicine , conventional pci , radial artery , timi , bivalirudin , acute coronary syndrome , cardiac catheterization , surgery , femoral artery , cardiology , activated clotting time , heparin , artery , myocardial infarction
Objectives : Our objective was to analyze the impact of arterial access site, sheath size, timing of sheath removal, and use of access site closure devices on high‐risk patients with acute coronary syndromes (ACS). Background : In the SYNERGY trial, 9,978 patients with ACS were randomly assigned to receive enoxaparin or unfractionated heparin. Methods : This analysis includes 9,404 patients for whom sheath access information was obtained for the first PCI procedure or diagnostic catheterization. Comparisons of baseline, angiographic, and procedural characteristics were carried out according to access site and sheath size. Results : Overall, 9,404 (94%) patients underwent angiography at a median of 21 hr (25th and 75th percentiles: 5, 42) and 4,687 (50%) underwent PCI at a median of 23 hr (6,49) of enrollment. The access site was femoral for 94.9% of cases, radial for 4.4%, and brachial for 0.7%. Radial access was associated with fewer transfusions than femoral access (0.9% vs. 4.8%, P = 0.007). For femoral access, the rates of noncoronary artery bypass grafting (CABG)‐related TIMI major bleeding by sheath size was 1.5% for 4 or 5 French (Fr), 1.6% for 6 Fr, 3.3% for 7 Fr, and 3.8% for ≥ 8 Fr ( P < 0.0001). After adjustment for baseline characteristics, femoral access site, larger sheath size, and delayed sheath removal were independent predictors of need for transfusion. Conclusions : Smaller sheaths, radial access, and timely sheath removal may mitigate the bleeding risk associated with potent antithrombotic/platelet therapy and early catheterization. © 2006 Wiley‐Liss, Inc.