中国循环杂志
中國循環雜誌
중국순배잡지
CHINESE CIRCULATION JOURNAL
2015年
4期
311-316
,共6页
李佳%徐晗%窦克非%徐波%尤士杰%吴永健%乔树宾%颜红兵%杨跃进
李佳%徐晗%竇剋非%徐波%尤士傑%吳永健%喬樹賓%顏紅兵%楊躍進
리가%서함%두극비%서파%우사걸%오영건%교수빈%안홍병%양약진
冠状动脉疾病%桡动脉%股动脉%安全性
冠狀動脈疾病%橈動脈%股動脈%安全性
관상동맥질병%뇨동맥%고동맥%안전성
Coronary artery disease%Radial artery%Femoral artery%safety
目的：通过与经股动脉（TF）径路比较，评价经桡动脉（TR）径路同期进行经皮冠状动脉（冠脉）介入治疗冠脉三支病变的安全性、可行性、住院期间及长期随访期间临床结果。
<br> 方法：4974例冠脉造影诊断为左主干未受累的冠脉三支病变并接受单次经皮血运重建治疗的患者入选了本项研究。分为TR组3856例，TF组1118例。手术和临床结果通过数据库和随访获得。本研究应用倾向评分匹配方法得到基线资料均衡的930对患者来比较TR组和TF组的住院期间和长期随访期间临床结果，用Cox比例风险模型评估两组间所有临床结果的风险差异，用Kaplan-Meier法估算两组安全性和有效性相关事件的累积发生率，并用log-rank法进行比较。
<br> 结果：倾向评分匹配后，两组的临床和血管造影特征无统计学意义。TR组较TF组住院时间更短[（7.49±4.46）天vs（8.63±6.23）天，P<0.0001]、出血事件更少（1.1％vs 2.9%，P=0.003）外，其余手术结果差异无统计学意义。临床随访显示TR组全因死亡率明显降低（TR组1.8％，TF组4.2％，P=0.0014；风险比0.44，95%可信区间0.25~0.79），而两组间其他长期随访期间临床结果差异无统计学意义。
<br> 结论：TR进行冠脉三支病变患者的同期介入治疗是安全、可行的，并具有与TF介入治疗相似的手术成功率，具更短的住院时间、更低的出血风险、更低的死亡率，长期疗效不亚于TF介入治疗。
目的：通過與經股動脈（TF）徑路比較，評價經橈動脈（TR）徑路同期進行經皮冠狀動脈（冠脈）介入治療冠脈三支病變的安全性、可行性、住院期間及長期隨訪期間臨床結果。
<br> 方法：4974例冠脈造影診斷為左主榦未受纍的冠脈三支病變併接受單次經皮血運重建治療的患者入選瞭本項研究。分為TR組3856例，TF組1118例。手術和臨床結果通過數據庫和隨訪穫得。本研究應用傾嚮評分匹配方法得到基線資料均衡的930對患者來比較TR組和TF組的住院期間和長期隨訪期間臨床結果，用Cox比例風險模型評估兩組間所有臨床結果的風險差異，用Kaplan-Meier法估算兩組安全性和有效性相關事件的纍積髮生率，併用log-rank法進行比較。
<br> 結果：傾嚮評分匹配後，兩組的臨床和血管造影特徵無統計學意義。TR組較TF組住院時間更短[（7.49±4.46）天vs（8.63±6.23）天，P<0.0001]、齣血事件更少（1.1％vs 2.9%，P=0.003）外，其餘手術結果差異無統計學意義。臨床隨訪顯示TR組全因死亡率明顯降低（TR組1.8％，TF組4.2％，P=0.0014；風險比0.44，95%可信區間0.25~0.79），而兩組間其他長期隨訪期間臨床結果差異無統計學意義。
<br> 結論：TR進行冠脈三支病變患者的同期介入治療是安全、可行的，併具有與TF介入治療相似的手術成功率，具更短的住院時間、更低的齣血風險、更低的死亡率，長期療效不亞于TF介入治療。
목적：통과여경고동맥（TF）경로비교，평개경뇨동맥（TR）경로동기진행경피관상동맥（관맥）개입치료관맥삼지병변적안전성、가행성、주원기간급장기수방기간림상결과。
<br> 방법：4974례관맥조영진단위좌주간미수루적관맥삼지병변병접수단차경피혈운중건치료적환자입선료본항연구。분위TR조3856례，TF조1118례。수술화림상결과통과수거고화수방획득。본연구응용경향평분필배방법득도기선자료균형적930대환자래비교TR조화TF조적주원기간화장기수방기간림상결과，용Cox비례풍험모형평고량조간소유림상결과적풍험차이，용Kaplan-Meier법고산량조안전성화유효성상관사건적루적발생솔，병용log-rank법진행비교。
<br> 결과：경향평분필배후，량조적림상화혈관조영특정무통계학의의。TR조교TF조주원시간경단[（7.49±4.46）천vs（8.63±6.23）천，P<0.0001]、출혈사건경소（1.1％vs 2.9%，P=0.003）외，기여수술결과차이무통계학의의。림상수방현시TR조전인사망솔명현강저（TR조1.8％，TF조4.2％，P=0.0014；풍험비0.44，95%가신구간0.25~0.79），이량조간기타장기수방기간림상결과차이무통계학의의。
<br> 결론：TR진행관맥삼지병변환자적동기개입치료시안전、가행적，병구유여TF개입치료상사적수술성공솔，구경단적주원시간、경저적출혈풍험、경저적사망솔，장기료효불아우TF개입치료。
Objectives: To evaluate the safety, feasibility, in-hospital and long-term follow-up period outcomes by trans-radial (TR) approach for treating the patients of triple vessel lesion coronary artery disease (CAD) with one-stage percutaneous coronary intervention (PCI) in comparison with trans-femoral (TF) access.
<br> Methods: A total of 4974 consecutive patients with triple vessel lesion CAD without LM disease who received one-stage PCI were enroll in this study. The patients were divided into 2 groups:TR group, n=3856 and TF group, n=1118. The procedural and clinical results were obtained from data base and follow-up study. There were 930 pairs of patients with comparable baseline data obtained from propensity score matching method served as control subjects for both TR and TF groups. The risk diversity between 2 groups was evaluated by Cox’s proportional-hazards model, the cumulative incidences for the safety and efifcacy were estimated by Kaplan-Meier method and meanwhile compare by log-rank test.
<br> Results: With propensity score matching, the clinical and angiographic characteristics were similar between 2 groups. TR group had the shorter in-hospital time than TF group (7.49 ± 4.46) days vs (8.63 ± 6.23) days, P<0.0001 and less incidence of bleeding 1.1% vs 2.9%, P<0.003; the other procedural feathers were similar between 2 group. The follow-up study presented that TR group had obviously lower all cause mortality than TF group (1.8% vs 4.2%,P=0.0014;HR=0.44, 95%CI 0.25-0.79);the other longer term follow-up outcomes were similar between 2 groups.
<br> Conclusion: TR intervention is safe and feasible for treating the patients with triple vessel lesion CAD, the procedural success rate and long term outcomes are similar to TF intervention, while it has shorter in-hospital time, lower risks for bleeding and death.
