CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices
George Dangas, MD, PhD, FACC*,
Roxana Mehran, MD, FACC*,
Spyros Kokolis, MD*,
Dmitriy Feldman, MD*,
Lowell F. Satler, MD, FACC ,
Augusto D. Pichard, MD, FACC,
Kenneth M. Kent, MD, PhD, FACC,
Alexandra J. Lansky, MD*,
Gregg W. Stone, MD, FACC* and
Martin B. Leon, MD, FACC*
* Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute, New York, New York, USA
Washington Hospital Center, Washington, DC, USA
Manuscript received October 12, 2000;
revised manuscript received April 19, 2001,
accepted June 1, 2001.
Reprint requests and correspondence: Dr. Roxana Mehran, Lenox Hill Heart & Vascular Institute, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022
OBJECTIVES
We evaluated the vascular complications after hemostasis with arteriotomy closure devices (ACD) versus manual compression after percutaneous coronary interventions (PCI).
BACKGROUND
Previous clinical studies have indicated that ACD can be used for achievement of hemostasis and early ambulation after PCI. This study investigated the safety of ACD in achieving hemostasis after PCI compared with manual compression in a large cohort of consecutive patients.
METHODS
A total of 5,093 patients were followed after PCI was performed with the transfemoral approach. Univariate and multivariate analysis were used to identify the predictors of vascular complications with ACD (n = 516) or with manual compression (n = 5,892) as a hemostasis option after sheath removal.
RESULTS
The use of ACD was associated with a more frequent occurrence of hematoma compared with manual compression (9.3 vs. 5.1%, p < 0.001). There was also a higher rate of significant hematocrit drop (>15%) with ACD versus manual compression (5.2% vs. 2.5%, p < 0.001). Similar rates of pseudoaneurysm and arteriovenous fistulae were noted with either hemostasis technique. Vascular surgical repair at the access site was required more often with ACD versus manual compression (2.5 vs. 1.5%, p = 0.03).
CONCLUSIONS
In this early experience with ACD after PCI, their use was associated with higher vascular complication rates than hemostasis with manual compression.
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Abbreviations and Acronyms
| | ACD | = arteriotomy closure devices | | ACT | = activated clotting time | | MACE | = major adverse cardiac events | | MI | = myocardial infarction | | PCI | = percutaneous coronary interventions |
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