Trends in Vascular Complications After Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Via the Femoral Artery, 1998 to 2007
Robert J. Applegate, MD, FACC*,
Matthew T. Sacrinty, MPH,
Michael A. Kutcher, MD, FACC,
Frederic R. Kahl, MD, FACC,
Sanjay K. Gandhi, MD, FACC,
Renato M. Santos, MD, FACC,
William C. Little, MD, FACC
Wake Forest University School of Medicine, Section of Cardiology, Winston-Salem, North Carolina.
* Reprint requests and correspondence: Dr. Robert J. Applegate, Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045. (Email: bapplega{at}wfubmc.edu).
Objectives: This study sought to evaluate trends in vascular complications after diagnostic cardiac catheterization (CATH) and percutaneous coronary intervention (PCI) from the femoral artery from 1998 to 2007.
Background: Vascular complications have been recognized as an important factor in morbidity after CATH and PCI. Whether strategies to reduce vascular complications performed from the femoral artery in the past decade have improved the safety of these procedures, however, is uncertain.
Methods: A total of 35,016 consecutive diagnostic cardiac catheterization (n = 20,777) and percutaneous coronary intervention procedures (n = 14,239) performed via a femoral access at a single site (Wake Forest University Baptist Medical Center) between 1998 and 2007 were evaluated. Annual rates of vascular complications were evaluated. Covariate effects on the risk of vascular complications were evaluated by logistic regression and risk-adjusted trend analysis.
Results: Overall, the incidence of any vascular complication decreased significantly for CATH, 1.7% versus 0.2%, and PCI, 3.1% versus 1.0%, from 1998 to 2007, both p < 0.001 for trend. Favorable trends in procedural covariates affecting vascular complications were mainly responsible for the decrease in the incidence of vascular complications, including fewer closure device failures and use of smaller sheath sizes.
Conclusions: In this large, single-center, contemporary observational study, the safety of CATH and PCI performed from the femoral artery improved significantly from 1998 to 2007. Reductions in the prevalence of adverse procedural factors contributed to the decrease in the incidence of vascular complications, suggesting that strategies to reduce vascular complications can be effective in improving the safety of these procedures.
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Abbreviations and Acronyms
| | CATH = diagnostic cardiac catheterization | | GP = glycoprotein | | MC = manual compression | | PCI = percutaneous coronary intervention | | VCD = vascular closure device |
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