Sex differences in transradial access failure in ST segment elevation myocardial infarction

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-09-30 DOI:10.1002/ccd.31247

Biljana Zafirovska MD, PhD, Aleksandar Jovkovski MD, Ivan Vasilev MD, Hajber Taravari MD, Darko Kitanoski MD, Danica Petkoska MD, Jorgo Kostov MD, PhD, Kalon K. L. Ho MD, Sasko Kedev MD, PhD

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Abstract

Background

Transradial access (TRA) is now the default access site for PPCI, but technically is a more challenging approach mostly due to anatomic challenges connected to the RA.

Aims

To assess the differences according to sex in radial artery (RA) access site characteristics during primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction (STEMI).

Material and Methods

All 5092 consecutive STEMI patients from our center in the period from March 2011 until December 2017 were examined. The right proximal radial was the “intention-to-treat” access in all patients. Preprocedural RA angiography was performed in all patients. Clinical and procedure characteristics, type of radial anatomy variants, need to use another arterial access sites (the primary endpoint for this study), and procedure time were analyzed by sex. Using logistic regression, we selected predictors of radial crossover. Access site bleeding complications and vascular complications were also recorded.

Results

The STEMI population in this period included 1326 females and 3766 male patients. Females were older (65 ± 11 years) than males (59 ± 11 years, p < 0.0001). Among standard risk factors, hypertension and diabetes mellitus were more common in women and smoking less common. RA anomalies were more frequent in the females (8.8% vs. 6.5%, p < 0.0001), with complex RA loop and tortuous RA twice as frequent in women. Failure of TRA access as the initially chosen site occurred in 4.6% (61) of females versus 2.5% (97) of male STEMI patients (p = 0.0003). The most common subsequent access site was right ulnar access in both groups (57 and 61% respectively). Access site bleeding complications were more common in women 4.4% versus 3.2%, mirrored in hematomas with EASY score III to V. Clinical RA spasm (RAS) was significantly more frequent in females (5.7% vs. 2.2%, p < 0.0001). Multiple regression analysis identified 5 independent predictors for TRA access crossover: previous TRA, anomalous RA, RAS, along with female sex and diabetes.

Conclusion

Female sex is a significant predictor of more complex TRA in STEMI. Understanding sex differences and predictors for TRA crossover will strengthen the use of different procedural modalities that can help in preserving a successful wrist access in female STEMI patients.

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ST 段抬高型心肌梗死经桡动脉入路失败的性别差异。

背景：经桡动脉入路（TRA）是目前经皮冠状动脉介入治疗（PPCI）的默认入路部位，但在技术上是一种更具挑战性的方法，这主要是由于与桡动脉相关的解剖学挑战：研究对象为我中心2011年3月至2017年12月期间连续收治的5092例STEMI患者。所有患者的 "意向治疗 "入路均为右近桡动脉。所有患者均进行了术前 RA 血管造影。我们按性别分析了临床和手术特征、桡动脉解剖变异类型、是否需要使用其他动脉通路（本研究的主要终点）以及手术时间。通过逻辑回归，我们筛选出了桡动脉交叉的预测因素。我们还记录了入路部位出血并发症和血管并发症：这一时期的 STEMI 患者包括 1326 名女性和 3766 名男性。女性年龄（65 ± 11 岁）大于男性（59 ± 11 岁，P 结论：女性性别是 STEMI 的重要预测因素：女性是 STEMI 更复杂 TRA 的重要预测因素。了解性别差异和 TRA 交叉的预测因素将加强对不同手术方式的使用，从而有助于为 STEMI 女性患者保留成功的腕部通路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.