TY - JOUR
T1 - Safety and efficacy of suture-mediated closure after percutaneous coronary interventions
AU - Rinder, Morton R.
AU - Tamirisa, Praveen K.
AU - Taniuchi, Megumi
AU - Kurz, Howard I.
AU - Mumm, Kimberly
AU - Lasala, John M.
PY - 2001
Y1 - 2001
N2 - Percutaneous coronary interventions (PCI) performed with concomitant use of heparin and platelet inhibitors are safe procedures with reported vascular complication rates of approximately 6.1%. EPILOG investigators demonstrated that utilizing a low-dose heparin regimen with abciximab, along with early sheath removal, vascular access-related bleeding was significantly lower than that reported in EPIC. Recently, a suture-mediated closure (SMC) device has been reported to be safe, appears effective, and may improve patient comfort by allowing early ambulation. We conducted a retrospective analysis (January 1999 to March 2000) of complication frequencies among PCI patients who underwent SMC and those who had manual compression (non-SMC). Furthermore, we compared the overall rates of complications to patients who underwent PCI prior to the introduction of SMC (1995-1998). When comparing the current cohort to the historical cohort, there was a significant decrease in the number of retroperitoneal bleeds (0.3% vs. 0.9%; P=0.003), hematomas (5% vs. 9%; P<0.001), pseudoaneurysms (1.2% vs. 2.7%; P<0.001), and need for vascular surgery (0.9% vs. 2.8%; P<0.001) . There was no difference in the number of arterio-venous fistulas and a slight increase in transfusion needs (12% vs. 10%; P=0.03). Within the current cohort, there was no difference in the vascular complications between SMC and non-SMC PCI patients, although there were lower rates of pseudoaneurysms (0.5% vs. 1.8%; P=0.02) and transfusion requirements (72/880 vs. 132/874; P<0.001). These results suggest that the complication rates for SMC are not different and may be lower when compared to non-SMC patients after PCI. At our institution, the practice of early sheath removal and less aggressive heparin dosing has led to a decrease in vascular complication rates and a 66% reduction in vascular surgeries on post-PCI patients. Because of the limitations of retrospective analyses, further studies will be necessary to confirm these findings.
AB - Percutaneous coronary interventions (PCI) performed with concomitant use of heparin and platelet inhibitors are safe procedures with reported vascular complication rates of approximately 6.1%. EPILOG investigators demonstrated that utilizing a low-dose heparin regimen with abciximab, along with early sheath removal, vascular access-related bleeding was significantly lower than that reported in EPIC. Recently, a suture-mediated closure (SMC) device has been reported to be safe, appears effective, and may improve patient comfort by allowing early ambulation. We conducted a retrospective analysis (January 1999 to March 2000) of complication frequencies among PCI patients who underwent SMC and those who had manual compression (non-SMC). Furthermore, we compared the overall rates of complications to patients who underwent PCI prior to the introduction of SMC (1995-1998). When comparing the current cohort to the historical cohort, there was a significant decrease in the number of retroperitoneal bleeds (0.3% vs. 0.9%; P=0.003), hematomas (5% vs. 9%; P<0.001), pseudoaneurysms (1.2% vs. 2.7%; P<0.001), and need for vascular surgery (0.9% vs. 2.8%; P<0.001) . There was no difference in the number of arterio-venous fistulas and a slight increase in transfusion needs (12% vs. 10%; P=0.03). Within the current cohort, there was no difference in the vascular complications between SMC and non-SMC PCI patients, although there were lower rates of pseudoaneurysms (0.5% vs. 1.8%; P=0.02) and transfusion requirements (72/880 vs. 132/874; P<0.001). These results suggest that the complication rates for SMC are not different and may be lower when compared to non-SMC patients after PCI. At our institution, the practice of early sheath removal and less aggressive heparin dosing has led to a decrease in vascular complication rates and a 66% reduction in vascular surgeries on post-PCI patients. Because of the limitations of retrospective analyses, further studies will be necessary to confirm these findings.
KW - Catheter-based interventions
KW - Closure devices
KW - Complications
KW - Coronary artery disease
KW - Perclose
KW - Vascular access
UR - http://www.scopus.com/inward/record.url?scp=0034797430&partnerID=8YFLogxK
U2 - 10.1002/ccd.1256
DO - 10.1002/ccd.1256
M3 - Article
C2 - 11590673
AN - SCOPUS:0034797430
SN - 1522-1946
VL - 54
SP - 146
EP - 151
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -