Safety and efficacy of suture-mediated closure after percutaneous coronary interventions.
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.
Rinder
M R
MR
Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Tamirisa
P K
PK
Taniuchi
M
M
Kurz
H I
HI
Mumm
K
K
Lasala
J M
JM
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology* / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000601:surgery; D001803:Blood Transfusion; D015331:Cohort Studies; D003327:Coronary Disease / Q000628:therapy*; D004434:Early Ambulation; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects* / Q000295:instrumentation*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology* / Q000601:surgery; D014656:Vascular Surgical Procedures