Reduced vascular complications after percutaneous coronary interventions with a nonmechanical suture device: results from the randomized RACE study.
The objective of this study was to evaluate the safety and efficacy of a novel nonmechanical percutaneous suture device, X-Press, after diagnostic catheterization and percutaneous coronary interventions (PCIs) in the setting of glycoprotein IIb/IIIa inhibitor usage. Current percutaneous vascular suture devices remain mechanically complex and expensive and have not been shown to reduce major vascular complications. Using a 2:1 randomization scheme (2:1 ratio, device vs. compression), 393 patients undergoing diagnostic catheterization (n = 133) or PCI (n = 260) were randomized in the prospective Rapid Ambulation After Closure (RACE) study and evaluated for time to ambulation, time to hemostasis, treatment success, and incidence of major vascular complications. Glycoprotein IIb/IIIa inhibitors were used in 52% of PCI patients. There was a significant reduction in the primary efficacy endpoint of median time to ambulation for device compared to control with both diagnostic (2.2 vs. 6.2 hr; P = 0.0001) and PCI patients (4.1 vs. 14.7 hr; P = 0.0001). Device malfunction occurred in 3.1% patients without clinical sequalae. Equivalence in the primary safety endpoint, the incidence of major complications (vascular repair, ultrasound-guided compression, transfusion, or infection) at 14 days, was observed with the X-Press device (1/261; 0.4%) compared to control (3/132; 2.3%; P = 0.11). In PCI patients, half of whom received glycoprotein IIb/IIIa inhibitors, there was a significant reduction in the incidence of vascular complications in patients using the device (0/172; 0%) compared to control (3/88; 3.4%; P = 0.037). In diagnostic catheterization and PCI, a novel nonmechanical suture device reduced the time to ambulation and demonstrated equivalence in major complications compared to conventional compression techniques. The incidence of major complications after PCI was reduced with the device.
Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA. tsanborn@enh.org
Timothy A
TA
Sanborn
J David
JD
Ogilby
James M
JM
Ritter
Gregg W
GW
Stone
Bruce D
BD
Klugherz
Ronald H
RH
Fields
Christopher C
CC
White
Robert L
RL
Wilensky
D001808:Blood Vessels / Q000293:injuries; D006328:Cardiac Catheterization; D004434:Early Ambulation; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D011677:Punctures; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors
D019039:Platelet Glycoprotein GPIIb-IIIa Complex