A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices.
BACKGROUND
Complications of vascular access are one of the most common adverse events after coronary angiography and percutaneous coronary intervention (PCI) and are reported to occur in 1% to 9% of cases. There are conflicting reports of the association of vascular complications with the use of vascular closure devices (VCDs). The purpose of this study was to assess femoral arterial access-related vascular outcomes after invasive cardiology procedures with the routine use of VCDs.


METHODS
A total of 12,937 consecutive patients were studied for inhospital outcomes through a prospective registry from January 2002 to December 2005. Of these, 6913 (53%) patients underwent PCI and 9996 (77%) patients received VCDs. Univariate and multivariate logistic regression analyses were used to determine the predictors of vascular complications. A propensity analysis of VCD use was performed to account for potential bias in the likelihood of using such devices.


RESULTS
Vascular complications occurred in 0.7% of diagnostic angiography and 2.7% of PCI patients. The risk of vascular complications was significantly lower with closure device use compared with manual compression in both diagnostic angiography (0.5% vs 1.1%, P = .01*) and PCI (2.4% vs 4.9%, P < .001*) groups. Multivariate logistic regression analysis, after accounting for the propensity to use such devices, revealed that VCD use was associated with a 58% (95% CI 19%-88%) reduction in the risk of vascular complications in diagnostic procedures catheterization and a 42% (95% CI 17%-59%) reduction in PCI patients.


CONCLUSIONS
In contemporary practice, VCDs offer reduced risk of vascular complications as compared with manual compression in appropriately selected patients undergoing diagnostic and therapeutic cardiac catheterizations.
Arora
Nipun
N
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Matheny
Michael E
ME
Sepke
Carrie
C
Resnic
Frederic S
FS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology*