title: Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
abstract: BACKGROUND
  The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI.
  
  
  METHODS
  A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion.
  
  
  RESULTS
  Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91).
  
  
  CONCLUSIONS
  The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.
authors.affiliation: Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Prada-Delgado
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.forename: Ramón
authors.initials: R
authors.lastname: Calviño-Santos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: Jorge
authors.initials: J
authors.lastname: Salgado-Fernández
authors.forename: Pablo
authors.initials: P
authors.lastname: Piñón-Esteban
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
authors.forename: Guillermo
authors.initials: G
authors.lastname: Aldama-López
authors.forename: Xacobe
authors.initials: X
authors.lastname: Flores-Ríos
authors.forename: María Rita
authors.initials: MR
authors.lastname: Soler-Martín
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez-González
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006470:Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D006488:Hemostasis, Surgical; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*
chemical_list: D010975:Platelet Aggregation Inhibitors