title: Active Versus Passive Anchoring Vascular Closure Devices Following Percutaneous Coronary Intervention: A Safety and Efficacy Comparative Analysis.
abstract: OBJECTIVE
  We evaluate the prevalence of complications and failure rates between the most commonly used "active" anchoring vascular closure device (VCD), AngioSeal™ and the "passive" anchoring VCD, Mynx™, in all-comers undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  A total of 4,074 patients between 2008 and 2014, representing an era when both devices were available, were included. Thirty-two percent were acute coronary syndromes (37% STEMI). VCD choice was at the operator's discretion and included AngioSeal (n = 2,910) or Mynx (1,164). Cardiogenic shock or patients receiving intra-aortic balloon pumps were excluded. Safety was assessed by vascular complications defined as either vascular injury (perforation, dissection, acute limb ischemia, arteriovenous fistula, pseudoaneurysm with thrombin injection, or surgical repair) or access-site bleed (hemoglobin droP >3 g/dL requiring transfusion, retroperitoneal bleed, or hematoma >5 cm, or the composite of both. Efficacy was evaluated by device failure and defined as inability to achieve immediate hemostasis or use of additional hemostatic mechanisms. Outcomes at 30-days were evaluated.
  
  
  RESULTS
  Groups (AngioSeal vs Mynx) were fairly balanced with regards to bleeding risk factors of gender (male, 65% vs 66%), body mass index (30 ± 6 vs 30 ± 7), heart failure class III/IV (5% vs 6%), chronic kidney disease (15% vs 17%), use of glycoprotein IIb/IIIa inhibitor (5% vs 4%), or bivalirudin (86% vs 88%), all P >0.5. The AngioSeal group was slightly younger (64 ± 12 vs 65 ± 12, P < 0.001) with less peripheral arterial disease (11.3% vs 13.9%, P = 0.03), and increased 7F sheath use compared with Mynx (59% vs 22%, P < 0.001). Safety and efficacy outcomes were similar between groups.
  
  
  CONCLUSIONS
  AngioSeal and Mynx appear to be equally safe and efficacious VCDs following PCI. The passive anchoring system may prove desirable as no intra-arterial anchor remains upon device removal.
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000517:prevention & control; D057186:Comparative Effectiveness Research; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D065506:Vascular Closure Devices / Q000009:adverse effects / Q000145:classification