Analysis of risk factors for radial artery spasm in patients with acute myocardial infarction undergoing radial artery interventional therapy

Abstract

Objective To analyze and summarize the risk factors of radial artery spasm in patients with acute myocardial infarction treated by radial artery interventional therapy. Methods From August 2017 to August 2018, 257 patients with chest pain in Deyang Second People's Hospital were selected and treated by percutaneous coronary intervention (PCI) through radial artery approach.According to the presence or absence of radial artery spasm, the patients were divided into two groups.The radial artery fistula group (RAS) and the non-RAS group.All data were statistically analyzed using SPSS 19.0 software. Results The following indicators were statistically different between the RAS group and the non-RAS group: age, gender, diabetes, hypertension, hyperlipidemia, smoking history, radial artery anatomy, catheter exchange times, radial artery diameter/height, radial artery diameter/catheter diameter, anxiety, excessive operation time, intraoperative moderate to severe forearm pain, the number of stents, grade 2, 3, and 4 of radial artery pulsation.There were significant differences between two groups(all P<0.05). Multivariate analysis showed: gender(OR(95%CI): 0.92(0.897-0.944), P=0.043), hyperlipidemia(OR(95%CI): 3.249(2.508-4.208), P=0.016), radial artery anatomy(OR(95%CI): 5.19(2.090-12.886, P=0.012), catheter exchange times(OR(95%CI): 6.19(3.087-12.413, P=0.011), radial artery diameter/height(OR(95%CI): 3.56(1.527-8.302, P=0.035), radial artery diameter/catheter diameter(OR(95%CI): 2.968(1.665-5.291), P=0.029), intraoperative moderate to severe forearm pain(OR(95%CI): 3.543(1.394-9.006), P=0.039) were independent risk factors for the induction of radial artery spasm in the interventional treatment of the radial artery.The difference between the two groups was statistically significant.ROC curve analysis showed that the area under the curve of the number of catheter exchanges, radial artery diameter/height, radial artery diameter/catheter diameter and the combined diagnosis were 0.806, 0.674, 0.645, and 0.895, respectively.By comparison, AUC of the combined diagnosis were highest, followed by catheter exchange times, radial artery diameter/height and radial artery diameter/catheter diameter were relatively lower.The best diagnostic point of catheter exchange times was 11.585, with a sensitivity of 0.86 and a specificity of 0.58.The best diagnostic point of radial artery diameter/height was 11.145, with a sensitivity of 71.8% and a specificity of 0.56.The best diagnostic point of arterial diameter/catheter diameter was 9.31, with a sensitivity of 95.3 and a specificity of 32.0%.The best diagnostic point of the combined diagnosis was 9.63, with a sensitivity of 0.72 and a specificity of 0.88. Conclusion Independent risk factors for radial artery spasm in the interventional treatment of the radial artery include catheter exchange times, radial artery anatomy, radial artery diameter/height, intraoperative moderate and severe forearm pain, hyperlipidemia, age and gender, and female incidence is greater than male. Key words: Radial artery spasm; Acute myocardial infarction; Interventional therapy