P65217.5-Fr sheathless guides versus 7-Fr glidesheath slender sheath/7-Fr guiding catheter combination for acute myocardial infarction: a propensity-matched analysis

Abstract

Abstract Purpose To investigate the differences between a 7.5-Fr sheathless guides and a 7-Fr Glidesheath slender sheath (GSS) /7-Fr guiding catheter combination regarding access-site complications and process time metrics in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods We enrolled 609 patients undergoing PCI for AMI at our hospital using either a 7.5-Fr sheathless guides or a 7-Fr GSS/7-Fr guiding catheter combination; 1:1 propensity score matching was performed. A propensity score was estimated using a multivariate logistic regression model. Variables included were age, gender, weight, hypertension, diabetes, smoking, statin, estimated glomerular filtration rate, end-procedural activated clotting time, oral anticoagulants, SYNTAX score I, previous PCI, history of MI, Killip class, prior ipsilateral transradial intervention, and radial artery diameter. Results A total of 336 subjects were included in the propensity-matched sample. Compared with the GSS group, the sheathless group had significantly less frequent severe radial spasm (Sheathless: 0.6% vs. GSS: 4.8%, p=0.037) and Bleeding Academic Research Consortium type 2, 3, or 5 bleeding events (Sheathless: 12.5% vs. GSS: 21.4%, p=0.041). Procedure outcomes Variables Total population Propensity-matched population Sheathless (n=368) Glidesheath (n=241) OR (95% CI) p Sheathless (n=168) Glidesheath (n=168) OR (95% CI) p Primary outcomes RAO at 30 days 10 (2.7) 3 (1.2) 0.45 (0.08–1.77) 0.26 4 (2.4) 1 (0.6) 0.25 (0.03–2.22) 0.37 Severe radial spasm (grade 3 or 4) 5 (1.4) 12 (5.0) 3.78 (1.22–13.87) 0.011 1 (0.6) 8 (4.8) 8.35 (1.03–67.52) 0.037 BARC type 2, 3, or 5 bleeding within 30 days 40 (10.9) 45 (18.7) 1.87 (1.15–3.05) 0.008 21 (12.5) 36 (21.4) 1.91 (1.06–3.43) 0.041 Procedural success 361 (98.6) 238 (98.8) 1.10 (0.21–7.14) 0.54 167 (99.4) 166 (98.8) 0.50 (0.05–5.53) 1.0 Secondary outcomes Coronary ostial dissection 7 (1.9) 3 (1.2) 0.65 (0.11–2.87) 0.75 4 (2.4) 3 (1.8) 0.75 (0.16–3.38) 1.0 MACCEs within 30 days 4 (1.1) 7 (2.9) 2.70 (0.68–12.73) 0.12 4 (2.4) 0 (0) n/a 0.12 Puncture to balloon time, min 26.0 (21.0–35.0) 27.0 (20.0–38.0) n/a 0.52 26.5 (21.0–37.0) 27.0 (20.0–38.0) n/a 0.77 Data are presented as median (interquartile range) or n (%), unless otherwise indicated. Bleeding Academic Research Consortium; CI, confidence interval; MACCEs, major adverse cardiac and cerebrovascular events; OR, odds ratio; RAO, radial artery occlusion. MACCEs include all-cause death, myocardial infarction, target-vessel revascularization, and cerebrovascular accident. Conclusions These data demonstrate a clear advantage of sheathless guides over GSS/guiding catheter combination for decreased risk of severe radial spasm and bleeding.