Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico
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Data
2009-01-01
Autores
Labrunie, André [UNESP]
Tebet, Marden Andre
Andrade, Pedro Beraldo de
Andrade, Mônica Vieira Athanazio de
Conterno, Lucieni de Oliveira
Mattos, Luiz Alberto
Carvalho, Fábio Cardoso de [UNESP]
Bregagnollo, Edson Antônio [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI
Resumo
INTRODUÇÃO: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O aces-so transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. MÉTODO: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clássica. RESULTADOS: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). CONCLUSÃO: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes.
BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. METHODS: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. RESULTS: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical technique group. The number of catheters used, the duration of the procedure and X-ray exposure were greater in the transradial group (P < 0.001). There were no differences in the major cardiac adverse events (death, infarct and stroke), and vascular and bleeding complications. Operators who had performed over 100 procedures using the transradial approach (3 centers/5 operators) had a lower failure rate (1.6% vs. 3.6%; P = 0.04). CONCLUSION: A learning period to perform coronary procedures using the transradial approach is required, but it is not associated with an increased risk of procedure failure or vascular complications compared with Sones or femoral approaches.
BACKGROUND: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. METHODS: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. RESULTS: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical technique group. The number of catheters used, the duration of the procedure and X-ray exposure were greater in the transradial group (P < 0.001). There were no differences in the major cardiac adverse events (death, infarct and stroke), and vascular and bleeding complications. Operators who had performed over 100 procedures using the transradial approach (3 centers/5 operators) had a lower failure rate (1.6% vs. 3.6%; P = 0.04). CONCLUSION: A learning period to perform coronary procedures using the transradial approach is required, but it is not associated with an increased risk of procedure failure or vascular complications compared with Sones or femoral approaches.
Descrição
Palavras-chave
Artéria radial, Angiografia coronária, Aprendizagem, Radial artery, Coronary angiography, Learning
Como citar
Revista Brasileira de Cardiologia Invasiva. Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI, v. 17, n. 1, p. 82-87, 2009.