Abstract 1000: Do Vascular Closure Devices Reduce Vascular Complications in Patients Undergoing Percutaneous Coronary Interventions: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Background: There are conflicting data on the optimal strategy (manual pressure versus vascular closure devices, VCD) for arterial access management in patients undergoing PCI.
Methods: We assessed the impact of VCD use on the outcome of 132,687 patients undergoing PCI from 2003–2008 in 30 hospitals participating in BMC2 PCI registry. Vascular complications (VCs) were defined as one of the following; acute thrombosis, loss of limb, retro-peritoneal bleeding, need for surgical repair, pseudo-aneurysm, hematoma requiring transfusion or A-V fistula.
Results: VCD use increased from 26 % of patients to 37% patients across the study period. One or more vascular complication occurred in 1.9% of patients treated with VCD compared with 2.7% of those treated with manual compression. All complications except retroperitoneal bleeding was less common in patients treated with VCDs (figure⇓). Independent predictors of VC were older age, larger sheaths, female gender, emergency PCI, acute myocardial infarction, use of glycoprotein IIbIIIa inhibitors, and use of heparin prior to the procedure while use of specific VCDs was associated with lower odds of VCs (Angioseal OR 0.77, 95% CI 0.70 – 0.86, P<0.001, Perclose OR 0.71, 95% CI 0.60 – 0.89, P<0.001).
Conclusions: Use of specific VCDs appears to be associated with lower odds of VCs. Large randomized controlled trials are warranted to assess the best groin management strategy for patients undergoing PCI.