Abstract 4161: Vascular Closure After Percutaneous Coronary Intervention: How Safe is It?
Background: In patients undergoing percutaneous coronary intervention (PCI), the placement of a vascular closure device (VCD) is common. This allows earlier ambulation compared with manual compression (MC). However, controversy exists regarding the effect of VCD use on bleeding and vascular complications. Additionally, data comparing the various VCD’s is lacking. We assessed the femoral artery-access related outcomes in PCI patients receiving hemostasis with manual compression vs. vascular closure devices.
Methods: Using the Hartford Hospital cardiac catheterization laboratory database, we developed propensity score matched groups, MC (n=1,213) and VCD (n=2,426), who underwent PCI between January 1, 2002 and May 1, 2009. The groups were matched for age, gender, body mass index, diabetes, hypertension, hyperlipidemia, tobacco use, peripheral vascular disease, renal insufficiency, chronic lung disease, need for emergent catheterization, procedure time, sheath size, platelet inhibitor use, thrombolytic use and anticoagulant use. Outcomes were compared for TIMI major and minor bleeding, hematoma ≥10 cm, retroperitoneal hemorrhage, vascular compromise (dissection, pseudoaneurysm, arterio-venous fistula, need for surgical repair) and length of hospital stay (LOS). A subset analysis comparing the outcomes of the three commonly used VCD’s was also performed (Angioseal® n=975, Perclose® n=981 and Starclose® n=470).
Results: Compared to MC, the VCD group had similar rates of TIMI major bleeding (VCD 1.3% vs. MC 1.4%), TIMI minor bleeding (VCD 5.2% vs. MC 5.8%) and vascular compromise (VCD 0.4% vs. MC 0.2%). However, LOS was shorter for the VCD group (2.8±3.0 vs. 3.0±5.4 days, p<0.01). Among the VCD’s, the rate of vascular compromise was highest with Angioseal® at 0.7% vs. 0.1% for Perclose® and 0.2% for Starclose® (p<0.05). Perclose® had the lowest rate of minor bleeding at 3.4% vs. 6.3% for Angioseal® and 6.4% for Starclose® (p<0.01).
Conclusions: In patients undergoing PCI, VCD use is a safe method for achieving femoral artery hemostasis and results in a shorter length of stay. Angioseal® use is associated with a higher rate of vascular compromise compared with Perclose® and Starclose®.