Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention

Hitinder S. Gurm Dr., Carrie Hosman Dr., David Share, Mauro Moscucci, Ben B. Hansen

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Background: The role of vascular closure devices (VCDs) in patients having percutaneous coronary intervention (PCI) is controversial, and recommendations for use vary. Objective: To examine the use of and outcomes associated with VCDs in real-world practice. Design: Observational cohort study. Setting: 32 hospitals in Michigan that participate in a large multicenter quality improvement collaborative. Patients: Consecutive patients having emergent and nonemergent PCI from 2007 to 2009. Measurements: Vascular complications and the need for transfusion. Results: Of the 85 048 PCIs performed during the study that met the inclusion criteria, 28 528 (37%) procedures used VCDs. In propensity score-matched analysis, VCDs were associated with reductions in vascular complications (odds ratio [OR], 0.78 [95% CI, 0.67 to 0.90]; P = 0.001) and postprocedure transfusions (OR, 0.85 [CI, 0.74 to 0.96]; P = 0.011). These findings were consistent across many prespecified subgroups except for patients with a body mass index (BMI) less than 25 kg/m2 and those treated with platelet glycoprotein (GP) 2b/3a inhibitors, in whom the benefit of VCDs over manual closure was attenuated. When the specific subtypes of vascular complications were evaluated, VCDs were associated with fewer hematomas (OR, 0.69 [CI, 0.58 to 0.83]; P < 0.001) or pseudoaneurysms (OR, 0.54 [CI, 0.38 to 0.76]; P < 0.001) but an increase in the odds of retroperitoneal bleeding (OR, 1.57 [CI, 1.12 to 2.20]; P = 0.009). Limitation: Unmeasured confounding cannot be excluded despite the study having measured and balanced many confounders. Conclusion: Vascular closure devices were associated with a significant reduction in vascular complications and need for transfusion in this large cohort of patients having transfemoral PCI. This benefit was lost in patients receiving GP 2b/3a inhibitors and those with normal or lean BMI and was counterbalanced by a small increase in the more serious risk for retroperitoneal bleeding. Primary Funding Source: Blue Cross Blue Shield of Michigan and the National Science Foundation.

Original languageEnglish (US)
Pages (from-to)660-666
Number of pages7
JournalAnnals of internal medicine
Volume159
Issue number10
DOIs
StatePublished - Nov 19 2013

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention'. Together they form a unique fingerprint.

  • Cite this