目的：通过经桡动脉与股动脉途径急诊经皮冠状动脉介入（PCI）治疗急性心肌梗死患者，评价两种方法的临床效果和安全性。方法回顾性分析2006年1月至2011年10月行急诊PCI的急性心肌梗死患者共308例。根据最初的穿刺途径，将患者分为桡动脉组（186例）和股动脉组（122例）。比较两组患者急诊PCI的手术成功率、手术时间、并发症及主要心血管事件。结果两组的手术成功率（91.9％vs92.6％）、手术时间（55.3±19.3 vs 56.1±20.4min）和住院期间主要心血管事件发生率差异均无统计学意义（P＞0.05）；与股动脉组比较，桡动脉组需要更改介入治疗途径的比例高（9.7％vs 2.5％，P＜0.05），而手术并发症的发生率低（10.8％vs 20.5％），卧床时间短（5.3±2.5 vs 22.1±5.0h），术后1年（6.5％vs 13.9％）及术后2年（13.4％vs 23.0％）主要心血管事件发生率低，差异均有统计学意义（P＜0.05）。结论急性心肌梗死急诊PCI经桡动脉途径可减少血管径路并发症及卧床时间，但更改血管径路的比例较高。%Objective To compare transradial and transfemoral artery approach for percutaneous coronary intervention (PCI) of acute myocardial infarction (AMI). Methods 308 patients underwent primary PCI for AMI from Jan 2006 to Nov 2011 were analyzed retrospectively. They were divided into transradial (TR group, n=186) and transfemoral groups (TF group, n=122) based on primary access site. The success rate, operation time, complications of primary PCI and main adverse cardiovascular events (MACE) were compared between two groups. Results The success rate (91.9% vs 92.6%), operation time (55.3±19.3 vs 56.1±20.4min)and MACE during hospitalization were not significantly difference between TR and TF groups (P >0.05). The crossover rate of vascular access was 9.7% in TR group, significantly higher than 2.5%in TF group(P<0.05). The operation- related complications(10.8%vs 20.5%), bed- rest time (5.3±2.5 vs 22.1±5.0h), and MACE within 1 and 2 years after procedure(6.5%,13.9%vs 13.4%,23.0%) were significantly lower in TR group than TF group (al P<0.05). Conclusion Transradial approach may reduce vascular access- related complications and bed- rest time but with a higher crossover rate of vascular access during primary PCI of AMI.
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