Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

Q: What are the key findings of this study?

Endovascular cardiac procedures resulted in vascular complications in 8.8% of patients (237/2,696), with over 96% of both major and minor events occurring within the first 6 hours.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing elective or urgent endovascular cardiac procedures (cardiac catheterization or PCI) (n=2696). Intervention: Elective or urgent endovascular cardiac procedures (cardiac catheterization or PCI via femoral or radial access). Primary outcome: Vascular complications at the arterial puncture site (hematoma <10 cm or ≥10 cm, stable or unstable bleeding, retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistula) within 48 hours.

Q: What does this research mean for the field?

Vascular complications occur in 8.8% of patients undergoing endovascular cardiac procedures, with over 96% of major and minor events occurring within the first six hours post-procedure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Angelita Paganin; Mariur Gomes Beghetto; Maria Karolina Echer Ferreira Feijó; Roselene Matte; Jaquelini Messer Sauer; Eneida Rejane Rabelo

doi:10.1590/1518-8345.2672.3060

October 10, 2018Revista Latino-Americana de EnfermagemOpen Access

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

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Key result

Vascular complications occur in ~9% of endovascular cardiac procedures, mostly within 6 hours.

n=2,696

Why the study?

This study aimed to analyze vascular complications among patients undergoing endovascular cardiac procedures in the hemodynamic laboratories of three referral centers.

Key Points

To analyze the incidence and timing of vascular complications among adult patients who underwent endovascular cardiac procedures across three referral centers.
Multicenter cohort study conducted in the hemodynamic laboratories of three referral facilities in Brazil between 2012 and 2014.
Included 2,696 adult patients undergoing elective or urgent percutaneous cardiac procedures (mean age 63±11 years; 59.8% male).
Patients were evaluated for puncture-site vascular complications and other immediate adverse events across three post-procedure intervals: 0–6 hours (n=2,696), 6–24 hours (n=1,349), and 24–48 hours (n=356).
Vascular complications occurred in 237 of 2,696 patients (8.8%), totaling 264 events: minor hematoma <10 cm (n=135), stable bleeding (n=86), major hematoma ≥10 cm (n=32), and unstable bleeding (n=11).
No retroperitoneal hematoma, pseudoaneurysm, or arteriovenous fistula events occurred.
Complications arose predominantly within the first six hours post-procedure, accounting for 97.3% of major complications and 96.8% of minor complications.

Study Design

Type

Cohort (n=2,696)

Multicenter

Yes

Structured PICO

P

Population

2,696 adult patients (mean age 63±11 years, 40.2% female) undergoing elective or urgent femoral or radial endovascular cardiac procedures across three referral centers in southern Brazil, followed for up to 48 hours.

E

Exposure

Elective or urgent endovascular cardiac procedures (cardiac catheterization or percutaneous coronary intervention) performed via femoral or radial artery puncture

O

Outcome

Vascular complications at the arterial puncture site within 48 hours (up to hospital discharge), including hematoma (major ≥10 cm or minor <10 cm per ACC classification), major bleeding (CRUSADE criteria or hemodynamic instability) or minor/stable bleeding, and surgical correction for retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistulasafety

Limitations

Procedures other than cardiac procedures performed in hemodynamics were not included
No follow-up after hospital discharge (assessed only up to 48 hours)
Missing data across different complication subtypes and follow-up time points
Procedures other than cardiac procedures performed in the hemodynamics laboratories were not included
No follow-up after hospital discharge (follow-up limited to up to 48 hours)
Missing data for specific complication subtypes and progressive attrition at 6-24h (50.1% assessed) and 24-48h (13.2% assessed)

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Implication

Vascular complications following percutaneous cardiac procedures occurred in 8.8% of patients (with major complications at 1.4%-1.6%) and clustered overwhelmingly within the first 6 hours, highlighting the critical window for immediate post-procedural nursing surveillance.

Abstract

OBJECTIVE: to analyze vascular complications among patients who underwent endovascular cardiac procedures in the hemodynamic laboratories of three referral centers. METHOD: a multicenter cohort study was conducted in three referral facilities. The sample was composed of 2,696 adult patients who had undergone elective or urgent percutaneous cardiac procedures. The outcomes were vascular complications, such as: hematoma at the site of the arterial puncture; major or minor bleeding; surgical correction for retroperitoneal hemorrhage; pseudoaneurysm; and arteriovenous fistula. RESULTS: 237 (8.8%) of the 2,696 patients presented a vascular complication at the site of the arterial puncture. The total number of vascular complications was 264: minor hematoma<10cm (n=135); stable bleeding (n=86); major hematoma ≥10cm (n=32); and unstable bleeding (n=11). There were no retroperitoneal hematoma events, pseudoaneurysm or arterial venous fistula. Most of the major and minor complications occurred in the first six hours after the procedure. CONCLUSION: the results concerning the current context of interventional cardiology indicate that the complications predominantly occur in the first six hours after the procedure, considering a 48-hour follow-up. The staff should plan and implement preventive measures immediately after the procedures.

Discussion

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Cite This Study

Paganin et al. (2018) conducted a cohort in Patients undergoing elective or urgent endovascular cardiac procedures (cardiac catheterization or PCI) (n=2,696). Elective or urgent endovascular cardiac procedures (cardiac catheterization or PCI via femoral or radial access) was evaluated on Vascular complications at the arterial puncture site (hematoma <10 cm or ≥10 cm, stable or unstable bleeding, retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistula) within 48 hours. Endovascular cardiac procedures resulted in vascular complications in 8.8% of patients (237/2,696), with over 96% of both major and minor events occurring within the first 6 hours.

synapsesocial.com/papers/6aefb9e0d7ab4a5ccafe4b83 https://doi.org/10.1590/1518-8345.2672.3060

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Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Vascular complications in patients who underwent endovascular cardiac procedures: multicenter cohort study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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