• Óscar Prada-Delgado, Rodrigo Estévez-Loureiro, Ramón Calviño-Santos, Eduardo Barge-Caballero, Jorge Salgado-Fernández, Pablo Piñón-Esteban, Jose Manuel Vázquez-Rodríguez, Guillermo Aldama-López, Xacobe Flores-Ríos, María Rita Soler-Martín, Nicolás Vázquez-González, and Alfonso Castro-Beiras.
• Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
• Am. Heart J. 2011 Jun 1; 161 (6): 1207-13.

BackgroundThe use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI.MethodsA total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion.ResultsOf the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91).ConclusionsThe use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.Copyright © 2011 Mosby, Inc. All rights reserved.

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