A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices

Abstract

Background: Complications of vascular access are one of the most common adverse events after coronary angiography and percutaneous coronary intervention (PCI) and are reported to occur in 1% to 9% of cases. There are conflicting reports of the association of vascular complications with the use of vascular closure devices (VCDs). The purpose of this study was to assess femoral arterial access-related vascular outcomes after invasive cardiology procedures with the routine use of VCDs.

Methods: A total of 12,937 consecutive patients were studied for inhospital outcomes through a prospective registry from January 2002 to December 2005. Of these, 6913 (53%) patients underwent PCI and 9996 (77%) patients received VCDs. Univariate and multivariate logistic regression analyses were used to determine the predictors of vascular complications. A propensity analysis of VCD use was performed to account for potential bias in the likelihood of using such devices.

Results: Vascular complications occurred in 0.7% of diagnostic angiography and 2.7% of PCI patients. The risk of vascular complications was significantly lower with closure device use compared with manual compression in both diagnostic angiography (0.5% vs 1.1%, P = .01*) and PCI (2.4% vs 4.9%, P < .001*) groups. Multivariate logistic regression analysis, after accounting for the propensity to use such devices, revealed that VCD use was associated with a 58% (95% CI 19%-88%) reduction in the risk of vascular complications in diagnostic procedures catheterization and a 42% (95% CI 17%-59%) reduction in PCI patients.

Conclusions: In contemporary practice, VCDs offer reduced risk of vascular complications as compared with manual compression in appropriately selected patients undergoing diagnostic and therapeutic cardiac catheterizations.