Vascular closure devices and the risk of vascular complications after percutaneous coronary intervention in patients receiving glycoprotein IIb-IIIa inhibitors

Vascular closure devices offer advantages over traditional means of obtaini ng hemostasis after percutaneous coronary intervention (PCI) in terms of pa tient comfort and time to ambulation. We investigate whether such devices a lso reduce the risk of vascular complications in selected patient populatio ns. We conducted a retrospective analysis of all patients who underwent PCI at our institution between January 1998 and December 1999. Of 3,151 consec utive patients, 3,027 were eligible tio receive vascular closure devices. O f these, 1,485 received a closure device and 1,409 received glycoprotein II Ib-IIIa antagonists. The overall vascular complication rate, as defined by the need for surgical repair or transfusion, or the development of arteriov enous fistula, pseudoaneurysm, or large hematoma, was 4.20%. By univariate analysis, the use of closure devices was associated with a lower vascular c omplication rate (3.03% vs 5.52%; p = 0.002) and a shorter length of hospit al stay (2.77 vs 3.97 days, p <0.001). Multivariate analysis showed a signi ficant reduction in vascular complications with closure devices (odds ratio 0.59, p = 0.007). For the subgroup of patients receiving glycoprotein IIb- IIIa antagonists, the use of closure devices was associated with an even mo re pronounced reduction in the risk of vascular complications (odds ratio 0 .45, p <0.008). Thus, the use of closure devices in selected patients under going PCI is associated with a low rate of vascular complications and decre ased length of stay. This benefit was most marked for patients receiving gl ycoprotein IIb-IIIa antagonists. (C) 2001 by Excerpta Medica, Inc.