Results
A total of 4734 CAs were analyzed. Baseline clinical and procedural
characteristics (per procedure assessment) including gender differences
are shown in Table 1. There were no meaningful differences in the
medication between males and females. Overall, 188 (4.0%) major
complications were detected: 86/1512 (5.7%) in females and 102/3222
(3.2%) in males (P < 0.0001). Of them, 59.6% were classified
as MVCs. A total of 112 (2.4%) MVCs were unevenly distributed between
genders: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (P
< 0.0001). Thrombin injection, blood transfusion or surgical
revision was required in 45% of all MVCs. There was a significant trend
in the reduction of MVCs during the study period (Figure 1) with an
average year-to-year drop by 0.13% (P = 0.048), which produced an
overall drop by 1.7% during the study span of almost 13 years. Several
clinical and procedural characteristics differed between those with and
without MVCs as shown separately for males and females in Table 2.
Details on gender differences in the frequency of individual MVCs are
provided in Table 3. The female
gender was associated with relative risk (RR) of 3.2 (95% confidence
interval (CI): 1.9–5.4, P < 0.0001) of developing groin
hematoma, RR of 3.9 (95% CI: 1.9–7.9, P < 0.0001) of
significant drop of hemoglobin level, RR of 2.6 (95% CI: 1.1–6.7, P =
0.02) of blood transfusion, and RR of 2.3 (95% CI: 1.1–5.1, P = 0.02)
of surgical revision.
Predictors of MVCs
Among “modifiable” factors, the strategy of non-interrupted
anticoagulation and “Z”-stitch for hemostasis did not appear to have a
significant impact on the reduction of the rate of MVCs (Table 2). On
the contrary, US-guided venipuncture was associated with 1.44% drop of
MVCs in males but not in females.
Longer procedures were associated with a higher rate of MVCs with an
increase of 0.21% and 0.39% per every 30 minutes of procedure duration
in males and females, respectively. The rate of MVCs slowly decreased by
0.15% and 0.12% per year in males and females, respectively, during
the study period. Both relationships were statistically significant only
in males (Table 4).
The risk of MVCs almost linearly
rose with age in both males and females (Figure 2). On univariate
regression analysis, older age, and lower body height were associated
with MVCs in females (Table 4). Particularly, low-stature women
(< 170 cm), were at the highest risk of MVCs (Figure 3). In
males, older age, smaller body surface area (BSA), persistent AF, and
longer procedure time was associated with MVCs (Table 4). Interestingly,
the body weight was almost unrelated to MVCs in both genders (Table 4,
Figure 3). The combined impact of body height and weight is illustrated
separately for females and males in Figure 4.
On multivariate regression analysis in males (Table 4), age and
US-guided venipuncture were independently associated with MVC that
increased by 0.64% per every decade of age and, on the other hand,
decreased by 1.55% when US-guided venous access was employed. The same
analysis in females revealed that only body height was independently
associated with MVCs that increased by 1.3% per 5-cm decrease of body
height.
When the multivariate analysis was performed in the total cohort, age (P
= 0.002), body height (P = 0.0002), and year of procedure (P = 0.01)
were associated with the rate of MVCs, while gender itself was not an
independent risk factor (P = 0.54).