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VIETNAM NATIONAL UNIVERSITY SCHOOL OF MEDICINE AND PHARMACY ANH THI NGOC VU LOCAL VASCULAR COMPLICATIONS AFTER CORONARY ANGIOGRAPHY AND/OR PERCUTANEOUS CORONARY INTERVENTION AND RELATED FACTORS AT CORONARY CARE UNIT OF VIETNAM NATIONAL HEART INSTITUTE GRADUATE THESIS OF GENERAL MEDICINE Hanoi– 2023 VIETNAM NATIONAL UNIVERSITY SCHOOL OF MEDICINE AND PHARMACY Thesis maker: ANH THI NGOC VU LOCAL VASCULAR COMPLICATIONS AFTER CORONARY ANGIOGRAPHY AND/OR PERCUTANEOUS CORONARY INTERVENTION AND RELATED FACTORS AT CORONARY CARE UNIT OF VIETNAM NATIONAL HEART INSTITUTE GRADUATE THESIS OF GENERAL MEDICINE Class year: QH.2017Y Suppervisor 1: M.Sc Dr HIEU BA TRAN Suppervisor 2: M.Sc Dr NHUNG THI HUYNH Hanoi– 2023 ACKNOWLEDGMENT On the occasion of completing my graduation thesis, with deep respect and gratitude, I would like to express my gratitude to: The Board of Directors, Department of Internal Medicine, University of Medicine and Pharmacy - Hanoi National University have created favorable conditions for me during my study and research I would like to express my sincerest thanks to my Ph.D Hoai Thi Thu Nguyen, head of the Internal Affairs Department, University of Medicine and Pharmacy - VNU, Deputy Director of the Institute of Cardiology opened up the opportunity for me to participate in research and complete this thesis In particular, I would like to express my deep respect and gratitude to M.Sc Hieu Ba Tran, doctor of C7 - Coronary Care Unit - Vietnam Heart Institute and teacher of Internal Affairs Department, VNU You are the one who wholeheartedly guided and created all conditions for me in the process of studying and researching I am also deeply thankful to M.Sc Nhung Thi Huynh, Internal Academic Affair, Department of Internal Medicine - University of Medicine and Pharmacy VNU has wholeheartedly supported me and enthusiastically facilitate to help me complete this thesis Thank you sincerely: Doctors, nurses, and staff of Vietnam Heart Institute, Bachmai Hospital I also thank my family who encouraged me and prayed for me throughout the time of my research Hanoi, day month 2023 Thesis maker Anh Thi Ngoc Vu GUARANTEE I hereby declare that all the data in this thesis is my own and has not been used or published in any other document If something goes wrong, I take full responsibility Hanoi, day month 2023 Thesis maker Anh Thi Ngoc Vu TABLE OF CONTENTS ACKNOWLEDGMENT LIST OF ACRONYMS INTRODUCTION CHAPTER 1: LITERATURE REVIEW 1.1 Coronary artery disease 1.2 Percutaneous coronary artery imaging and intervention (PCI) 1.2.1 Intravascular access in coronary angiography and intervention 1.2.2 Hemostasis after removal of sheaths and other types of compression and vascular closure devices .6 1.2.3 Local Vascular Complications 1.3 Research on local vascular complications after intervention and/or angiograpgy in Vietnam and worldwide 12 1.3.1 Studies in the world 12 1.3.2 Studies in Vietnam 12 CHAPTER II: SUBJECTS AND METHODS 15 2.1 Subjects 15 2.1.1 Object .15 2.1.2 Time, place .15 2.1.3 Selection Criteria 15 2.1.4 Exclusion criteria .15 2.1.5 The criteria used in the study 16 2.2 Research Methods 25 2.2.1 Research design 25 2.2.2 Sample size 25 2.2.3 Research process 25 2.3 Main research variable 27 2.3.1 Characteristics of the research object 27 2.3.2 Procedure variables: 27 2.3.3 Variables for follow-up in the ward 27 2.4 Analyzing data 28 2.5 Research media 28 2.6 Research Ethics 29 CHAPTER 3: RESULTS 30 3.1 General characteristics of the study population 30 3.1.1 Distribution of age and gender 30 3.1.2 Distribution characteristics of coronary artery disease 31 3.1.3 Characteristics of the comorbidities 31 3.1.4 Characteristics of clinical indicators of the study group 32 3.1.5 Features of coronary angiography and intervention: 34 3.1.6 Features of the use of anticoagulants and antiplatelet agents 35 3.1.7 Use of unfractionated heparin in the procedure .36 3.1.8 Rate of radial and femoral artery intervention 36 3.1.9 Sheath size ratio .37 3.1.10 Procedure time and sheath withdrawal time 37 3.2 Complications of vascular puncture wound complications 37 3.2.1 Rate of some complications of puncture wound 37 3.2.2 Percentage of hematoma by size 38 3.3 Factors associated with vascular complications: 38 3.3.1 The relationship of complications with age .38 3.3.2 Complications relationship with gender 39 3.3.3 The relationship of complications with the comorbidities .40 3.3.4 The relationship between some clinical indicators with hematoma complications: 43 3.3.5 The relationship of complications with drug use .44 3.3.6 Comparison of mean values of some paraclinical indicators in the group with complications and without complications 45 3.3.7 Relationship of complications with the performing artery 46 3.3.8 Relationship of complications with the procedure performed: 47 3.3.9 Comparison of mean procedure time in the hematoma group and no hematoma 47 CHAPTER 4: DISCUSSION 48 4.1.1 Characteristics of age and sex 48 4.1.2 Features of cardiovascular disease 48 4.1.3 Characteristics of comorbidities 49 4.1.4 Clinical features .49 4.1.5 Paraclinical features 50 4.1.6 Features of using anticoagulants and antiplatelet drugs 50 4.1.7 Features of the intervention process 51 4.2 Factors related to local vascular complications 52 4.2.1 Complication rate .52 4.2.2 The relationship between clinical parameters and complications of hematoma 52 4.2.3 The relationship between paraclinical parameters and complications of hematoma 54 4.2.4 Relationship between complications and access: 54 4.2.5 Relationship of complications with the procedure performed: 55 4.2.6 Relationship of complications with antiplatelet therapy used: 55 4.2.7 The relationship between the parameters of the procedure and after the procedure with local bleeding complications: 55 CONCLUSION 57 REFERRENCE LIST OF ACRONYMS WHO World Health Organization CT Computer Tomography MSCT Multislice Computer Tomography MRI Magnetic Resonance Imaging ACS Acute coronary syndrome CCS Chronic coronary syndrome STEMI ST Elevation Myocardial Infarction ESC European Society of Cardiology BMI Body Mass Index BP Blood pressure SBP Systolic blood pressure DBP Diastolic blood pressure PCI Percutaneous Coronary Intervention Non – STEMI Non -ST Elevation Myocardial Infarction UA Unstable angina DAPT Dual antiplatelet therapy MI Myocardial Infraction LIST OF TABLES Table 1 Comparison of femoral and radial arteries in percutaneous coronary angiography and intervention Table Classification of angina CCS 17 Table Age distribution by age group .30 Table 3 Distribution of coronary artery disease .31 Table Comorbidity characteristics 31 Table Blood pressure characteristics .32 Table Prevalence of hypertension by age group 32 Table BMI characteristics by gender .33 Table BMI characteristics by age group 33 Table Characteristics of some subclinical test of research subjects 34 Table 10 Characteristics of coronary angiography and coronary intervention 34 Table 11 Prevalence of use of anticoagulants, anticoagulants 35 Table 12 Doses of unfractionated heparin used in the procedure 36 Table 13 Characteristics of the vascular access routes .36 Table 14 Characteristics of using a sheath .37 Table 15 Procedure time 37 Table 16 Rate of some complications at the puncture site .38 Table 17 Proportion of hematomas by size 38 Table 18 Distribution of complications by age group 39 Table 19 Distribution of complications by gender 39 10
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