Comparison of transradial and transfemoral access in patients undergoing percutaneous coronary intervention for complex coronary lesions.

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 89(4):640-646, 2017 Mar 01PMID: 27860277Institution: MedStar Health Research Institute | MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Acute Coronary Syndrome/su [Surgery] | *Catheterization, Peripheral/mt [Methods] | *Percutaneous Coronary Intervention/mt [Methods] | *Postoperative Complications/ep [Epidemiology] | Acute Coronary Syndrome/di [Diagnosis] | Aged | Cause of Death/td [Trends] | Coronary Angiography | District of Columbia/ep [Epidemiology] | Electrocardiography | Female | Femoral Artery | Follow-Up Studies | Humans | Incidence | Male | Middle Aged | Prognosis | Radial Artery | Retrospective Studies | Time FactorsYear: 2017Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: Radial access has been shown to confer superior results in patients undergoing PCI, especially in patients with acute coronary syndromes. However, radial access has limitations of sheath and device size, which may increase procedure time and result in inferior outcomes.CONCLUSIONS: In patients with complex coronary lesions undergoing PCI, the radial approach demonstrates similar mid-term outcomes as the femoral approach with a potentially lower rate of complications. © 2016 Wiley Periodicals, Inc.Copyright © 2016 Wiley Periodicals, Inc.METHODS: Patients undergoing PCI for complex lesions, defined as type C according the ACC/AHA classification system, were included in this study. Propensity matching was performed to adjust for differences in baseline characteristics. Transradial patients were then compared to transfemoral patients in regard to procedural, in-hospital, and 6-month outcomes.OBJECTIVE: Comparison of transradial versus transfemoral access for complex percutaneous coronary intervention (PCI) with regard to both complications and long-term outcomes.RESULTS: Among 2142 patients with 2591 lesions treated, 1876 had femoral access and 267 had radial access. Radial access patients were more likely to be male (75% vs. 66%, P=0.003) and less likely to present with acute myocardial infarction (27% vs. 42%, P<0.001). Procedural characteristics demonstrated lower use of heparin in the femoral group (17% vs. 73%, P<0.001) with similarly low use of glycoprotein inhibitors (5.6% vs. 3.4%, P=0.14). Patients in the femoral group had higher rates of transfusions (3.7% vs. 0%, P=0.004) and vascular complications (1.7% vs. 0%, P=0.03). Following propensity matching, there was no difference in mid-term outcomes between radial and femoral groups.All authors: Baker NC, Ben-Dor I, Bernardo NL, Escarcega RO, Gaglia MA Jr, Gai J, Gallino RA, Kiramijyan S, Koifman E, Lager RA, Lipinski MJ, Negi SI, Pichard AD, Satler LF, Suddath WO, Torguson R, Waksman RFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-07-07
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 27860277 Available 27860277

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: Radial access has been shown to confer superior results in patients undergoing PCI, especially in patients with acute coronary syndromes. However, radial access has limitations of sheath and device size, which may increase procedure time and result in inferior outcomes.

CONCLUSIONS: In patients with complex coronary lesions undergoing PCI, the radial approach demonstrates similar mid-term outcomes as the femoral approach with a potentially lower rate of complications. © 2016 Wiley Periodicals, Inc.

Copyright © 2016 Wiley Periodicals, Inc.

METHODS: Patients undergoing PCI for complex lesions, defined as type C according the ACC/AHA classification system, were included in this study. Propensity matching was performed to adjust for differences in baseline characteristics. Transradial patients were then compared to transfemoral patients in regard to procedural, in-hospital, and 6-month outcomes.

OBJECTIVE: Comparison of transradial versus transfemoral access for complex percutaneous coronary intervention (PCI) with regard to both complications and long-term outcomes.

RESULTS: Among 2142 patients with 2591 lesions treated, 1876 had femoral access and 267 had radial access. Radial access patients were more likely to be male (75% vs. 66%, P=0.003) and less likely to present with acute myocardial infarction (27% vs. 42%, P<0.001). Procedural characteristics demonstrated lower use of heparin in the femoral group (17% vs. 73%, P<0.001) with similarly low use of glycoprotein inhibitors (5.6% vs. 3.4%, P=0.14). Patients in the femoral group had higher rates of transfusions (3.7% vs. 0%, P=0.004) and vascular complications (1.7% vs. 0%, P=0.03). Following propensity matching, there was no difference in mid-term outcomes between radial and femoral groups.

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