Author + information
- Received October 2, 2017
- Revision received November 28, 2017
- Accepted January 9, 2018
- Published online June 4, 2018.
- Muhammad Rashid, MBBSa,∗ (, )
- Claire Lawson, PhDa,
- Jessica Potts, MSca,
- Evangelos Kontopantelis, PhDb,
- Chun Shing Kwok, MBBSa,c,
- Olivier Francois Bertrand, MD, PhDd,
- Ahmad Shoaib, MBBS, MDa,c,
- Peter Ludman, MDe,
- Tim Kinnaird, MBBChf,
- Mark de Belder, MDg,
- James Nolan, MDa,c and
- Mamas A. Mamas, BM, BCh, DPhila,c
- aKeele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
- bFaculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- cAcademic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom
- dQuebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada
- eDepartment of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- fDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- gThe James Cook University Hospital, Middlesbrough, United Kingdom
- ↵∗Address for correspondence:
Dr. Muhammad Rashid, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent ST4 7QB, United Kingdom.
Objectives The authors sought to determine the relationships between left radial access (LRA) or right radial access (RRA) and clinical outcomes using the British Cardiovascular Intervention Society (BCIS) database.
Background LRA has been shown to offer procedural advantages over RRA in percutaneous coronary intervention (PCI) although few data exist from a national perspective around its use and association with clinical outcomes.
Methods The authors investigated the relationship between use of LRA or RRA and clinical outcomes of in-hospital or 30-day mortality, major adverse cardiovascular events (MACE), in-hospital stroke, and major bleeding complications in patients undergoing PCI between 2007 and 2014.
Results Of 342,806 cases identified, 328,495 (96%) were RRA and 14,311 (4%) were LRA. Use of LRA increased from 3.2% to 4.6% from 2007 to 2014. In patients undergoing a repeat PCI procedure, the use of RRA dropped to 72% at the second procedure and was even lower in females (65%) and patients >75 years of age (70%). Use of LRA (compared with RRA) was not associated with significant differences in in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 0.90 to 1.57; p = 0.20), 30-day mortality (OR: 1.17, 95% CI: 0.93 to 1.74; p = 0.16), MACE (OR: 1.06, 95% CI: 0.86 to 1.32; p = 0.56), or major bleeding (OR: 1.22, 95% CI: 0.87 to 1.77; p = 0.24). In propensity match analysis, LRA was associated with a significant decrease in in-hospital stroke (OR: 0.52, 95% CI: 0.37 to 0.82; p = 0.005).
Conclusions In this large PCI database, use of LRA is limited compared with RRA but conveys no increased risk of adverse outcomes, but may be associated with a reduction in PCI-related stroke complications.
- 30-day mortality
- in-hospital mortality
- in-hospital stroke
- left radial access
- major adverse cardiovascular event(s)
- major bleeding
- right radial access
- successive PCI
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 2, 2017.
- Revision received November 28, 2017.
- Accepted January 9, 2018.
- 2018 American College of Cardiology Foundation