Author + information
- Received August 13, 2018
- Revision received September 7, 2018
- Accepted September 11, 2018
- Published online December 17, 2018.
- Tim Kinnaird, MDa,b,∗ (, )
- Richard Anderson, MDa,
- Sean Gallagher, MDa,
- Alex Sirker, PhDc,
- Peter Ludman, MDd,
- Mark de Belder, MDe,
- Samuel Copt, PhDf,
- Keith Oldroyd, MDg,
- Nick Curzen, PhDh,
- Adrian Banning, MDi and
- Mamas Mamas, DPhilb,j
- aDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- bKeele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- cDepartment of Cardiology, University College Hospital, London, United Kingdom
- dDepartment of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
- eDepartment of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom
- fDivision of Statistics, Biosensors SA, Morges, Switzerland
- gDepartment of Cardiology, Golden Jubilee Hospital, Glasgow, United Kingdom
- hDepartment of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom
- iDepartment of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
- jDepartment of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom
- ↵∗Address for correspondence:
Dr. Tim Kinnaird, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
Objectives Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, temporal trends, predictors, and outcomes of radial access (RA) versus femoral access (FA) for unprotected left main stem percutaneous coronary intervention (LMS-PCI) were studied.
Background Data on arterial access site for LMS-PCI are poorly defined.
Methods Data were analyzed from 19,482 LMS-PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes.
Results The frequency of FA use fell from 77.7% in 2007 to 31.7% in 2014 (p < 0.001 for trend). In the most contemporary study years (2012 to 2014), the strongest associates of FA use for unprotected LMS-PCI were renal disease, PCI for restenosis, chronic total occlusion intervention, and female sex. Use of intravascular imaging and chronic anticoagulation were associated with a higher likelihood of RA use. Complexity of the PCI procedure in the RA cohort increased significantly during the study period. Length of stay was shorter (2.6 ± 9.2 vs. 3.6 ± 9.0; p < 0.001) and same day discharge greater (43.0% vs. 26.6%; p < 0.001) with RA use. After propensity matching, RA use was associated with significant reductions in in-hospital events including access site arterial complications, major bleeding, and major adverse cardiovascular events. Conversion to RA for LMS-PCI was associated with similar reductions in the whole patient cohort. RA use was not associated with lower 12-month mortality.
Conclusions In contemporary practice, the radial artery is the predominant access site for unprotected LMS-PCI, and its use is associated with shorter length of stay, less vascular complications, and less major bleeding than femoral access.
- access site choice
- access site complications
- left main artery
- national database
- percutaneous coronary intervention
Dr. Banning has received an institutional interventional fellowship sponsored by Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 13, 2018.
- Revision received September 7, 2018.
- Accepted September 11, 2018.
- 2018 American College of Cardiology Foundation
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