Author + information
- Received October 20, 2017
- Revision received December 13, 2017
- Accepted December 19, 2017
- Published online March 5, 2018.
- Tim Kinnaird, MDa,b,∗ (, )
- Richard Anderson, MDa,
- Sean Gallagher, MDa,
- James Cockburn, MDc,
- Alex Sirker, MDd,
- Peter Ludman, MDe,
- Mark de Belder, MDf,
- Samuel Copt, PhDg,
- James Nolan, MDb,h,
- Azfar Zaman, PhDi and
- Mamas Mamas, PhDb,h
- 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, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
- dDepartment of Cardiology, University College Hospital, London, United Kingdom
- eDepartment of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- fDepartment of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom
- gBiosensors SA, Morges, Switzerland
- hDepartment of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
- iDepartment of Cardiology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- ↵∗Address for correspondence:
Dr. Tim Kinnaird, Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
Objectives Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied.
Background Given the influence of access site on outcomes, use of radial access in PCI-CABG warrants further investigation.
Methods Data were analyzed from 58,870 PCI-CABG procedures performed between 2005 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes.
Results The number of PCI-CABG cases and the percentage of total PCI increased significantly during the study period. Femoral artery (FA) utilization fell from 90.8% in 2005 to 57.6% in 2014 (p < 0.001), with no differences in the rate of change of left versus right radial use. In contemporary study years (2012 to 2014), female sex, acute coronary syndrome presentation, chronic total occlusion intervention, and lower operator volume were independently associated with FA access. Length of stay was shortened in the radial cohort. Unadjusted outcomes including an access site complication (1.10% vs. 0.30%; p < 0.001), blood transfusion (0.20% vs. 0.04%; p < 0.001), major bleeding (1.30% vs. 0.40%; p < 0.001), and in-hospital death (1.10% vs. 0.60%; p = 0.001) were more likely to occur with FA access compared with radial access. After adjustment, although arterial complications, transfusion, and major bleeding remained more common with FA use, short- and longer-term mortality and major adverse cardiac event rates were similar.
Conclusions In contemporary practice, FA access remains predominant during PCI-CABG with case complexity associated with it use. FA use was associated with longer length of stay, and higher rates of vascular complications, major bleeding, and transfusion.
- access choice
- coronary artery bypass surgery
- national database
- percutaneous coronary intervention
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 20, 2017.
- Revision received December 13, 2017.
- Accepted December 19, 2017.
- 2018 American College of Cardiology Foundation
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