Author + information
- Received April 29, 2010
- Revision received August 30, 2010
- Accepted September 1, 2010
- Published online October 1, 2010.
- Yue-Jin Yang, MD⁎,⁎ (, )
- David E. Kandzari, MD†,
- Zhan Gao, MD⁎,
- Bo Xu, MBBS⁎,
- Ji-Lin Chen, MD⁎,
- Shu-Bin Qiao, MD⁎,
- Jian-Jun Li, MD⁎,
- Xue-Wen Qin, MD⁎,
- Min Yao, MD⁎,
- Yong-Jian Wu, MD⁎,
- Jin-Qing Yuan, MD⁎,
- Jue Chen, MD⁎,
- Hai-Bo Liu, MD⁎,
- Jun Dai, MD⁎,
- Tao Chen, MSc⁎,
- Yang Wang, PhD⁎,
- Wei Li, PhD⁎ and
- Run-Lin Gao, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Yue-Jin Yang, Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
Objectives This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy.
Background The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared.
Methods Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method.
Results Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively.
Conclusions In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.
Dr. Kandzari receives research/grant support and consulting honoraria from Abbott Vascular, Medtronic CardioVascular, Inc., and Cordis Corporation. All other authors have reported that they have no relationships to disclose.
- Received April 29, 2010.
- Revision received August 30, 2010.
- Accepted September 1, 2010.
- American College of Cardiology Foundation