Author + information
- Received March 6, 2012
- Revision received April 19, 2012
- Accepted April 27, 2012
- Published online August 1, 2012.
- Benjamin Hibbert, MD⁎,
- Trevor Simard, MD⁎,
- Kumanan R. Wilson, MD†,
- Steven Hawken, MSc‡,
- George A. Wells, PhD⁎,§,
- F. Daniel Ramirez, MD⁎,
- Michel R. Le May, MD⁎,
- Derek Y. So, MD⁎,
- Chris A. Glover, MD⁎,
- Michael Froeschl, MD⁎,
- Jean-Francois Marquis, MD⁎,
- Marino Labinaz, MD⁎,
- Alexander Dick, MD⁎ and
- Edward R. O'Brien, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Edward R. O'Brien, University of Ottawa, Division of Cardiology, Room H-2263, 40 Ruskin Avenue, Ottawa, Ontario K1Y 4W7, Canada
Objectives This study sought to evaluate the safety and efficacy of transradial versus transfemoral access for coronary angiography and percutaneous coronary intervention in patients with a body mass index ≥40 kg/m2.
Background Coronary angiography is most commonly performed via femoral artery access; however, the optimal approach in extremely obese (EO) patients remains unclear.
Methods Between January 2007 and August 2010, a cohort of consecutive EO patients who underwent coronary angiography was identified in our center's registry of angiography and percutaneous coronary intervention procedures. Of 21,103 procedures, 564 (2.7%) were performed in unique EO patients: 203 (36%) via the transradial approach; and 361 (64%) via the transfemoral approach.
Results The primary outcome, a combined endpoint of major bleeding, access site complications, and nonaccess site complications, occurred in 7.5% of the transfemoral group and 2.0% of the transradial group (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.10 to 0.88, p = 0.029), an endpoint driven by reductions in major bleeding (3.3% vs. 0.0%, OR: 0.12, 95% CI: 0 to 0.71, p = 0.015), as well as access site injuries (4.7% vs. 0.0%, OR: 0.08, 95% CI: 0 to 0.48, p = 0.002). There were no differences in nonaccess site complications (1.7% vs. 2.0%, OR: 1.50, 95% CI: 0.41 to 5.55), but transradial access procedures were associated with an increase in procedure time and patient radiation dose (p < 0.05).
Conclusions Transfemoral access for coronary angiography and percutaneous coronary intervention was associated with more bleeding and access site complications when compared with a transradial approach. Important reductions in procedural associated morbidity may be possible with a transradial approach in EO patients.
- access site complication
- coronary angiography
- extreme obesity
- nonaccess site complication
Dr. So has received unrestricted research grants from Spartan Biosciences and Abbott Vascular Canada; and speaker honoraria from Lilly Canada. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Hibbert and Simard contributed equally to this paper.
- Received March 6, 2012.
- Revision received April 19, 2012.
- Accepted April 27, 2012.
- American College of Cardiology Foundation