Author + information
- Received June 4, 2014
- Accepted June 19, 2014
- Published online January 1, 2015.
- Karim Ratib, MB ChB∗,
- Mamas A. Mamas, BM BCh, DPhil†,‡,
- Simon G. Anderson, MBBCh, PhD‡,
- Gurbir Bhatia, MD§,
- Helen Routledge, MD‖,
- Mark De Belder, MA, MD¶,
- Peter F. Ludman, MA, MD#,
- Douglas Fraser, MB BChir†,
- James Nolan, MD∗∗ (, )
- British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research
- ∗Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
- †Manchester Heart Centre, United Kingdom
- ‡University of Manchester, Manchester, United Kingdom
- §Heart of England National Health Service Trust, west Midlands, United Kingdom
- ‖Worcestershire Royal Hospital, Worcestershire, United Kingdom
- ¶James Cook University Hospital, Middlesbrough, United Kingdom
- #University Hospital Birmingham, Birmingham, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. James Nolan, Department of Cardiology, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom.
Objectives This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population.
Background Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice.
Methods Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice. Patients were categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 30-day mortality, major adverse cardiac events, bleeding, and arterial access site complications was studied.
Results Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed. Following multivariate analysis, TRA was independently associated with a reduction in bleeding in all presenting syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared with a transfemoral access (TFA) with a vascular closure device in a propensity matched cohort.
Conclusions In this large study, TRA is associated with reduced percutaneous coronary intervention–related complications in all patient groups and may reduce major adverse cardiac events and mortality in ACS patients. TRA is superior to transfemoral access with closure devices. Use of TRA may lead to important patient benefits in routine practice. TRA should be considered the preferred access site for percutaneous coronary intervention.
Dr. de Belder has received speakers fees from Boehringer Ingelheim and Cordis; and travel expenses from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 4, 2014.
- Accepted June 19, 2014.
- 2015 American College of Cardiology Foundation