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Radial access interventions on rise in US
Transradial coronary intervention now accounts for one of six PCI procedures performed in the United States and is associated with lower vascular and bleeding complication rates compared with traditional femoral access, according to results published by Circulation.
“We found that transradial primary PCI in the United States is increasing gradually, but still lags behind transradial PCI for other nonacute indications. This likely reflects concerns over metrics related to rapid reperfusion (door-to-balloon time) that may be adversely affected by radial access,” study researcher Dmitriy N. Feldman, MD, assistant professor of medicine at Weill Cornell Medical College, New York Presbyterian Hospital, Greenberg Division of Cardiology, and colleagues wrote.
For the retrospective cohort study, Feldman and colleagues used data from the CathPCI registry, which included 2,820,874 procedures performed at 1,381 sites from January 2007 to September 2012.
Transradial PCI procedures increased from 1.2% in the first quarter of 2007 to 16.1% in the third quarter of 2012, totaling 6.3% (178,643) of procedures from 2007 to 2012. Median site rate of use of transradial PCI was 2.38%. Among all sites, 10.1% (140/1,381) used radial access in more than 19.2% of total PCIs performed (90th percentile). Thirteen percent (180/1,381) of sites did not perform any transradial PCIs, whereas 22 sites performed it in more than half of all PCIs.
Dmitriy N. Feldman
After multivariable adjustment, transradial PCI use was associated with lower risk for bleeding (adjusted OR=0.51; 95% CI, 0.49-0.54) and lower risk for vascular complications (adjusted OR=0.39; 95% CI, 0.31-0.50) compared with transfemoral access PCI. This reduction was consistent across important subgroups of age, sex and clinical presentation.
“There is significant geographic variation in adoption of transradial procedures, and transradial PCI is underused in patients at high risk for bleeding such as older patients, women and patients presenting with ACS. A ‘learning curve’ is important in developing proficiency in radial PCI procedures, particularly in high-risk patients,” Feldman told Cardiology Today’s Intervention, adding that wider adoption of transradial PCI in interventional practice, particularly in higher-risk patients, presents an opportunity to potentially improve overall PCI safety.
Disclosure: Feldman reports consulting for Gilead Sciences and Maquet Cardiovascular, and has received speakers’ fees from Abbott Vascular, Daiichi-Sankyo, Eli Lilly and The Medicines Company.
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