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Healio
June 05, 2014
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Transradial PCI yielded decreases in bleeding

A moderate or high increase in transradial access use was associated with a decrease in access site bleeding of more than 50%.

Researchers of the study noted that it is unknown whether the use of radial access has improved outcomes in PCI and aimed to evaluate whether a relationship exists between increased use of transradial access at the facility level and improved periprocedural outcomes.

Data from the National Cardiovascular Data Registry (NCDR) CathPCI Registry during 2009 to 2012 underwent analysis. The researchers assessed risk-adjusted associations between hospital category of change in transradial PCI use and trends in several outcome measures, including access site and overall bleeding, fluoroscopy time and contrast use. There were 818 facilities included in the analysis. Eligible sites had low baseline use of transradial PCI.

The four categories of change in transradial access use were as follows:

  • Very low: baseline, 0.2% increasing to 1.8% at the end of 3 years;
  • Low: 0.9% increasing to 8.9%;
  • Moderate: 1.6% increasing to 27.2%;
  • High: 1% increasing to 45.1%.

Decreases in access site bleeding were reported in the risk-adjusted analysis for all hospital categories. However, variation occurred in the rate of decline across the hospital categories (P<.001).

Hospitals with moderate or high increases in transradial access use experienced significantly greater decreases in access site bleeding (RR=0.45; 95% CI, 0.36-0.56) compared with hospitals with very low or low use of this access site (RR=0.65; 95% CI, 0.58-0.74; P=.002).

Outcomes with regard to overall bleeding were similar as those for access site bleeding, according to the researchers.

Hospitals with moderate and high use of transradial PCI demonstrated increases in fluoroscopy time of approximately 1.3 minutes (P=.01).

All hospital categories demonstrated similar trends in contrast use.

“In a national sample of hospitals performing [PCI], bleeding rates decreased over time for all hospital categories of change in [transradial PCI] use,” the researchers concluded, and added that increased adoption of this strategy yielded more significant decreases in bleeding.

Disclosure: The researchers report financial disclosures with Medtronic, the NCDR and Terumo Medical.

Sources/Disclosures

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Source: Bradley SM. Circ Cardiovasc Qual Outcomes. 2014;doi:10.1161/circoutcomes.114.001020.