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Transradial access may be preferable for patients with stable ACS
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Compared with transfemoral access, transradial access was associated with reduced bleeding, fewer access-site complications and improved outcomes in a large cohort of patients undergoing PCI in the United Kingdom.
Researchers for the British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research investigated relationships between access site, clinical presentation and procedural outcomes among patients in the BCIS database who underwent PCI from 2007 to 2012. For this study, patients were classified as stable or having non-ST-segment elevation ACS (NSTEACS) or ST-elevation ACS.
The analysis included 210,260 patients in whom transradial access was utilized and 229,687 in whom transfemoral access was utilized. Thirty-day mortality, MACE, bleeding and complications at the arterial access site served as primary outcome measures.
Multivariable analysis revealed an independent association between transradial access and reduced bleeding incidence in all presenting syndromes: stable (OR=0.24; P<.001), NSTEACS (OR=0.35, P<.001) and STEACS (OR=0.47, P<.001). Access-site complications also were decreased after transradial access in all presenting syndromes: stable (OR=0.21, P<.001), NSTEACS (OR=0.19; P<.001) and STEACS (OR=0.16, P<.001).
Transradial access yielded reductions in MACE compared with transfemoral access, but only in patients with unstable syndromes: stable (OR=1.08; P=.25), NSTEACS (OR=0.72; P<.001) and STEACS (OR=0.7; P<.001).
The 30-day mortality rate for patients who underwent PCI via transradial access was 2.5% compared with 1.3% for patients who underwent PCI via transfemoral access (transradial vs. transfemoral OR=0.53; 95% CI, 0.5-0.56).
In addition, results of a propensity-matched cohort indicated that transradial access was associated with improved outcomes compared with transfemoral access among patients in whom a vascular closure device was used.
Other findings indicated that clinicians were more likely to use transradial access in NSTEACS and STEACS patients, but less likely to use this access route in patients with pre-procedural shock or those on ventilation.
“In the United Kingdom, use of transradial access has increased dramatically since 2007 and is currently the most commonly used access site for PCI. In this study with over 210,000 transradial access procedures, 30-day mortality, MACE, bleeding and access-site complications were all less frequent than in the transfemoral access group,” the researchers wrote.
“Our study indicates that the benefits of transradial access seen in selected populations in randomized trials and other observational studies may translate into real patient benefits in day-to-day clinical practice. … Combining transradial access with optimal antithrombotic therapy and other antibleeding strategies has the potential to deliver major patient benefit.”
Disclosure: One researcher reports associations with Boehringer Ingelheim, Cordis and Medtronic. All other researchers report no relevant financial disclosures.
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