With experienced operators, MACE rates comparable between transulnar, radial access PCI

SAN DIEGO — PCI performed via transulnar access was associated with a similar rate of MACE as procedures performed via transradial access, according to findings presented at the American College of Cardiology Scientific Sessions.

Rajendra Gokhroo, MD, of Jawaharlal Nehru Medical College in Ajmer, India, and colleagues, suggested that transulnar access may be a feasible and noninferior alternative to transradial access. The current prospective, single-center study included 2,533 patients. Researchers randomly assigned 1,270 patients to transulnar access and 1,263 to transradial access. The per-protocol analysis included 1,176 patients in the transulnar group and 1,140 in the transradial group.

Cannulation was performed by operators who had performed a minimum of 50 ulnar artery cannulations. “Does experience matter in the case of cannulation?” Gokhroo said. “Our observation is that [with experienced operators] there is a significant difference in crossover, vasospasm and hematoma.”

In-hospital MACE served as the primary endpoint, along with crossover to another arterial site, major in-hospital vascular events (including large hematoma with a hemoglobin drop of ≥ 5 gm%) and occlusion rate.

The composite primary endpoint was reported in 14.6% of patients in the transulnar group vs. 14.4% of the transradial group (RR = 1.01; 95% CI, 0.83-1.2).

MACE occurred in 2.9% of patients in the transulnar group vs. 3.2% of those in the transradial group. Large hematoma rates were also similar (1% for transulnar vs. 0.9% for transradial access).

The crossover rates were 4.4% in the transulnar arm and 3.8% in the transradial arm, while spasm was reported in 6.9% of the transulnar group and 8.7% of those in the transradial arm.

“In the intention-to-treat analysis, all primary and secondary endpoints were in the zone of noninferiority,” Gokhroo said. “Also, in the per-protocol analysis, all were within the zone of noninferiority.”

Ultimately, “the transulnar approach is noninferior to the transradial approach when done by experienced operators,” Gokhroo said. “Our take home is that transulnar cannulation is an easy, safe and comfortable procedure.” – by Rob Volansky

Reference:

Gokhroo R, et al. Abstract 406-04. Presented at: American College of Cardiology Scientific Sessions; March 14-16, 2015; San Diego.

Disclosure: Gokhroo reports no relevant financial disclosures.