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Transradial PCI after thrombolysis lowers risk for death, complications
In patients with STEMI undergoing PCI after receiving thrombolysis, transradial access decreased the odds for bleeding, MACE and mortality, according to data published in JACC: Cardiovascular Interventions.
Using the British Cardiovascular Intervention Society dataset, Muhammad Rashid, MBBS, from the Keele Cardiovascular Research Group and the Royal Stoke Hospital in the United Kingdom, and colleagues evaluated practice trends and the effect of access-site selection on CV outcomes in patients undergoing PCI after receiving thrombolysis from 2007 to 2014 in England and Wales.
Of the 10,209 patients included in the analysis, 48% underwent transradial PCI. Compared with patients who underwent transfemoral PCI, patients who had transradial PCI had lower in-hospital mortality (1.8% vs. 4.7%) as well as lower mortality at 30 days (3.7% vs. 7.5%) and at 1 year (5.6% vs. 9.8%). After adjustment, 1-year mortality rates were similar with the two approaches (OR = 0.82; 95% CI, 0.66-1.02); however, transradial access was associated with reduced risks for in-hospital (OR = 0.59; 95% CI, 0.42-0.83) and 30-day mortality (OR = 0.72; 95% CI, 0.55-0.94).
Moreover, patients who underwent transradial PCI, compared with transfemoral PCI, had less access-site complications (0.6% vs. 2.5%), major bleeding (1% vs. 2.2%) and MACE, defined as a composite of in-hospital mortality, in-hospital MI or reinfarction and revascularization (2.7% vs. 5.7%). Similarly, after adjustment, transradial PCI was associated with decreased risks for access site complications (OR = 0.3; 95% CI, 0.2-0.45), in-hospital MACE (OR = 0.72; 95% CI, 0.55-0.94) and major bleeding (OR = 0.45; 95% CI, 0.31-0.66).
Data from a propensity score matching analysis did not denote any differences in results.
The researchers noted that the proportion of patients requiring PCI after thrombolysis decreased significantly from 38% in 2007 to 1.2% in 2014. During the study, transradial access also became more common, increasing from 43% in 2009 to 82% in 2012. However, the use of PCI after thrombolysis, as well as access-site practice, varied significantly among regions.
A large evidence base demonstrating the benefits of transradial access as well as newer approaches will likely continue to boost its uptake, Sunil V. Rao, MD, FSCAI, FACC, associate professor of medicine at Duke University School of Medicine and Duke Clinical Research Institute and Cardiology Today’s Intervention Editorial Board member, and Surya Dharma, MD, PhD, from the National Cardiovascular Center Harapan Kita Hospital in Jakarta, Indonesia, noted in an accompanying editorial.
Moving forward, they wrote, current initiatives should encourage the use of transradial PCI in patients at higher risk for bleeding and focus on education and discussion of best practices.
Rao and Dharma also noted that innovation in equipment should focus on transradial endovascular and structural heart disease procedures. Additionally, as adoption of the transradial approach increases, efforts should be made to maintain proficiency in femoral access, they wrote. – by Melissa Foster
Disclosures: The authors and Dharma report no relevant financial disclosures. Rao reports he has served as a consultant for Medtronic.