SURF: Transradial access superior to transfemoral access in 30-day clinical outcomes

In the randomized SURF trial of unselected patients with CAD with or without ACS, transradial access was associated with better 30-day clinical outcomes than transfemoral access, according to data presented at EuroPCR.

Patients were also randomly assigned ultrasound guidance or standard guidance, and there was no difference between the approaches in clinical outcomes, but ultrasound guidance was linked to more favorable access-related results, researchers reported.

Phong Nguyen, MBBS, FRACP, from Western Sydney University in Australia, and colleagues conducted a randomized 2x2 factorial design trial in which 1,388 patients with CAD and with or without ACS were assigned to undergo PCI via transradial or transfemoral access and with ultrasound or standard guidance.

All operators had performed at least 50 PCIs with transradial access, at least 50 PCIs with transfemoral access and at least 10 proctored ultrasound-guided PCIs with transradial and transfemoral access, Nguyen said during a presentation.

The primary outcome was a composite of ACUITY major bleeding; MACE, defined as death, stroke, MI or urgent target lesion revascularization; and vascular complications at 30 days.

Secondary outcomes included access time, number of attempts, venipuncture, difficult accesses and first-pass success.

The primary outcome occurred in 1.3% of the transradial group compared with 3.5% of the transfemoral group (RR = 0.373; 95% CI, 0.171-0.813), according to the researchers.

The primary outcome most heavily favored the transradial group in patients with BMI of at least 25 kg/m² (RR = 0.22; 95% CI, 0.073-0.664), patients with diabetes (RR = 0.098; 95% CI, 0.012-0.77) and women (RR = 0.211; 95% CI, 0.046-0.979), Nguyen said.

There was no difference in the primary endpoint according to type of guidance overall (ultrasound, 2.3%; standard, 2.5%; RR = 0.895; 95% CI, 0.443-1.806) or in any subgroup, according to the researchers.

Compared with transfemoral access, transradial access had longer mean access time, more mean access attempts, longer procedural time, higher dose area product, more difficult accesses and fewer cases of venipuncture, Nguyen said.

Compared with standard guidance, ultrasound guidance had shorter mean access time, fewer mean access attempts, more first-pass successes, fewer difficult accesses and fewer cases of venipuncture, he said.

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“Transradial access is superior and reduces the composite outcome compared to transfemoral access, especially in diabetics, females and patients with BMI [of at least] 25 kg/m²,” Nguyen said during the presentation. “Ultrasound guidance increases success rates by reducing access time, attempts, number of difficult accesses and venipuncture and improving first-pass success.” – by Erik Swain

Reference:

Nguyen P, et al. Trials and registries – Peripheral interventions and techniques for access site. Presented at: EuroPCR; May 21-24, 2019; Paris.

Disclosure: Nguyen reports no relevant financial disclosures.