Radial vs Femoral Access for Coronary Angiography and Intervention in the Elderly (>75) - A Meta-Analysis (original) (raw)
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Radial vs. Femoral Artery Access in Elderly Patients Undergoing Percutaneous Coronary Intervention
Revista Brasileira de Cardiologia Invasiva (English Version), 2014
Background: Studies demonstrate that radial artery access reduces the risk of vascular and bleeding complications associated to percutaneous coronary intervention. Our objective was to evaluate in-hospital results of the transradial approach in elderly patients undergoing percutaneous coronary intervention. Methods: Prospective registry including patient's ≥ 70 years of age; safety and efficacy endpoints were compared for the radial and femoral artery access groups. Results: We included 255 patients, 117 (52%) treated using the radial approach and 108 using the femoral approach. Except for age, the remaining clinical characteristics did not show differences between groups. Male patients prevailed (60%), 36.7% were diabetic and over one third were diagnosed with acute coronary syndrome. Angiographic and procedure-related variables did not show differences between groups. When vascular complication rates were compared only hematomas < 5 cm (5.1% vs. 17.6%; p < 0.01) were more prevalent with the femoral access. Major bleedings, according to the ACUITY criteria (zero vs. 5.6%; p = 0.01) and minor bleedings, according to the TIMI criteria (zero vs. 7.4%; p < 0.01), were also more frequent in the femoral group. In-hospital clinical endpoints, death (0.9% vs. 5.6%; p = 0.06) and non-fatal infarction (zero vs. 3.7%; p = 0.05) were more frequent in patients treated by the femoral access. Conclusions: In a non-selected patient population ≥ 70 years of age, percutaneous coronary intervention by radial access was associated to a lower incidence of in-hospital clinical endpoints, especially of bleeding events related to the vascular access route.
Indian Heart Journal, 2020
Background: This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of trans-radial access for primary percutaneous coronary interventions (PCI) in patients with ST-segment evaluation myocardial infarction (STEMI). Methods: In this study, we compared two propensity-matched cohorts of patients who underwent primary PCI via trans-radial (TRA) and trans-femoral access (TFA) in a 1:1 ratio. The profile of two cohorts was matched for gender, age, and body mass index, diabetes, hypertension, family history, and smoking. The outcomes of primary PCI were compared for the two cohorts which included all-cause in-hospital mortality, heart failure, re-infarction, cardiogenic shock, bleeding, transfusion, cerebrovascular accident, and dialysis. Results: This analysis was performed on a total of 2316 patients with 1158 patients each in the TRA and TFA group. We observed significantly lower rates of mortality, 0.8% (9) vs. 3.5% (41); p < 0.001 and bleeding, 0.5% (6) vs.1.6% (19); p ¼ 0.009 with shorter hospital stay, 1.61 ± 1.39 vs. 1.98 ± 1.5 days, in trans-radial vs. trans-femoral. However, both fluoroscopic time and contrast volume were significantly higher in the TRA as compared to TFA group 15.57 ± 8.16 vs. 12.79 ± 7.82 min; p < 0.001 and 143.22 ± 45.33 vs. 133.78 ± 45.97; p < 0.001 respectively. Conclusions: Compared with TFA access, TRA for primary PCI is safe for patients with STEMI, it was found to be associated with a significant reduction in in-hospital mortality and bleeding complications.
Safety and Efficacy of Femoral Access vs Radial Access in ST-Segment Elevation Myocardial Infarction
JAMA Cardiology
IMPORTANCE Among patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI), a survival benefit associated with radial access compared with femoral access remains controversial. OBJECTIVE To assess whether there is a survival benefit when radial access is used instead of femoral access among patients with STEMI referred for primary PCI. DESIGN, SETTING, AND PARTICIPANTS This multicenter, open-label, randomized clinical trial was conducted at 5 PCI centers in Canada. In total, 2292 patients with STEMI referred for primary PCI were enrolled between July 2011 and December 2018, with a 30-day follow-up. The primary analyses were conducted based on the intention-to-treat population. INTERVENTIONS Patients were randomized to radial access (n = 1136) or to femoral access (n = 1156) for PCI. MAIN OUTCOMES AND MEASURES Initially, the primary outcome was bleeding, but this outcome was modified to 30-day all-cause mortality following the recommendation of the granting agency. Secondary outcomes included recurrent myocardial infarction, stroke, and Thrombolysis in Myocardial Infarction-defined major or minor bleeding. RESULTS Among the 2292 patients enrolled, the mean (SD) age of the patients randomized to radial access was 61.6 (12.3) years and to femoral access was 62.0 (12.1) years, with 883 male patients in the radial access and 901 male patients in the femoral access group. The trial was stopped early following a futility analysis. Primary PCI was performed in 1082 of 1136 patients (95.2%) in the radial access group and 1109 of 1156 patients (95.9%) in the femoral access group. Bivalirudin was administered to 1001 patients (88.1%) in the radial access group and to 1068 patients (92.4%) in the femoral access group, whereas glycoprotein IIb/IIIa inhibitors were administered in only 69 patients (6.1%) in the radial access group and 68 patients (5.9%) in the femoral access group. A vascular closure device was used in 789 patients (68.3%) in the femoral group. The primary outcome, 30-day all-cause mortality, occurred in 17 patients (1.5%) assigned to radial access and in 15 patients (1.3%) assigned to femoral access (relative risk [RR], 1.15; 95% CI, 0.58-2.30; P = .69). There were no significant differences between patients assigned to radial and femoral access in the rates of reinfarction (1.8% vs 1.6%; RR, 1.07; 95% CI, 0.57-2.00; P = .83), stroke (1.0% vs 0.4%; RR, 2.24; 95% CI, 0.78-6.42; P = .12), and bleeding (1.4% vs 2.0%; RR, 0.71; 95% CI, 0.38-1.33; P = .28). CONCLUSIONS AND RELEVANCE No significant differences were found for survival or other clinical end points at 30 days after the use of radial access vs femoral access in patients with STEMI referred for primary PCI. However, small absolute differences in end points cannot be definitively refuted given the premature termination of the trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01398254
Circulation, 2013
P ercutaneous coronary intervention (PCI) has traditionally been performed using femoral arterial access. 1 Risks associated with transfemoral PCI (f-PCI) include access site bleeding and major vascular complications, which are associated with a risk of subsequent morbidity, mortality, and costs. 2 Alternative vascular access sites for PCI include the brachial, radial, and ulnar arteries. 3 Data from singlecenter and small randomized trials comparing transradial PCI (r-PCI) with the femoral approach suggested a lower rate of bleeding and vascular complications associated with r-PCI. 4 More recently, a large randomized trial of patients with acute coronary syndrome (ACS) undergoing coronary angiography or intervention, demonstrated that both radial and femoral approaches were equally effective and safe, with a lower rate of vascular complications in the radial approach cohort. 5 In addition, the high-risk subgroup of patients with ST-segment elevation myocardial infarction had a reduction in cardiovascular events, driven by an apparent reduction in mortality in the r-PCI group. A subsequent meta-analysis of observational and randomized studies showed that r-PCI was associated with a 78% reduction in bleeding in comparison with f-PCI. 6 Despite this growing body of evidence, data from Background-Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. Methods and Results-We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49-0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31-0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. Conclusions-There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.
The Journal of Invasive Cardiology, 2014
an optimal strategy to re-open the occluded coronary artery (culprit vessel) and improves the outcomes of patients with ST-elevation myocardial infarction (STEMI). 1-3 Access-site selection is an important procedural issue in PPCI. Transfemoral approach (TFA) has been associated with higher rate of access-site bleeding and vascular complications in comparison with transradial approach (TRA). This has been particularly evident with the aggressive use of antithrombotic and antiplatelet treatment in patients with acute coronary syndrome. 4,5 Vascular access-site complications have been shown to be associated with worse outcomes. Whether there is a possibility to further improve the outcomes with preferred radial access instead of femoral access in an all-comer STEMI population remains to be assessed.
International Journal of Cardiology, 2016
Background: Trans-radial access for percutaneous coronary intervention (PCI) has been associated with lower vascular complication rates and improved outcomes. We assessed the current uptake of trans-radial PCI in Victoria, Australia, and evaluated if patients were selected according to baseline bleeding risk in contemporary clinical practise, and compared selected clinical outcomes. Methods: PCI data of all patients between 1st January 2013 and 31st December 2014 were analysed using The Victorian Cardiac Outcomes Registry (VCOR). Propensity-matched analysis was performed to compare the clinical outcomes. Results: 11,711 procedures were analysed. The femoral route was the predominant access site (66%). Patients undergoing trans-radial access PCI were younger (63.9 ± 11.6 vs. 67.2 ± 11.8; p b 0.001), had a higher BMI (28.9 ± 5.5 vs. 28.5 ± 5.2; p b 0.001), more likely to be male (80.0 vs. 74.9%;p b 0.001), less likely to have presented with cardiogenic shock (0.9 vs. 2.8%; p b 0.001) or have the following comorbidities: diabetes (19.8 vs. 23.1%; p b 0.001), peripheral vascular disease (2.9 vs. 4.3%; p = 0.005) or renal impairment (13.6 vs. 22.1%; p b 0.001). The radial group had less bleeding events (3.2 vs. 4.6%; p b 0.001) and shorter hospital length of stay (3.1 ± 4.7 vs. 3.3 ± 3.9; p = 0.006). There was no significant difference in mortality (1.0 vs. 1.4%; p = 0.095). Conclusions: Trans-femoral approach remains the dominant access site for PCI in Victoria. The choice of route does not appear to be selected by consideration of bleeding risk. The radial route is associated with improved clinical outcomes of reduced bleeding and length of stay consistent with previous findings, and this supports the efficacy and safety of trans-radial PCI in real-world clinical practise.
Circulation, 2013
Background— Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. Methods and Results— We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quart...
Journal of Cardiology & Current Research, 2018
Objectives: This study sought to assess whether transradial access improves clinical outcomes in patients with ST-segment elevation acute myocardial infarction (STEMI) compared with conventional transfemoral access. Background: In patients with STEMI the radial approach for PCI has been suggested to improve the prognosis due to a lower rate of vascular complications in comparision with femoral approach. Methods: This is a single-center, observational registry of all STEMI patients who underwent emergent coronary angiography between January 2016 to January 2017. The primary endpoint was the 30-day rate of net adverse clinical events (NACE), defined as a composite of death, MI, stroke, target vessel revascularization, BARC bleeding ≥3 and vascular complications. Secondary endpoints were 30-day individual components of NACEs and length of hospital stay. Results: The primary endpoint of 30-day NACE occurred in 6.4 % of the radial group (n: 218) and 12.1 % of the femoral group (n: 182; p=0.049). Compared with femoral, radial access was associated with significantly lower rates of BARC bleeding ≥3 (0.9 vs 3.8%, p=0.049) and shorter intensive coronary unit stay (2.04±2.3 vs 2.5±2.56, p=0.001). Mortality, stroke and myocardial infarction were similar in both groups. Multivariate regression analysis identified femoral approach as the only independent predictor of 30-day NACE (OR: 2.2; 95% CI: 1.0 to 4.7; p = 0.032). Conclusion: In patients with STEMI undergoing emergent PCI, radial access reduces net adverse clinical events, trough a reduction in BARC bleeding ≥3. The study supports the preferential use of radial access for STEMI PCI.
European Heart Journal. Acute Cardiovascular Care
Objectives The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. Results During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of...