A Comparison of Transradial and Transfemoral Percutaneous Coronary Intervention in Chinese Women Based on a Propensity Score Analysis

Abstract

Background and ObjectivesOver the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China.MethodsThe study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched.ResultsBaseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p<0.001) and access site complications (OR, 0.67; 95% CI, 0.61–0.74; p<0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) both during hospitalization and at 1-year follow-up (p>0.05).ConclusionsIn this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.

Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis

“…Since then rapid advances in this technique and related devices have catapulted transradial intervention (TRI) to an internationally accepted benchmark and a clinically viable approach to PCIs [8][9][10][11]. A series of studies have demonstrated the superiority of TRI compared to conventional transfemoral intervention (TFI) in terms of reduced risk of adverse outcomes and shorter lengths of hos-pital stays [12][13][14][15][16][17][18][19][20][21][22][23]. A recent Scientific Statement from the American Heart Association highlights these advantages and recommends TRI even in patients with acute coronary syndrome (ACS) [24].…”

The Transradial Approach for Coronary Intervention: More Comfort, Better Outcome

“… 3) 4) 5) Furthermore, the radial approach is technically more difficult in women than in men because of their smaller-caliber radial artery and higher risk of radial artery spasm. In this issue of the Korean Circulation Journal , 6) the investigators compared the safety and efficacy of transradial and transfemoral PCI in Chinese women. In 899 propensity score-matched patients, transradial PCI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p<0.001) and access site complications (OR, 0.67; 95% CI, 0.61–0.74; p<0.001).…”