A Randomized Comparison of the Transradial and Transfemoral Approaches for Coronary Artery Bypass Graft Angiography and Intervention

Michael, Tesfaldet T.; Alomar, Mohammed; Papayannis, Aristotelis; Mogabgab, Owen; Patel, Vishal; Rangan, Bavana V.; Luna, Michael; Hastings, Jeffrey L.; Grodin, Jerrold; Abdullah, Shuaib; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1016/j.jcin.2013.08.004

Cited by 115 publications

(30 citation statements)

References 31 publications

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“…Previous studies have shown radial access to be associated with many benefits, such as reductions in bleeding rates and major vascular complications 37, 38, 39, 40, 41, 42, 43. It is also the patient‐preferred arterial access site44, 45 and associated with lower cost 34, 36.…”

Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

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Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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“…Among these, contrast volume is a well-established, dose-dependent, and potentially modifiable risk factor for CIN[22]. Although there have been reports of greater contrast use with TRA and concerns about possible subsequent CIN from this more extensive dye load[2,7,24], our meta-analysis shows that the volume of contrast used is not higher among patients undergoing PCI with TRA compared to TFA.…”

Section: Discussionmentioning

confidence: 78%

“…However, data for the mean contrast used was available for only 13 RCTs, which used 3165 patients, and these were used for final analysis[4,5,7,11,13-20]. Figure 1 shows the search flow diagram.…”

Section: Resultsmentioning

confidence: 99%

“…However, CathPCI registry data suggest that adaption of TRA-PCI in patients with lower glomerular filtration rates (GFRs) is lower compared to patients with higher GFRs; one wonders if this could be the result of concern over the larger amount of contrast used in TRA compared to TFA[6]. Data from individual studies have been variable: Some show larger contrast volume is used with TRA[2,7], others show equal amounts used in both strategies[5,8], and yet others showless contrast used with TRA[3,9]. Therefore, we performed an updated comprehensive meta-analysis of randomized controlled trials (RCTs) comparing the amounts of contrast used in TRA and TFA during PCI.…”

Section: Introductionmentioning

confidence: 99%

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Contrast use in relation to the arterial access site for percutaneous coronary intervention: A comprehensive meta-analysis of randomized trials

Shah

Mattox

Khan

et al. 2017

WJC

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AIMTo compare the amount of contrast used during percutaneous coronary intervention (PCI) via trans-radial access (TRA) vs trans-femoral access (TFA).METHODSScientific databases and websites were searched for:randomizedcontrolledtrials (RCTs). Data were extracted by two independent reviewers and was summarized as the weighted mean difference (WMD) of contrast used with a 95%CI using a random-effects model.RESULTSThe meta-analysis included 13 RCTs with a total of 3165 patients. There was no difference between the two strategies in the amount of contrast used (WMD = - 0.65 mL, 95%CI: -10.94-9.46 mL; P = 0.901).CONCLUSIONThis meta-analysis shows that in patients undergoing PCI, the amount of contrast volume used was not different between TRA and TFA.

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“…14 There are also concerns that greater use of TRI and the reduced risk of access site bleeding may lead to more liberal use of antithrombotic agents with a subsequent rise in nonaccess site bleeding. 15 Moreover, as sites perform an increasing proportion of their cases via radial access, fluoroscopy times may be longer, 12,16 contrast use may be greater, 17 and there may be unintended negative consequences on femoral access management and complication rates, 18 raising concerns about safety tradeoffs with greater TRI use.…”

mentioning

confidence: 99%

Change in Hospital-Level Use of Transradial Percutaneous Coronary Intervention and Periprocedural Outcomes

Bradley

Rao

Curtis

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes. Methods and Results Within the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (P for interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36–0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58–0.74; P for comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories. Conclusions In a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.

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A Randomized Comparison of the Transradial and Transfemoral Approaches for Coronary Artery Bypass Graft Angiography and Intervention

Cited by 115 publications

References 31 publications

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Contrast use in relation to the arterial access site for percutaneous coronary intervention: A comprehensive meta-analysis of randomized trials

Change in Hospital-Level Use of Transradial Percutaneous Coronary Intervention and Periprocedural Outcomes

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