The Prevalence and Outcomes of Transradial Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Abstract

Objectives The purpose of this study was to examine use and describe outcomes of radial access for percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Background Transradial PCI (TRI) is associated with reduced risk of bleeding and vascular complications, as compared with femoral access PCI (FPCI). Studies have suggested that TRI may reduce mortality among patients with STEMI. Methods We examined 294,769 patients undergoing PCI for STEMI at 1,204 hospitals in the CathPCI Registry between 2007 and 2011. Patients were grouped according to access site used for PCI. The temporal trend in the rate of radial versus femoral approach was determined. For minimization of confounding, an inverse probability weighting analysis incorporating propensity scores was used to compare procedural success, post-PCI bleeding, door-to-balloon times, and in-hospital mortality between radial and femoral access. Results Over the 5-year period, the use of TRI versus FPCI in STEMI increased from 0.9% to 6.4% (p < 0.0001). There was no difference in procedural success. TRI was associated with longer median door-to-balloon time (78 vs. 74 min; p < 0.0001) but lower adjusted risk of bleeding (odds ratio [OR]: 0.62; 95% CI: 0.53 to 0.72; p < 0.0001) and lower adjusted risk of in-hospital mortality (OR: 0.76; 95% CI: 0.57 to 0.99; p = 0.0455). Conclusions In this large national database, use of radial access for PCI in STEMI increased over the study period. Despite longer door-to-balloon times, the radial approach was associated with lower bleeding rate and reduced in-hospital mortality. These data provide support to execute an adequately powered randomized controlled trial comparing radial and femoral approaches for PCI in STEMI.

中国老年患者经桡动脉与股动脉介入治疗比较

“…Similar trends were observed in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Taken together with previous studies, [1][2][3][4][5][6][7][8][9] these results support the current recommendations for adoption of tranradial approach in patients undergoing PCI. [24][25][26] The prevalence of CAD is associated with increasing age.…”

“…29 Several strategies have been suggested to reduce the risk of post-PCI bleeding, including pharmacologic, technological, and procedural approaches. 30 As one of the procedural approaches, TRI has been shown to reduce bleeding by both observational 4,6,9 and random- Despite the advantages of transradial approach mentioned above, so far no study has examined the economic impact of TRI in elderly patients. In our previous analysis of TRI vs. TFI in all age groups, we found that TRI was associated with an average cost-saving of CNY8147.…”

“…Previous studies have demonstrated fewer access site-related bleeding and vascular complications, shorter length of stay, and better satisfaction in patients undergoing TRI. [1][2][3][4][5][6][7][8][9] Elderly patients with coronary artery disease (CAD) are a growing population who will benefit from PCI. Nevertheless, they are also reported to have a higher risk of access siterelated complications and post-procedural bleeding.…”

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

“…Although used less often in contemporary US practice, TRI is more commonly used in Europe and Asian countries 6, 7, 8. Despite widespread adoption, the impact of different access strategies on treatment costs and outcomes remain poorly defined.…”

Nonlinear Mathematics of Death and Vascular Access

“…Previous studies have suggested similar radial access-related reductions in the odds of death in selected PCI populations. [5][6][7] The authors use a complex statistical approach to mortality association that is not easily critiqued by a clinical interventional cardiologist (me): "Using the combined model estimates (across the 50 data sets) with the mimrgns command (and necessarily assuming that the random-effect of the model was zero), we calculated the probability of 30 day mortality by arterial access type, within each SHA and year, while setting all covariates at their mean value within each SHA year stratum." So, let's assume their model is statistically sound and move on from that point of humble ignorance.…”