Transradial Versus Transfemoral Method of Percutaneous Coronary Revascularization for Unprotected Left Main Coronary Artery Disease: Comparison of Procedural and Late-Term Outcomes

Yang, Yuejin; Kandzari, David E.; Gao, Zhan; Xu, Bo; Chen, Jilin; Qiao, Shubin; Li, Jianjun; Qin, Xue-Wen; Yao, Min; Wu, Yongjian; Yuan, Jinqing; Chen, Jue; Liu, Hai-Bo; Dai, Jun; Chen, Tao; Wang, Yang; Li, Wei; Gao, Runlin

doi:10.1016/j.jcin.2010.09.003

Cited by 53 publications

(62 citation statements)

References 31 publications

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“…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.…”

Section: Discussionsupporting

confidence: 87%

“…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.…”

Section: Chinese Medical Sciences Journal September 2017mentioning

confidence: 99%

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中国老年患者经桡动脉与股动脉介入治疗比较

Jin

Qiao

et al. 2017

cmsj

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Objective To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years.Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases.Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%CI: CNY4419-10 420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days, 95%CI: 1.1-2.7 days), shorter post-procedural stay (0.7 days, 95%CI: 0.3-1.1 days), and fewer major adverse cardiac events (adjusted odds ratio = 0.47, 95%CI: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (P>0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina.Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

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Section: Discussionsupporting

confidence: 87%

Section: Chinese Medical Sciences Journal September 2017mentioning

confidence: 99%

中国老年患者经桡动脉与股动脉介入治疗比较

Jin

Qiao

et al. 2017

cmsj

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“…Of note, it has been proven that transradial PCI is feasible and associated with similar procedural success rates, as well as comparable long‐term clinical safety and efficacy for complex lesions and unprotected left main coronary artery disease 34, 35. Just as previously mentioned, patients taking OAC undergoing PCI receiving the triple therapy regimen were exposed to a high risk of bleeding, so that the current guidelines recommended the radial approach in these patients, due to concern about increased bleeding associated with femoral access.…”

Section: Discussionmentioning

confidence: 99%

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

Gao

Chen

Fan

et al. 2015

Clinical Cardiology

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The optimal antithrombotic regimen remains controversial in patients taking oral anticoagulation (OAC) undergoing coronary stenting. This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 0.82‐1.39, P = 0.65), all‐cause mortality (OR: 0.98, 95% CI: 0.76‐1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI: 0.77‐1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49‐1.69, P = 0.75) were similar between triple and dual therapy. Compared with dual therapy, triple therapy was associated with a reduced risk of ischemic stroke (OR: 0.57, 95% CI: 0.35‐0.94, P = 0.03) but with higher major bleeding (OR: 1.52, 95% CI: 1.11‐2.10, P = 0.01) and minor bleeding (OR: 1.59, 95% CI: 1.05‐2.42, P = 0.03). Subgroup analysis indicated there were similar ischemic stroke and major bleeding outcomes between triple therapy and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel was associated with similar efficacy and safety outcomes compared with triple therapy. Triple therapy could be replaced by OAC plus clopidogrel without any concern about additional risk of thrombotic events.

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“…Bifurcation angioplasty via the radial approach has been shown to be feasible and safe [14,15]. High success rates (>96%) of transradial unprotected left main artery stenting have been reported, and are associated with lower rates of vascular complications and bleeding [16][17][18]. The current literature suggests that high success rates of complex coronary procedures can be achieved with transradial access in experienced transradial operators.…”

Section: Pci Success In Transradial Versus Transfemoral Approach: Arementioning

confidence: 99%

Comparing radial and femoral access for coronary angiography and interventions

Hsieh

Jolly

2013

J. Compar. Effect. Res.

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Cardiac catheterization and coronary intervention via the radial approach is increasingly adopted as the preferred vascular access to avoid transfemoral vascular complications. Recent clinical trials have confirmed that radial access reduces vascular complications and local bleeding with similar procedural efficacy. Transradial access has inherent technical challenges, including smaller vessel size of the radial artery, arterial spasm and tortuosity involving the radial and subclavian arteries, which may undermine the procedural success of this approach. A number of strategies have been reported to minimize complications of radial access, including the use of hydrophilic introducer sheaths and smaller sheath sizes, administration of nitroglycerin and unfractionated heparin during the procedure, patent hemostasis of the radial artery and careful patient selection. Operators experienced in transradial percutaneous coronary intervention can achieve comparable clinical outcomes to the transfemoral approach and minimize vascular complications. Radial artery access is likely to become widely accepted as the preferred percutaneous coronary intervention approach.

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Transradial Versus Transfemoral Method of Percutaneous Coronary Revascularization for Unprotected Left Main Coronary Artery Disease: Comparison of Procedural and Late-Term Outcomes

Abstract: In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.

Cited by 53 publications

References 31 publications

中国老年患者经桡动脉与股动脉介入治疗比较

中国老年患者经桡动脉与股动脉介入治疗比较

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients

Comparing radial and femoral access for coronary angiography and interventions

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