Abstract 19592: Predictors of Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention in an Australian Cohort

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rosanna Tavella ◽  
Matthew Worthley ◽  
Margaret Arstall ◽  
Christopher Zeitz ◽  
John Beltrame
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Real World ◽  
South Australia ◽  
Coronary Intervention ◽  
Current Smoker ◽  
Bleeding Events ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary

Background: Extensive studies have been undertaken to define clinical predictors of bleeding events in patients undergoing percutaneous coronary intervention (PCI). Few studies have included a large cohort of ‘real world’ patients undergoing PCI via a radial approach. Methods: The Coronary Angiogram Database of South Australia (CADOSA) captures all PCI procedures performed in each public hospital in the state of South Australia (population 1.675 million). CADOSA utilizes identical data specifications to CathPCI® Registry. Thus a significant PCI-related bleeding event was defined as blood loss from any location (percutaneous entry site, retroperitoneal, gastrointestinal, genitourinary) within 72 hours of procedure, resulting in a fall in haemoglobin > 3.0g/dL, transfusion, or prolonged hospital admission. Clinical determinants of PCI-related bleeding events were identified in a multivariable logistic regression model. Results: In 2012, there were 1,409 PCI procedures performed, with 80% undertaken for acute coronary syndrome, 56% via radial access, 14% using bivalirudin/enoxaparin and 5% utilizing novel anti-platelet agents (prasugrel 5%, ticagrelor 0.1%). Of these procedures, 1.7% had significant bleeding events. Univariate determinants of bleeding included increasing age, female, current smoker, prior PCI, ST elevation MI presentation, femoral access, cardiogenic shock, intra-aortic balloon pump insertion and administration of clopidogrel, glycoprotein IIb/IIIa inhibitors, verapamil or metaraminol prior/during procedure. The final model identified the following clinical determinants as significant independent predictors of bleeding with a C-index of 0.87: age over 80 years (OR=10.7; 3.4-34.0, p<0.01), current smoker (OR=5.7; 2.0-16.5, p<0.01), the use of glycoprotein IIb/IIIa inhibitor (OR=3.9; 1.4-10.6, p<0.01), use of clopidogrel (2.7; 1.0-7.1, p<0.05) and femoral access site (OR=10.6; 3.1-37.1, p<0.01). Conclusion: In a ‘real world’, representative PCI cohort where radial access approach is frequently used, there was a low prevalence of bleeding events. In addition to access site, several distinctive baseline clinical features along with administration of blood thinning agents predicted bleeding.

scholarly journals Comparison of Radial and Femoral Percutaneous Coronary Intervention

2020 ◽  
Vol 18 (3) ◽  
pp. 366-372
Author(s):  
Mahesh Bhattarai ◽  
Arun Maskey ◽  
Ram Kishore Shah ◽  
Buna Bhandari ◽  
Chandramani Adhikari ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Heart Center

Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal. Keywords: Femoral; percutaneous coronary intervention; radial

scholarly journals Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jörg Reifart ◽  
Stefan Göhring ◽  
Alexander Albrecht ◽  
Winfried Haerer ◽  
Benny Levenson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Invasive Cardiology ◽  
Percutaneous Coronary

Abstract Background In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. Methods The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. Results From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). Conclusion Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

scholarly journals Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention

Circulation ◽  
2013 ◽  
Vol 127 (23) ◽  
pp. 2295-2306 ◽  
Author(s):  
Dmitriy N. Feldman ◽  
Rajesh V. Swaminathan ◽  
Lisa A. Kaltenbach ◽  
Dmitri V. Baklanov ◽  
Luke K. Kim ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary

Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction

2017 ◽  
Vol 130 (5-6) ◽  
pp. 182-189 ◽  
Author(s):  
Christiana Schernthaner ◽  
Matthias Hammerer ◽  
Stefan Harb ◽  
Matthias Heigert ◽  
Kurt Hoellinger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Access Site ◽  
Femoral Access ◽  
Percutaneous Coronary

P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tokarek ◽  
A Dziewierz ◽  
K Plens ◽  
T Rakowski ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Access Site ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary

Abstract Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09). Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

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