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

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

Download Full-text

O214 State Variation in Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention

Global Heart ◽

10.1016/j.gheart.2014.03.1419 ◽

2014 ◽

Vol 9 (1) ◽

pp. e59-e60

Author(s):

Matthew Worthley ◽

Rosanna Tavella ◽

Philippa Loane ◽

Angela Brennan ◽

Chris Zeitz ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Femoral Access ◽

Radial Access ◽

Percutaneous Coronary ◽

State Variation

Download Full-text

Association Between Radial Versus Femoral Access for Percutaneous Coronary Intervention and Long‐Term Mortality

Journal of the American Heart Association ◽

10.1161/jaha.121.021256 ◽

2021 ◽

Author(s):

Andrew Kei‐Yan Ng ◽

Pauline Yeung Ng ◽

April Ip ◽

Man‐Hong Jim ◽

Chung‐Wah Siu

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Cardiac Events ◽

Femoral Access ◽

Arterial Access ◽

Radial Access ◽

Adverse Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality

Background Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long‐term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory‐wide retrospective cohort study including 26 022 patients who underwent first‐ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all‐cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all‐cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63–0.78; P <0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73–0.83, P <0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70–0.87, P <0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68–0.85, P <0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82–1.13, P =0.655). Conclusions Radial access was associated with a significant reduction in all‐cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.

Download Full-text

Radial artery access is associated with lower mortality in patients undergoing primary PCI: a report from the SWEDEHEART registry

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620908032 ◽

2020 ◽

Vol 9 (4) ◽

pp. 323-332 ◽

Cited By ~ 1

Author(s):

Christian Dworeck ◽

Björn Redfors ◽

Sebastian Völz ◽

Inger Haraldsson ◽

Oskar Angerås ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiogenic Shock ◽

Primary Percutaneous Coronary Intervention ◽

Lower Risk ◽

Coronary Intervention ◽

Femoral Access ◽

Risk Of Death ◽

Radial Access ◽

Percutaneous Coronary ◽

St Elevation

Objectives The purpose of this observational study was to evaluate the effects of radial artery access versus femoral artery access on the risk of 30-day mortality, inhospital bleeding and cardiogenic shock in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods We used data from the SWEDEHEART registry and included all patients who were treated with primary percutaneous coronary intervention in Sweden between 2005 and 2016. We compared patients who had percutaneous coronary intervention by radial access versus femoral access with regard to the primary endpoint of all-cause death within 30 days, using a multilevel propensity score adjusted logistic regression which included hospital as a random effect. Results During the study period, 44,804 patients underwent primary percutaneous coronary intervention of whom 24,299 (54.2%) had radial access and 20,505 (45.8%) femoral access. There were 2487 (5.5%) deaths within 30 days, of which 920 (3.8%) occurred in the radial access and 1567 (7.6%) in the femoral access group. After propensity score adjustment, radial access was associated with a lower risk of death (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.55–0.88, P = 0.025). We found no interaction between access site and age, gender and cardiogenic shock regarding 30-day mortality. Radial access was also associated with a lower adjusted risk of bleeding (adjusted OR 0.45, 95% CI 0.25–0.79, P = 0.006) and cardiogenic shock (adjusted OR 0.41, 95% CI 0.24–0.73, P = 0.002). Conclusions In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention by radial access rather than femoral access was associated with an adjusted lower risk of death, bleeding and cardiogenic shock. Our findings are consistent with, and add external validity to, recent randomised trials.

Download Full-text

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

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02283-0 ◽

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.

Download Full-text

In patients undergoing percutaneous coronary intervention with rotational atherectomy radial access is safer and as efficient as femoral access

Journal of Interventional Cardiology ◽

10.1111/joic.12496 ◽

2018 ◽

Vol 31 (4) ◽

pp. 471-477

Author(s):

Piotr Kübler ◽

Wojciech Zimoch ◽

Michał Kosowski ◽

Brunon Tomasiewicz ◽

Artur Telichowski ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Rotational Atherectomy ◽

Femoral Access ◽

Radial Access ◽

Percutaneous Coronary

Download Full-text

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

Circulation ◽

10.1161/circ.130.suppl_2.19592 ◽

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.

Download Full-text

Radial access versus femoral access in myocardial infarction – a single-center experience

Slovenian Medical Journal ◽

10.6016/zdravvestn.2849 ◽

2019 ◽

Vol 88 (7-8) ◽

pp. 327-337

Author(s):

Vojko Kanič ◽

Igor Balevski ◽

Samo Granda ◽

Franjo Husam Naji ◽

Igor Krajnc ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Confounding Factors ◽

Femoral Access ◽

Radial Access ◽

Single Center Experience ◽

Contrast Volume ◽

Percutaneous Coronary ◽

The Difference

Background Data on the relationship between radial access (RA) and outcome in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) are inconclusive. The aim of our study was to assess whether RA is associated with 30-day mortality in patients with MI undergoing percutaneous coronary intervention in our center or whether the possible benefit of RA is the result of less bleeding and other confounding factors. Methods We retrospectively studied 3501 consecutive patients with MI who underwent PCI between January 2012 and December 2016. The 30-day mortality in the RA and femoral access (FA) groups was observed. Data were analyzed using descriptive statistics. Results RA patients had a significantly lower 30-day unadjusted mortality [53(3.8%) patients died in the RA group compared to 207(9.8%) patients in the FA group; p<0.0001]. After adjustments for confounders, the difference was no longer significant (adjusted OR: 0.84; 95% CI: 0.58 to 1.22). Cardiogenic shock, age over 70 years, hypertension, hyperlipidemia, anemia on admission, renal dysfunction on admission, ST-elevation MI, bleeding, the contrast volume/GFR ratio, but not RA, predicted 30-day mortality. Conclusion RA was not associated with 30-day mortality in patients with MI undergoing PCI. Our study result suggests that the better outcome in the RA group was influenced by confounding factors, especially bleeding and hemodynamic impairment.

Download Full-text