A-31 | Percutaneous Coronary Intervention Access Site in Acute Coronary Syndrome Patients Treated with Glycoprotein IIb/IIIa Inhibitors During: A Contemporary Assessment

Trials conducted in the era of dual antiplatelet therapy failed to demonstrate a beneficial effect of the routine use of glycoprotein (Gp) IIb/IIIa inhibitors in percutaneous coronary intervention (PCI) patients (pts), mainly due to an increased risk of access site bleeding complications. Radial access may obviate the bleeding risk associated with Gp IIb/IIIa.The aim of the study was to assess major bleeding and major adverse cardiac and cerebrovascular events (MACCE) in PCI pts treated with Gp IIb/IIIa inh, divided by radial vs. femoral access. Data was collected for quality assurance on all PCI pts. Bleeding was classified by a modified Bleeding Academic Research Consortium (BARC). Major bleeding was BARC ≥3. MACCE was the composite of BARC ≥3, mortality, myocardial infarction and stroke. Between 2010 to 2018, 2157 PCI pts received Gp IIb/IIIa inh, 921 radial access (42.7%) and 1236 (57.3%) femoral access (Table). Femoral access pts were older, likely female, had more comorbidities and often presented with NSTEMI or STEMI (68%). Femoral access pts had >3-fold major bleeding and mortality rates when compared with radial access pts. Multivariable model demonstrated that femoral access, older age, females and assist devices had greater odds of MACCE. In a contemporary database of PCI pts treated with Gp IIb/IIIa inh: 1) femoral access still is the default access for sicker pts, particularly in STEMI; 2) femoral access pts had worse outcomes with higher mortality, BARC ≥3 and MACCE; and 3) by covariate adjustment, femoral access, age, female gender and the use of ventricular assist devices had greater odds of MACCE.