Key result
Radial access for PCI is linked to ~30% lower 3-year mortality versus femoral access.
Why the study?
Published data regarding long-term mortality and major adverse cardiac events after percutaneous coronary intervention using radial versus femoral arterial access remained inconclusive.
Does radial arterial access reduce long-term all-cause mortality up to 3 years compared with femoral arterial access in adults undergoing first-ever percutaneous coronary intervention?
Cohort (n=14,614)
Yes
Does radial arterial access reduce long-term all-cause mortality up to 3 years compared with femoral arterial access in adults undergoing first-ever percutaneous coronary intervention?
In a large territory-wide propensity-matched cohort, radial arterial access for PCI was associated with sustained 3-year reductions in all-cause mortality, MACE, MI, and unplanned revascularization compared with femoral access, supporting a 'radial first' strategy.
Answers are grounded in this paper and cite their sources.
Radial access was associated with lower 3-year mortality after PCI; extends short-term safety data but leaves open causal confirmation in RCTs.
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.
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Ng et al. (2021) conducted a cohort in Coronary artery disease undergoing first-ever percutaneous coronary intervention (PCI) (n=14,614). Radial arterial access for percutaneous coronary intervention vs. Femoral arterial access for percutaneous coronary intervention was evaluated on All-cause mortality up to 3 years after index PCI (HR 0.70, 95% CI 0.63-0.78, p=<0.001). Radial arterial access for PCI was associated with a 30% lower risk of 3-year all-cause mortality compared with femoral access (7.6% vs 10.8%; HR 0.70, 95% CI 0.63-0.78, P<0.001).
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