Key result
In patients with prior CABG, transradial access reduced 30-day major vascular complications vs transfemoral access (OR 0.24; 95% CI 0.07-0.83) with no difference in 36-month MACE (28.6% vs 27.6%).
Why the study?
Little data are available on the effect of access strategy outcomes during cardiac catheterization in patients with prior CABG.
Does transradial access reduce major vascular complications and MACE compared to transfemoral access in patients with prior CABG undergoing cardiac catheterization?
Cohort (n=1,084)
No
Does transradial access reduce major vascular complications and MACE compared to transfemoral access in patients with prior CABG undergoing cardiac catheterization?
Odds Ratio: 0.24 (95% CI 0.07–0.83)
Absolute Event Rate: 0.7% vs 3%
p-value: p=.024
In patients with prior CABG undergoing cardiac catheterization, transradial access is associated with fewer short-term major vascular complications and lower contrast use compared to transfemoral access, without compromising long-term efficacy.
May reduce short-term vascular complications in prior CABG; observational data leave preference over transfemoral access open.
Little data are available on access strategy outcomes for cardiac catheterizations in patients with prior coronary artery bypass graft surgery (CABG). We investigated the effect of transradial access (TRA) and transfemoral access (TFA) on short-term major vascular complications (MVC) and long-term major adverse cardiovascular events (MACE). In this single-center, retrospective cohort study, 1084 patients met our inclusion criteria (TRA = 469; TFA = 615). The cumulative incidence for the primary safety endpoint MVC at 30 days (a composite of major bleeding, retroperitoneal hematoma, dissection, pseudoaneurysm, and arteriovenous fistula) was lower with TRA (0.7% vs 3.0%, P < .01) and this difference remained significant after propensity score adjustment (odds ratio: 0.24; 95% CI, 0.07-0.83; P = .024). The cumulative incidence for the primary efficacy endpoint MACE at 36 months (a composite of all-cause mortality, myocardial infarction, stroke, and urgent target vessel revascularization) was 28.6% with TRA and 27.6% with TFA, respectively. Kaplan-Meier curves showed no difference for the primary efficacy endpoint ( P = .65). Contrast use (mL) was significantly lower with TRA (130 [100-180] vs 150 [100-213], P < .01). In conclusion, in patients with prior CABG, TRA was associated with significantly fewer short-term MVC and contrast use, but not with a difference in long-term MACE, compared with TFA.
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Groenland et al. (2021) conducted a cohort in Prior coronary artery bypass graft surgery (CABG) requiring cardiac catheterization (n=1,084). Transradial access vs. Transfemoral access was evaluated on Major vascular complications (MVC) at 30 days (OR 0.24, 95% CI 0.07-0.83, p=.024). In patients with prior CABG, transradial access reduced 30-day major vascular complications vs transfemoral access (OR 0.24; 95% CI 0.07-0.83) with no difference in 36-month MACE (28.6% vs 27.6%).
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