Key result
The transradial approach for PCI was associated with lower in-hospital bleeding (1.8% vs 5.1%) and a reduced 4-year risk of death, MI, TVR, or CABG (HR 0.62; 95% CI 0.55-0.70) in the 2013-2017 period.
Why the study?
Although the transradial approach has increasingly been adopted for PCI with reported clinical benefits, little is known regarding the change in outcomes over time.
Does the transradial approach improve clinical outcomes compared to the transfemoral approach in patients undergoing percutaneous coronary intervention?
Cohort (n=15,429)
No
Does the transradial approach improve clinical outcomes compared to the transfemoral approach in patients undergoing percutaneous coronary intervention?
Hazard Ratio: 0.62 (95% CI 0.55–0.7)
p-value: p=<0.0001
The transradial approach for PCI has increasingly been adopted over time and is associated with consistent short- and long-term clinical benefits, including reduced bleeding and ischemic events.
May support transradial PCI preference to curb bleeding; extends observational data but leaves causality open.
OBJECTIVE: The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. PATIENTS AND METHODS: From our large single-center PCI registry, we have analyzed 15 429 patients in two periods - 2008-2012 (period 1) and 2013-2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. RESULTS: The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P < 0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P < 0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR) = 0.86; 95% confidence interval (CI): 0.77-0.96; P = 0.007, during period 1 and HR = 0.62; 95% CI 0.55-0.7; P < 0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR = 0.69, 95% CI: 0.59-0.81, P < 0.001). CONCLUSION: Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients - a course which is associated with consistent short and long-term clinical benefits.
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Perl et al. (2019) conducted a cohort in percutaneous coronary interventions (n=15,429). Transradial approach vs. Transfemoral artery approach was evaluated on Composite of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery at 4 years (2013-2017 period) (HR 0.62, 95% CI 0.55-0.7, p=<0.0001). The transradial approach for PCI was associated with lower in-hospital bleeding (1.8% vs 5.1%) and a reduced 4-year risk of death, MI, TVR, or CABG (HR 0.62; 95% CI 0.55-0.70) in the 2013-2017 period.
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