Document Detail


Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience.
MedLine Citation:
PMID:  19061699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Studies evaluating the efficacy and safety of the transradial approach for percutaneous coronary intervention (PCI) were carried out mainly before the widespread use of stents and glycoprotein (GP) IIb/IIIa inhibitors. We sought to determine the association between the choice of the vascular access site and procedural complications after PCI performed with routine stenting and GP IIb/IIIa inhibition. METHODS: The data source was a prospective registry of 13,499 consecutive cases of PCI at the University Health Network, Toronto, Canada, from April 2000 to September 2006. Logistic regression was used to calculate the probability of selection to the radial access group. Using propensity score methodology, 3,198 patients with femoral access were randomly matched to 3,198 patients with radial access based on clinical, angiographic, and procedural characteristics. Multivariable logistic regression analysis was used to identify the independent predictors of access site-related complications. Major adverse cardiac event was defined as death, myocardial infarction, abrupt vessel closure, or coronary artery bypass surgery. RESULTS: Use of the transradial approach was associated with fewer vascular access complications (1.5% vs 0.6%, P<.001) and a shorter length of hospital stay. Multivariable analysis revealed transradial access (OR 0.39, 95% CI 0.2-0.7) to be an independent predictor of lower risk, whereas primary PCI (OR 4.36, 95% CI 1.4, 13), recent myocardial infarction (OR 2.0 95% CI 1.2, 3.4), age (per 10 years increase: OR 1.37, 95% CI 1.1-1.7) and female gender (0R 2.78 95% CI 1.7, 4.6) were independent predictors of a higher risk of access site complications. CONCLUSIONS: Use of transradial access for PCI is safe and is independently associated with a reduced rate of in-hospital access site complications and reduced length of hospital stay.
Authors:
Jonas Eichhöfer; Eric Horlick; Joan Ivanov; Peter H Seidelin; John R Ross; Douglas Ing; Paul Daly; Karen Mackie; Brenda Ridley; Leonard Schwartz; Alan Barolet; Vladimír Dzavík
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-12-08     Completed Date:  2009-01-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  864-70     Citation Subset:  AIM; IM    
Affiliation:
Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*,  methods*
Female
Femoral Artery*
Humans
Male
Middle Aged
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Radial Artery*
Registries
Stents
Chemical
Reg. No./Substance:
0/Platelet Glycoprotein GPIIb-IIIa Complex
Comments/Corrections
Comment In:
Am Heart J. 2008 Nov;156(5):805-7   [PMID:  19061690 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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