Abstract 985: The Influence of the Arterial Access Site and its Management on Bleeding Events in Acute Coronary Syndromes in TRITON - TIMI 38
Background: Bleeding during acute coronary syndromes (ACS) is associated with worse prognosis. TRITON - TIMI 38 was designed for all patients to have cardiac catheterization, providing an opportunity to evaluate the effects of arterial access site and management on the rates of hemorrhage.
Methods: TRITON - TIMI 38 included 13608 patients with ACS; 99% underwent PCI at the time of randomisation. We compared the incidence of non-CABG TIMI major and minor bleeding between three groups: radial artery access (RAA), and femoral artery access with (FAA-CD) and without the use of an arterial closure device (FAA-NC).
Results: FAA was used in 12273 (92%) of patients undergoing angiography. FAA-CD was used in 3842 (31%) of FAA. RAA was used in 1120 patients (8%). Compared to FAA, patients with RAA had less prior CAD (MI, PCI or CABG) less frequently received drug-eluting stents and glycoprotein IIb/IIIa inhibitors (GPI). Femoral closure devices were used more often in patients > 90 kg, with a GPI and less frequently in patients chronic kidney disease or prior atherosclerosis (MI, stroke, PAD). TIMI non-CABG major bleeding was non-significantly less frequent with RAA. RAA was associated with a lower rate of TIMI major or minor non-CABG instrumented bleeding (Table⇓, HR 3.09; P=0.004) and blood transfusion (Table⇓; HR 2.05; P=0.002). The rates of spontaneous bleeding were not affected by the site of the arterial access. (Table⇓). FAA-CD had similar bleeding and transfusion rates to FAA-NC. (Table⇓). The previously reported higher rates of bleeding and transfusion with prasugrel were limited to FAA.
Conclusions: In this large group of patients undergoing PCI for ACS, RAA, but not femoral closure devices, were associated with significantly lower rates of instrumented bleeding and transfusion and attenuated the bleeding differences between prasugrel or clopidogrel. A strategy of RAA in the presence of intensive antiplatelet therapy warrants further study to reduce bleeding complications.