Abstract 10358: Radial versus Femoral Approach in Non-ST Elevation ACS: Lessons From EARLY
Background: EARLY-ACS patients (pts) with non-ST elevation acute coronary syndromes (NSTEACS) were randomized to early vs delayed provisional eptifibatide: pts subsequently underwent an invasive strategy. Because this was performed at 440 centers in 29 countries it offered a unique opportunity to examine the use of radial vs femoral vascular access for coronary angiography.
Methods: Selected pt and procedural characteristics and pre-specified efficacy and safety outcomes were available in 9126 pts undergoing angiography (60% of whom subsequently underwent PCI) were examined according to the investigator-determined route of vascular access. The association between vascular access and outcomes was assessed using multivariate logistic regression accounting for pt and procedural characteristics.
Results: Femoral access was more common in older, female pts and those with high-risk baseline characteristics and prior CABG/PCI (Table). Although time to the start of PCI was slightly delayed with radial access, overall procedure time for PCI was shorter. Radial access was higher in non-US countries relative to the US (17.0% versus 2.2%, p<0.001). Whereas procedural success was equal in both groups (96%), there was a trend towards increased 30-day death/MI in radial access pts (adjusted OR 1.19, 95% CI 0.99–1.43 p=0.066). Although there was no overall difference in TIMI/GUSTO bleeding rates, a trend towards less frequent red-blood-cell transfusion occurred with radial access (adjusted OR 0.79, 95%CI 0.61–1.04 p=0.09).
Conclusions: These data highlight the profound differences in baseline characteristics of ACS pts preferentially receiving radial versus femoral catheterization. Although radial access was only employed in 13.1%, substantial regional differences existed especially relating to the US vs other countries. The potential trade-offs in efficacy and safety of differing vascular access routes for angiography in pts with ACS deserves further study.
- © 2010 by American Heart Association, Inc.