Abstract 17173: Reduced Bleeding Rates and Improved Clinical Outcomes With the Use of Radial Access in Octogenarians Undergoing Percutaneous Coronary Intervention
Background: Octogenarians undergoing PCI are at a higher risk of bleeding complications. The use of the radial artery for vascular access site has been proposed to lower the risk of bleeding in patients undergoing PCI. We sought to compare bleeding risks with transradial PCI vs transfemoral PCI in octogenarians undergoing PCI.
Methods And Results: We retrospectively analyzed a cohort of 891 consecutive octogenarians who underwent PCI between 2002 and 2007 at a tertiary care centre where the default vascular access is the radial artery. Bleeding events and long-term mortality were obtained by chart review and phone interview (98% complete). Outcomes of patients who underwent transradial PCI (n=779) were compared to those of patients who were treated from the femoral artery (n=112). Transfemoral patients more frequently had a history of heart failure (26.8% vs 18.7%;p=0.04), peripheral vascular disease (34.8% vs 19.2%;p=0.0003), prior CABG (26.8% vs 12.1%;p<0.0001), a lower creatinine clearance (41 vs 44 ml/min/1.73m2; p=0.04), and a lower baseline Hb value (121 vs 126;p=0.004). The use of GP2b3a inhibitors was more frequent in transradial patients (34.2 vs 24.1;p=0.03). After adjusting for confounders, transradial PCI was independently associated with less bleeding as assessed by several scores: TIMI (OR 0.42 95%CI[0.23–0.75]; p=0.003), GUSTO (OR 0.40 95%CI[0.25–0.62]; p<0.0001), REPLACE2 (OR 0.34 95%CI[0.22–0.53]; p<0.0001). Adjusted one-year mortality was lower with transradial PCI (HR 0.47 95%CI[0.30–0.73]; p=0.001).
Conclusion: In octogenarians undergoing PCI, the use of a transradial approach was associated with a lower risk of bleeding and improved one-year survival. This suggests that transradial PCI is an effective bleeding reduction strategy which may potentially reduce long-term mortality. Radial access should be encouraged in all patients with an increased bleeding risk, including octogenarians.
- © 2010 by American Heart Association, Inc.