Abstract 12423: Adoption of Radial Access and Comparison of Outcomes to Femoral Approach in Percutaneous Coronary Intervention: An Updated Report From the NCDR® (2007-2011)
Background: Prior reports have shown slow uptake of transradial percutaneous coronary intervention (r-PCI) in the US despite its widespread dissemination outside the US and association with lower rates of bleeding and vascular complications.
Methods: Data from the CathPCI Registry® (N=1,776,625 procedures from 1,248 sites) between January 2007 and September 2011 were analyzed to evaluate temporal trends and procedural outcomes associated with r-PCI. Logistic regression was used to evaluate the adjusted association between r-PCI and procedural success, bleeding, and vascular complications using femoral approach (f-PCI) as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome (ACS) were also examined.
Results: The proportion of r-PCI procedures increased from 1.3% in Quarter 1 2007 to 12.7% in Quarter 3 2011 and accounted for 4.7% of total procedures from 2007-2011 (n=83,708). Compared to f-PCI, patients undergoing r-PCI were younger, less often female, and less often had medical comorbidities like chronic kidney disease, prior MI, prior PCI, and prior CABG. They were also more likely to present with stable angina rather than NSTE ACS or STEMI. After adjustment, r-PCI use was associated with greater procedural success, lower risk of bleeding, and lower risk of vascular complications compared with f-PCI (Figure). The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation.
Conclusions: Due to continuous growth of r-PCI over 4 years, r-PCI accounts for 1 out of 8 PCIs performed in contemporary US clinical practice. Radial PCI is associated with greater procedural success and lower complication rates. Its continued preferential use in younger patients, males, and those with lower risk clinical features presents an opportunity to improve overall PCI safety by increasing its application to higher risk patients.
- © 2012 by American Heart Association, Inc.