Abstract 10742: Arterial Access Site and Outcomes in Patients Undergoing Percutaneous Coronary Intervention With and Without Vorapaxar
Background: Vorapaxar reduces ischemic events but increases the risk of major bleeding. We evaluated clinical outcomes associated with investigator-assigned transradial (TR) compared with a transfemoral (TF) vascular access with and without vorapaxar in ACS patients undergoing percutaneous coronary intervention (PCI) in the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial. We hypothesized that TR access lowers bleeding rates and consequently can improve the safety profile of vorapaxar.
Methods and Results: We compared 30-day and 2-year major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, stroke, recurrent ischemia with rehospitalization, and urgent coronary revascularization) and non CABG-related bleeding in 2192 TR and 4880 TF patients undergoing PCI after adjusting for confounding variables including the propensity to undergo radial access. Overall, 2-year GUSTO moderate/severe bleeding and non-CABG TIMI major/minor bleeding occurred less frequently in TR as compared to TF patients (3.4 vs 4.8%, p= 0.006; 3.4 vs 5.0%, p= 0.004; respectively). There was no difference in MACE (18.1 vs 21.0%, p=0.083), including the risk of stroke (1.3% vs 1.9%; p=0.198). Although bleeding rates were higher with vorapaxar (vs. placebo) in TF than TR patients, there was no significant treatment interaction. (Figure) In addition, the access site did not modulate the association between vorapaxar and MACE.
Conclusions: Compared to TF, TR access was associated with lower bleeding rates and similar long-term ischemic outcomes. These data suggest that radial access is a safer alternative to femoral access among ACS patients receiving potent antiplatelet therapies. Because of the non-randomized allocation of arterial access, these results should be considered exploratory.
- © 2013 by American Heart Association, Inc.