Abstract 12389: Safety and Efficacy of Radial vs Femoral Access for Percutaneous Coronary Interventions: A Propensity Score-Adjusted Analysis
Background: While RCTs have shown reduced bleeding outcomes with radial vs. femoral access following PCI performed for ACS, it is not clear if such benefit extends only to patients with ST-elevation acute coronary syndrome (STEACS).
Method: 5,628 PCI procedures performed between 12/2010 and 09/2012 in 2 large hospitals were analyzed for a primary composite bleeding endpoint. Secondary outcome of death/myocardial infarction/stroke and a composite of bleeding/death/myocardial infarction/stroke were analyzed. Composite bleeding endpoint was defined as any access site or nonaccess site bleeding. In-hospital outcomes defined by ACC-NCDR data definitions were used. A propensity score adjusted analysis separately for the overall population (n=5,628) and in patients with ACS (n=4,385) was performed. ACS subgroup analysis with Bonferroni correction was performed.
Results: Of 5,628 PCI procedures, 3,899 were performed via femoral access and 1,729 via radial access. Primary composite bleeding endpoint was significantly reduced in patients with radial access (1.28% vs. 0.35%, p=0.001). After propensity score adjustment, composite bleeding endpoint was significantly reduced in patients with radial access (OR 0.34, 95% CI 0.14-0.82, p=0.02). However, secondary outcomes were not significantly different between both groups. In patients with ACS (n=4,385), 3,157 had femoral access and 1,228 had radial access. A propensity score adjusted analysis showed that patients with NSTEACS had a significant reduction in composite bleeding endpoint (OR 0.24, 95% CI 0.07-0.79, p=0.02) where as patients with STEACS had no significant reduction in composite bleeding endpoint. The secondary outcomes were not significantly different in both ACS subgroups.
Conclusion: In this observational registry, reduction in bleeding outcomes was seen in the overall population and in patients NSTEACS subgroup of ACS patients with no significant reduction in secondary outcomes.
- © 2013 by American Heart Association, Inc.