In‐hospital outcome differences between transradial and transfemoral coronary approaches: Data from the Korean percutaneous coronary intervention registry

Abstract

Objectives We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced. Background The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern. Methods Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in‐hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all‐cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed. Results The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55–0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33–0.60) and nonfatal MI (OR 0.66, 95% CI 0.54–0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59–0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST‐elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all). Conclusions Compared to TFI, TRI had favorable composite in‐hospital outcomes. TRI benefits were pronounced in high‐risk clinical settings and in high PCI volume centers.

Radial artery access among mainstays of contemporary percutaneous coronary intervention: Is it time to forget how to puncture a femoral artery?

“…The remarkable results favoring patients undergoing procedure by radial access encompassed all the endpoints at crude analysis . After multivariable adjustment or propensity score matching results remained essentially unchanged with strong risk reductions . The strength of this study is the confirmation of conclusions of previous smaller studies and randomized clinical trials with more stringent eligibility criteria in a large‐scale contemporary cohort.…”

“…The strength of this study is the confirmation of conclusions of previous smaller studies and randomized clinical trials with more stringent eligibility criteria in a large‐scale contemporary cohort. In particular, after propensity score matching the radial access group continued to show a lower risk of all‐cause death, nonfatal myocardial infarction, or need for transfusion (OR 0.63, 95% CI 0.55–0.72, p < .001) . By analyzing the individual endpoints, relevant conclusions came out but also unexpected findings .…”

“…In particular, after propensity score matching the radial access group continued to show a lower risk of all‐cause death, nonfatal myocardial infarction, or need for transfusion (OR 0.63, 95% CI 0.55–0.72, p < .001) . By analyzing the individual endpoints, relevant conclusions came out but also unexpected findings . Indeed, the reductions in the need for transfusions (OR 0.72, 95% CI 0.59–0.88, p < .001) and all‐cause death (OR 0.44, 95% CI 0.33–0.60, p < .001) in the radial access group were reasonable and consistent with previous evidence, while the lower risks of cardiac death (OR 0.41, 95% CI 0.27–0.63, p < .001), nonfatal myocardial infarction (OR 0.66, 95% CI 0.54–0.81, p < .001), and stroke (OR 0.48, 95% CI 0.25–0.93, p = .030) were more challenging to interpret and usually not observed in other nation‐wide registries after adjustment for between‐group imbalance in baseline characteristics .…”

“…In this issue, Ahn and colleagues present an elegant analysis from a nation‐wide contemporary cohort of 38,574 patients who underwent coronary angiography or PCI according to radial or femoral access in South Korea . The remarkable results favoring patients undergoing procedure by radial access encompassed all the endpoints at crude analysis . After multivariable adjustment or propensity score matching results remained essentially unchanged with strong risk reductions .…”

“…Unfortunately, in the study the magnitude of effects between groups could not be adequately assessed across the entire spectrum of vascular complications and bleeding variants. Indeed, the specific aim of investigating outcomes by transradial versus transfemoral procedure was not prespecified and the reporting design imposed a limited number of variables . For all these reasons, some findings need to be taken into account with caution in light of the following considerations.…”