Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications

Rafie, Ihsan; Uddin, Muez M.; Ossei-Gerning, Nicholas; Anderson, Richard; Kinnaird, Timothy

doi:10.4244/eijv9i10a200

Cited by 30 publications

(27 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This reinforces the need for dedicated training programs for TRA, especially in teaching hospitals [44]. On the other hand, patients undergoing PCI from the TFA by default radial operators may be at higher risk of vascular access-site complication [45]. Third, this meta-analysis provides clinical follow-up within 30 days and it is still underpowered to evaluate the risk of death as demonstrated by trial sequential analysis.…”

Section: Discussionmentioning

confidence: 81%

Transradial versus Transfemoral Approach in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

et al. 2014

View full text Add to dashboard Cite

BackgroundTransfemoral approach (TFA) remains the most common vascular access for percutaneous coronary intervention (PCI) in many countries. However, in the last years several randomized trials compared transradial approach (TRA) with TFA in patients with acute coronary syndrome (ACS), but only few studies were powered to estimate rare events. The aim of the current study was to clarify whether TRA is superior to TFA approach in patients with ACS undergoing percutaneous coronary intervention. A meta-analysis, meta-regression and trial sequential analysis of safety and efficacy of TRA in ACS setting was performed.Methods and ResultsMedline, the Cochrane Library, Scopus, scientific session abstracts and relevant websites were searched. Data concerning the study design, patient characteristics, risk of bias, and outcomes were extracted. The primary endpoint was death. Secondary endpoints were: major bleeding and vascular complications. Outcomes were assessed within 30 days. Eleven randomized trials involving 9,202 patients were included. Compared with TFA, TRA significantly reduced the risk of death (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.53–0.94; p = 0.016), but this finding was not confirmed in trial sequential analysis, indicating that sufficient evidence had not been yet reached. Furthermore, TRA compared with TFA reduced the risk of major bleeding (OR 0.60; 95% CI, 0.41–0.88; p = 0.008) and vascular complications (OR 0.35; 95% CI, 0.28–0.46; p<0.001); these findings were supported by trial sequential analyses.ConclusionsIn patients with ACS undergoing PCI, a lower risk of death was observed with TRA. Nevertheless, the association between mortality and TRA in ACS setting should be interpreted with caution because it is based on insufficient evidence. However, because of the clinical relevance associated with major bleeding and vascular complications reduction, TRA should be recommended as first-choice vascular access in patients with ACS undergoing cardiac catheterization.

show abstract

Section: Discussionmentioning

confidence: 81%

Transradial versus Transfemoral Approach in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Finally, increased use of radial access may have unintended consequences on the management and complication rates of patients undergoing femoral PCI. 18 As a result, it has remained unclear if increasing use of TRI in routine practice has resulted in better overall PCI outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…14 There are also concerns that greater use of TRI and the reduced risk of access site bleeding may lead to more liberal use of antithrombotic agents with a subsequent rise in nonaccess site bleeding. 15 Moreover, as sites perform an increasing proportion of their cases via radial access, fluoroscopy times may be longer, 12,16 contrast use may be greater, 17 and there may be unintended negative consequences on femoral access management and complication rates, 18 raising concerns about safety tradeoffs with greater TRI use.…”

mentioning

confidence: 99%

Change in Hospital-Level Use of Transradial Percutaneous Coronary Intervention and Periprocedural Outcomes

Bradley

Rao

Curtis

et al. 2014

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes. Methods and Results Within the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (P for interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36–0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58–0.74; P for comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories. Conclusions In a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.

show abstract

“…Previous work has suggested that patients undergoing femoral procedures in predominantly radial centers tend to be older, more hemodynamically unstable, and have a greater prevalence of adverse procedural risk factors, such as renal failure, poor left ventricular function, and at higher bleeding risk 12,13,31 as defined by the Mehran bleeding risk score. 32 Our work shows that nearly 60% of centers in the United Kingdom (53 of 92 centers) have transitioned to become predominantly radial centers with more than two-third of their PCI case mix being undertaken through the TRA approach.…”

Section: Discussionmentioning

confidence: 99%

Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom

Hulme

Sperrin

Kontopantelis

et al. 2017

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background— The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach. Methods and Results— Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235 250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97–1.02; P =0.472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (odds ratio, 1.00; 95% confidence interval, 0.98–1.01; P =0.869). The in-hospital vascular complication rate was 1.0%, and this outcome was not significantly associated with recent femoral proportion after risk-adjustment (odds ratio, 0.97; 95% confidence interval, 0.94–1.00; P =0.060 per 0.1 increase in proportion). Conclusions— The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.

show abstract

Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications

Abstract: The risk factors for access-site bleeding are disproportionately high in the population requiring FA puncture by default radial operators, and as a result such patients have a high rate of vascular access-site complications.

Cited by 30 publications

References 26 publications

Transradial versus Transfemoral Approach in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Transradial versus Transfemoral Approach in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Change in Hospital-Level Use of Transradial Percutaneous Coronary Intervention and Periprocedural Outcomes

Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom

Contact Info

Product

Resources

About