Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program

Abstract

Objectives We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM‐PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. Background TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM‐PCI remain less studied. Methods All LM‐PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure‐related variables were compared by access site. Both short‐ and long‐term clinical outcomes were analyzed using propensity score matching. Results A total of 4004 LM‐PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM‐PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1‐year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. Conclusion Use of TRA for LM‐PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1‐year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM‐PCI.

Outcomes of Percutaneous Coronary Intervention for Protected versus Unprotected Left Main Coronary Artery Disease: Insights from the VA CART Program

“…This study had a high rate of transfemoral access for left main PCI (81%) versus transradial (18%), but a recent analysis from the VA healthcare system showed similar MACE and success rate between both access strategies. 22 Despite adjusting for common co-morbidities, we found a higher frequency of MACE and all-cause mortality in the ULM PCI group compared to the PLM PCI group. These patients may have undergone PCI after being declined for surgical revascularization which could have increased the risk profile of patients included in this analysis.…”

A Scoping Review of The Percutaneous Coronary Intervention: Practice Transformation for the Operational Access

“…Transradial approach PCI has been increasingly used since its first successful application in 1997 not only because of the easier puncturing and hemostasis but also for the better survival rate in certain patients. [39][40][41][42] However, there is a scarcity of publications on the practice of PCI via TRA in the Bangladeshi population.…”