Radial Versus Femoral Access Is Associated With Reduced Complications and Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction

Iqbal, Mohammad; Arujuna, Aruna; Ilsley, Charles; Archbold, R. Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep; Knight, Charles; Lim, Pitt; Malik, Iqbal; Mathur, Anthony; Meier, Pascal; Rakhit, Roby; Redwood, Simon; Whitbread, Mark; Bromage, Daniel I; Rathod, Krishnaraj S.; Wragg, Andrew; MacCarthy, Philip; Dalby, Miles

doi:10.1161/circinterventions.114.001314

Cited by 33 publications

(18 citation statements)

References 28 publications

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“…Previous literature has only considered radial/total volumes in isolation and not considered the proportion of cases undertaken through the TRA route when examining relationships between radial experience and outcomes. 4,[14][15][16]25 The more recent MATRIX randomized controlled trial showed a relationship between center TRA proportion and the coprimary outcome, with highest proportion radial centers having the greatest magnitude of benefit in the coprimary outcome, although data around operator proportion was not presented in this analysis. 26 In the highest proportion radial operator and center analysis, we have consistently observed that the cases undertaken through the femoral approach are much sicker, higher risk patients than those undertaken in the lowest proportion operators/centers.…”

Section: Discussionmentioning

confidence: 89%

“…In a retrospective analysis derived from 8 centers in the United Kingdom, TRA utilization independently predicted decreased 30-day, 6-month, and 1-year mortality in patients undergoing PCI for non-ST-elevated MI indications although this benefit was only observed in high-volume radial centers. 25 Interestingly, in the recent Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) randomized controlled trial, that demonstrated decreases in all-cause mortality, MACE and major Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding rates in the TRA arm, with positive tests for trend across tertiles of the centers' percentage of TRA for PCI for both coprimary outcomes and all-cause mortality, with a particularly pronounced benefit of TRA access in centers that did 80% or more radial PCIs.…”

Section: Discussionmentioning

confidence: 99%

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Is There a Relationship of Operator and Center Volume With Access Site–Related Outcomes?

Hulme

Sperrin

Rushton

et al. 2016

Circ: Cardiovascular Interventions

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Background-Transradial access is associated with reduced access site-related bleeding complications and mortality post percutaneous coronary intervention. The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise. Methods and Results-The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial versus femoral). Operator/center experience/expertise were defined by both total volume and transradial access proportion. A total of 164 395 procedures between 2012 and 2013 in the National Health Service in England and Wales were analyzed. After case-mix adjustment, transradial access was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (odds ratio, 0.61; 95% confidence interval, 0.55-0.68; P<0.001). The magnitude of this risk reduction was modified by increases in total procedural volume and radial proportion at the operator level (odds ratio reduction of 11% per 100 extra procedures, 95% confidence interval, 3%-19%; odds ratio reduction of 6% per 10%-point increase in radial proportion, 95% confidence interval, 1%-11%) with no significant impact of operator radial volume, center total volume, center radial volume, and center radial proportion. Conclusions-The lower mortality associated with transradial access adoption relates to both the total procedural volume and the proportion of procedures undertaken radially by operator, with operators undertaking the greatest proportion of their procedures radially having the largest relative reduction in mortality risk. (Circ Cardiovasc Interv. 2016;9:e003333.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Is There a Relationship of Operator and Center Volume With Access Site–Related Outcomes?

Hulme

Sperrin

Rushton

et al. 2016

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

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“…6 The gain in experience is reflected on the performance of more complex procedures, in patients with more severe conditions, with an impact on morbidity and mortality, as demonstrated in a London registry involving 10,095 patients with ACS without ST-segment elevation. 12 Data for the triennium 2005-2007, when the radial program started, did not indicate the technique as a predictor of mortality reduction. Since 2008, after the learning curve was transposed, the choice of the radial route has promoted a 35% reduction in mortality at 12 months (OR = 0.65; 95% CI: 0.46-0.92; p = 0.02).…”

Section: Discussionmentioning

confidence: 96%

Insucesso da Técnica Radial em Centro com Alto Volume de Procedimentos

Andrade¹,

Rinaldi²,

Bienert³

et al. 2014

Rev. Bras. Cardiol. Invasiva

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Background:The mechanisms and predictors of failure of the transradial approach in centers dedicated to this technique are not well characterized and were the main objective of this analysis. Methods: 6,808 consecutive patients undergoing transradial coronary procedures by operators with utilization rate greater than 90% were included. Simple and multiple logistic regression models were used to identify the predictors of failed transradial approach. Results: Transradial failure rate was 1.7%. Vascular complications were observed in 5% of the sample, with a prevalence of asymptomatic arterial occlusion and subcutaneous hematomas. Predictors of failure were female gender (OR = 1.87; 95% CI: 1.29-2.71; p = 0.01), age > 70 years (OR = 1.78; 95% CI: 1.06-2.98; p = 0.03) and presence of chronic peripheral arterial disease (OR = 5.71; 95% CI: 2.40-13.54; p < 0.01). Conclusions: In a high-volume radial center, the failure rate was < 2% and variables associated with failure of the technique were female gender, advanced age and peripheral arterial disease.

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“…14 Similarly, recent work has also focused around whether there is an association between operator and center radial volume with access site-related outcomes, 5,16,28,29 although most of these were not based on whether the relationships reported might relate to worse femoral outcomes in the high-volume radial operators or centers. 18 The RIVAL study reported that in the subgroup of highvolume radial centers the primary outcome was reduced by TRA versus TFA (1.6% versus 3.2%; hazards ratio [ 17 Interestingly, when femoral outcomes were studied in the different radial tertiles, no significant differences for the primary outcome for patients randomized to femoral access (high-volume radial centers 3.2% versus low-volume 4.2% for femoral patients; adjusted HR, 0.67; 95% CI, 0.42-1.09; P=0.10) and non-CABG major bleeding (adjusted HR, 1.07; 95% CI, 0.41-2.79; P=0.89) were observed, 16 suggesting that femoral outcomes were not worse in the highest tertile TRA centers.…”

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

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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.

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Radial Versus Femoral Access Is Associated With Reduced Complications and Mortality in Patients With Non–ST-Segment–Elevation Myocardial Infarction

Cited by 33 publications

References 28 publications

Is There a Relationship of Operator and Center Volume With Access Site–Related Outcomes?

Is There a Relationship of Operator and Center Volume With Access Site–Related Outcomes?

Insucesso da Técnica Radial em Centro com Alto Volume de Procedimentos

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

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