Temporal trends in the practice of the transradial approach for percutaneous coronary intervention in a large tertiary center

Abstract

Objective The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. Patients and methods From our large single-center PCI registry, we have analyzed 15 429 patients in two periods – 2008–2012 (period 1) and 2013–2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. Results The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P < 0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P < 0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR) = 0.86; 95% confidence interval (CI): 0.77–0.96; P = 0.007, during period 1 and HR = 0.62; 95% CI 0.55–0.7; P < 0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR = 0.69, 95% CI: 0.59–0.81, P < 0.001). Conclusion Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients – a course which is associated with consistent short and long-term clinical benefits.

Trends in ST-elevation myocardial infarction

“…As was described earlier by Mehta et al [16], Pang et al [17] and Perl et al [18], our findings show a reduced rate of ischemic events, including TVR (figure 3) and AMI (figure 4), and improved overall mortality in parallel with more frequent use of transradial pPCI approach. These benefits are thought to be driven by fewer bleeding events, but there may be other latescent advantages, such as early ambulation and more liberal anticoagulant use post-PCI when indicated [19][20][21].…”

Trends in Ischemic Mitral Regurgitation Following ST-Elevation Myocardial Infarction Over a 20-Year Period

“…We have previously shown that in our cohort, the transradial approach improves survival in our PCI patients (20), as was evident in numerous other studies, including in cohorts of STEMI (21)(22)(23)(24)(25). Additionally, 2nd generation DES in primary PCI was shown to improve outcomes as compared to 1st generation or bare metal stents (26)(27)(28).…”