Influence of bleeding risk on outcomes of radial and femoral access for percutaneous coronary intervention: An analysis from the GLOBAL LEADERS trial

Abstract Background Radial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer this route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding. Methods Patients from the GLOBAL-LEADERS trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days. Results In the overall population, there were no statistical differences between radial and femoral access in the rate of the primary endpoint, a composite of all-cause mortality or new Q-wave MI (HR: 0.70, 95%CI: 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety endpoint, BARC 3 or 5 bleeding (HR: 0.55, 95%CI: 0.36-0.84). Compared respectively by bleeding risk strata, in the high bleeding score population, the primary (HR: 0.47, 95%CI: 0.26-0.85, p=0.012, pinteraction=0.019) and secondary safety endpoint (HR: 0.57, 95%CI: 0.35-0.95, p=0.030, pinteraction=0.631) favored radial access. In the low bleeding score population however, the differences in the primary and secondary safety endpoints between vascular access were no longer statistically significant. Conclusions Our findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favor radial access in patients with a high, but not those with a low, risk of bleeding. Since this was not a primary analysis, it should be considered hypothesis-generating.