Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials
Gani BajraktariZarife RexhajShpend EleziFjolla Zhubi BakijaArtan BajraktariIbadete BytyçiArlind BatalliMichael Y. Henein
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Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.Keywords:
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To assess the application status of transradial coronary angiography (TRA) and transradial coronary intervention (TRI) in China in 2007.From Feb 10th to Apr 30th 2008, investigating questionnaires of this study were sent to 450 hospitals in China to collect information on application of percutaneous coronary intervention (PCI) and TRI in these centers.One hundred and twelve questionnaires were received. A total of 115 142 coronary angiography (CAG) and 48 379 PCI were performed in these centers including 69 354 TRA (60.24%) and 27 227 TRI (56.28%). A total of 77 488 stents were implanted from 47 160 PCI (1.64 stents per PCI) and 93.98% implanted stents were drug-eluting stent. Total 9290 stents (86.95% drug-eluting stent) were implanted in 7140 primary PCI (1.30 stents per PCI).TRA and TRI have become the major approaches of CAG and PCI in China in 2007.
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Key Points Patients undergoing percutaneous coronary intervention (PCI) in the state of Michigan have more comorbidities compared to patients undergoing PCI in the United Kingdom. While the adoption of radial artery access for PCI has increased steadily over time in both Michigan and the United Kingdom, the use of radial access was significantly greater in the UK at all time points compared to Michigan for all PCI indications. The use of mechanical support during PCI has increased over time in Michigan but decreased over time in the United Kingdom.
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Objective To observe the clinical outcome of patients with acute myocardial infartion(AMI) and multivessel coronary disease(MVD) undergoing primary percuteneous coronary intervention(PCI),whether staged PCI or drug therapy.Evaluate optimal treatment strategy of non-culprit vessels.Methods Data of 151 patients with STEMI and MVD treated by primary PCI were analyzed.Patients were divided into 2 groups,Group 1(n=64)with staged PCI of non-culprit vessels after primary PCI 7-14days,Group 2(n=87)with drug therpy.Comparing clinical and coronary angiographic data,in-hospital and long-term major adverse cardiovascular events(MACE).Results Clinical and angiographic data are similar between two groups.In Group 1 more hospital stay(16.98±5.84 days) than Group 2(11.29±5.00)(P=0.000).Group 1 patients underwent staged PCI 7.9±6.0 days after primary PCI.The mean length of follow-up was 14 months(433.3±325.9days).The incidence of in-hospital MACE was 4.69%in Group 1 and 4.60% in Group 2(P=1.0);the incidence of follow-up MACE was3.13% in Group 1 and 13.79% in Group 2(P=0.026).Conclusions Our data show that staged PCI in STEMI patients with MVD underwent primary PCI is associated with a low incidence of MACE at follow-up.
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Background— Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. Methods and Results— We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49–0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31–0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. Conclusions— There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.
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Percutaneous coronary intervention (PCI) continues to advance at pace with an ever-broadening indication. In this article we will review the recent technological advances in PCI that have enabled more complex coronary disease to be treated. The choice of revascularisation strategy must take into account the evidence-just because we can treat by PCI does not necessarily mean we should. When PCI is indicated, a safe, precision PCI approach guided by physiology, imaging and optimal lesion preparation should be the goal to obtain complete revascularisation and a durable long-term result. When these standards are adhered to, the outcomes can be excellent, in even complex coronary disease. We provide contemporary trial evidence to justify PCI and treatment algorithms that ensure optimal revascularisation decision making to achieve the best patient outcomes.
Interventional cardiology
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Background: The use of radial access for percutaneous coronary intervention (r-PCI) is associated with reduced risk of bleeding complications and higher patient satisfaction. However, the use of r-PCI differs greatly by country and is unknown in China. We examined trends in the adoption of r-PCI in China over the past decade and identified factors associated with its use. Methods: We used a two-stage random sampling strategy to create a nationally representative sample of 5,462 patients undergoing percutaneous coronary intervention (PCI) in China in 2001 (n=402; 24 sites), 2006 (n=1,390; 44 sites), and 2011 (n=3,670; 54 sites). We calculated the weighted proportion of patients receiving r-PCI in each time period and conducted multivariable analysis to identify the patient and hospital characteristics associated with not receiving r-PCI in 2011. Results: Among 5,462 patients who underwent PCI, the use of r-PCI increased markedly over time (2001: 3.4% [95% CI 0.0%-8.5%]; 2006: 36.5% [95% CI 34.2%-38.9%], 2011: 74.7% [95% CI 73.9-75.6]; P for trend <0.001). Increases in r-PCI use were widespread, including high-risk subgroups such as the elderly, women, and patients with acute coronary syndromes (Figure). In multivariable analysis of 3,670 patients undergoing PCI in 2011, cardiogenic shock and emergency PCI were strongly associated with failure to use r-PCI in 2011. Conclusion: Over a recent ten-year period, radial access became the predominant strategy for PCI in China, even among high-risk patients. This study demonstrates the responsiveness of the interventional cardiology community to emerging evidence. A deeper understanding of the factors facilitating r-PCI adoption in China may help increase its usage in countries in which r-PCI use remains low.
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