Transradial and Transfemoral Access Compared in PCI for Complex Coronary Lesions
November 14, 2016—A comparison of transradial versus transfemoral access for complex percutaneous coronary intervention (PCI) with regard to both complications and long-term outcomes was published online ahead of print by Edward Koifman, MD, et al in Catheterization and Cardiovascular Interventions.
According to the investigators, radial access has been shown to confer superior results in patients undergoing PCI, especially in patients with acute coronary syndromes. However, radial access has limitations of sheath and device size, which may increase procedure time and result in inferior outcomes.
The study included patients undergoing PCI for complex lesions, defined as type C according the American College of Cardiology/American Heart Association classification system. Propensity matching was performed to adjust for differences in baseline characteristics. Transradial patients were then compared to transfemoral patients in regard to procedural, in-hospital, and 6-month outcomes.
As summarized in Catheterization and Cardiovascular Intervention, among 2,142 patients with 2,591 lesions treated, 1,876 had femoral access and 267 had radial access. The investigators reported that radial access patients were more likely to be male (75% vs 66%; P = .003) and less likely to present with acute myocardial infarction (27% vs 42%; P < .001). Procedural characteristics demonstrated lower use of heparin in the femoral group (17% vs. 73%; P < .001) with a similarly low use of glycoprotein inhibitors (5.6% vs 3.4%; P = .14). Patients in the femoral group had higher rates of transfusions (3.7% vs. 0%; P = .004) and vascular complications (1.7% vs 0%; P = .03). After propensity matching, there was no difference in midterm outcomes between radial and femoral groups.
In patients with complex coronary lesions undergoing PCI, the radial approach demonstrates similar midterm outcomes as the femoral approach with a potentially lower rate of complications, concluded the investigators.