British Study Evaluates Whether Increased Use of Radial Access Resulted in Worse Femoral Outcomes
February 24, 2017—William Hulme, MD, et al reported that increased use of radial access is not associated with worse femoral access outcomes for percutaneous coronary intervention (PCI) in the United Kingdom. The investigators published the findings online ahead of print in Circulation: Cardiovascular Interventions.
This study assessed whether a change in access site practice toward transradial access nationally in the United Kingdom has led to worse outcomes in PCI procedures performed through the transfemoral access approach.
The background of the study is that 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. The investigators noted, however, that concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access.
Using the British Cardiovascular Intervention Society database, a retrospective analysis of 235,250 transfemoral access PCI 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.
As summarized in Circulation: Cardiovascular Interventions, 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 [OR], 0.99; 95% confidence interval [CI], 0.97–1.02; P = .472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (OR, 1; 95% CI, 0.98–1.01; P = .869). The in-hospital vascular complication rate was 1%, and this outcome was not significantly associated with recent femoral proportion after risk adjustment (OR, 0.97; 95% CI, 0.94–1; P = .06 per 0.1 increase in proportion).
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 PCI wherever possible in line with current best evidence, concluded the investigators in Circulation: Cardiovascular Interventions.