Radial Artery Access in Unprotected Left Main Stem PCI Analyzed in British Study
December 17, 2018—An analysis of the British Cardiovascular Intervention Society (BCIS) database concluded that the radial artery is the predominant access site for unprotected left main stem percutaneous coronary intervention (LMS-PCI), and its use is associated with shorter length of hospital stay, fewer vascular complications, and less major bleeding than with femoral access.
Tim Kinnaird, MD, et al published the findings in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2018;11:2480–2491).
Investigators used the BCIS PCI database to study temporal trends, predictors, and outcomes of radial access (RA) versus femoral access (FA) for unprotected LMS-PCI. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes in 19,482 LMS-PCI procedures performed in England and Wales between 2007 and 2014.
As summarized in JACC: Cardiovascular Interventions, the investigators found the following:
- The frequency of FA use fell from 77.7% in 2007 to 31.7% in 2014 (P < .001 for trend).
- In the most contemporary study years (2012–2014), the strongest associates of FA use for unprotected LMS-PCI were renal disease, PCI for restenosis, chronic total occlusion intervention, and female sex.
- Intravascular imaging and chronic anticoagulation were associated with a higher likelihood of RA use.
- Complexity of the PCI procedure in the RA cohort increased significantly during the study period.
- Length of stay was shorter (2.6 ± 9.2 days vs 3.6 ± 9.0 days; P < .001) and same-day discharge greater (43% vs 26.6%; P < .001) with RA use.
After propensity matching, RA use was associated with significant reductions in in-hospital events including access site complications, major bleeding, and major adverse cardiovascular events. Conversion to RA for LMS-PCI was associated with similar reductions in the entire patient cohort.
RA use was not associated with lower 12-month mortality, noted the investigators in JACC: Cardiovascular Interventions.