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December 21, 2017

Outcomes Compared for Radial and Femoral Access in Rotational Atherectomy

December 21, 2017—A United Kingdom observational study composed of 8,622 patients compared radial versus femoral access for rotational atherectomy (RA) procedures. The findings were published online by Jonathan Watt, MD, et al in Circulation: Cardiovascular Interventions.

Noting that RA is an important interventional tool for heavily calcified coronary lesions, the investigators identified all patients in England and Wales who underwent the procedure between January 1, 2005 and March 31, 2014. Of the 8,622 patients included in the analysis, 3,069 were treated via radial access and 5,553 were treated via femoral access.

The study's primary outcome was 30-day mortality. Propensity scores were calculated to determine the factors associated with treatment assignment to radial or femoral access. The investigators used the calculated propensity scores to perform multivariable logistic regression analysis.

As summarized in Circulation: Cardiovascular Interventions, the investigators reported that 30-day mortality was 2.2% in the radial group and 2.3% in the femoral group (P = .76).

Radial access compared with femoral access was associated with equivalent 30-day mortality (adjusted odds ratio [OR], 1.06; 95% confidence interval [CI], 0.77–1.46; P = .71), procedural success (OR, 1.04; 95% CI, 0.84–1.29; P = .73), major adverse cardiac and cerebrovascular events (OR, 1.05; 95% CI, 0.80–1.38; P = .72), and net adverse clinical events (OR, 0.90; 95% CI, 0.71–1.15; P = .41). However, radial access demonstrated lower rates of in-hospital major bleeding (OR, 0.62; 95% CI, 0.40–0.98; P = .04) and major access site complications (OR, 0.05; 95% CI, 0.01–0.38; P = .004), compared with femoral access.

In this large real-world study of patients undergoing RA, radial access was associated with equivalent 30-day mortality and procedural success, but reduced major bleeding and access site complications, compared with femoral access, concluded the investigators in Circulation: Cardiovascular Interventions.

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