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November 27, 2017

Study Evaluates Impact of Access Site on Outcomes in Patients Undergoing PCI After Thrombolysis for STEMI

November 27, 2017—Online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, Muhammad Rashid, MD, et al published findings from a study that sought to examine the relationship between access site location and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) after thrombolysis for ST-segment elevation myocardial infarction (STEMI).

The background of the study is that a transradial access (TRA) approach improves outcomes in patients undergoing PCI for STEMI. Additionally, a significant proportion of STEMI patients may undergo thrombolysis before PCI in many countries across the world. However, there are limited data on access site choice and the associated outcomes in this patient population

As summarized in JACC: Cardiovascular Interventions, the investigators used the British Cardiovascular Intervention Society dataset to investigate the outcomes of patients undergoing PCI after thrombolysis between 2007 and 2014. Patients were divided into TRA and transfemoral access groups depending on the access site used. Multiple logistic regression and propensity score matching were used to study the association of access site with in-hospital and long-term mortality, major bleeding, and access site–related complications.

The investigators reported that a total of 10,209 patients underwent thrombolysis and PCI during the study period: TRA was used in 48% (n = 4,959) of patients, 3.3% (n = 336) of patients died in the hospital, 1.6% (n = 165) experienced major bleeding, 4.2% (n = 437) experienced major adverse cardiac events (MACEs), and 4.6% (n = 468) experienced 30-day mortality.

After multivariate adjustment, TRA was associated with significantly reduced odds of in-hospital mortality (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.42–0.83; P = .002), major bleeding (OR, 0.45; 95% CI, 0.31–0.66; P < .001), MACEs (OR, 0.72; 95% CI, 0.55–0.94; P = .01), and 30-day mortality (OR, 0.72; 95% CI, 0.55–0.94; P = .01).

TRA is associated with decreased odds of bleeding complications, mortality, and MACEs in patients undergoing PCI following thrombolysis and should be the preferred access site in this cohort of patients, concluded the investigators in JACC: Cardiovascular Interventions.

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