November 24, 2019
Study Shows Increased Use of Transradial PCI Does Not Significantly Decrease Overall Vascular Access Site Complications
November 25, 2019—In Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2019;22:2247–2256), David Kopin, MD, published a study examining the trends in primary and secondary vascular access sites and vascular access site complications (VASCs) among patients who underwent percutaneous coronary intervention (PCI).
As reported in JACC: Cardiovascular Interventions, there is a concern that the frequency of transradial PCI will cause operators to lose proficiency in femoral access, thus increasing PCI complications. An increase in secondary access during PCI has also been observed.
To evaluate the use of transradial and transfemoral PCI and their associated VASCs, the study queried data from the BMC2 registry, a prospective, longitudinal, multicenter, statewide registry of vascular surgeries and carotid interventions.
The investigators found an increase in transradial PCI from 25.9% in 2013 to 45.2% in 2017; the overall use of secondary vascular access increased from 4.9% to 8.7% with a minimal change in overall VASCs from 1.2% to 1.4%. Secondary access was associated with increased VASCs (odds ratio [OR], 5.82; 95% confidence interval [CI], 5.26–6.43).
Additionally, although patients treated by operators with the highest radial use were more likely to experience femoral VASCs (adjusted OR, 1.51; 95% CI, 1.08–2.13), they were associated with an overall reduction in all VASCs (adjusted OR, 0.62; 95% CI, 0.46–0.83).
The investigators in JACC: Cardiovascular Interventions concluded that despite the increased use of transradial PCI, there has not been a significant VASC decrease—in part due to increased incidence of femoral VASC and increased use of secondary vascular access. To reduce transradial VASCS, further strategies are needed.