June 10, 2018
United Kingdom Study Compares Left and Right Radial Access for PCI Procedures
June 11, 2018—Findings from a study comparing the use of left radial access (LRA) versus right radial access (RRA) in patients undergoing percutaneous coronary intervention (PCI) in the United Kingdom were published by Muhammad Rashid, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2018;11:1021–1033).
Using the British Cardiovascular Intervention Society database, investigators evaluated the relationship between use of LRA or RRA and clinical outcomes of in-hospital or 30-day mortality, major adverse cardiovascular events (MACE), in-hospital stroke, and major bleeding complications in patients undergoing PCI between 2007 and 2014.
The investigators identified 342,806 cases; of these, 328,495 (96%) were RRA and 14,311 (4%) were LRA. Use of LRA increased from 3.2% to 4.6% from 2007 to 2014. In patients undergoing a repeat PCI procedure, the use of RRA decreased to 72% at the second procedure and was lower in females (65%) and patients aged > 75 years (70%).
As compared with RRA, the use of LRA was not associated with significant differences in in-hospital mortality (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.90–1.57; P = .2), 30-day mortality (OR, 1.17; 95% CI, 0.93–1.74; P = .16), MACE (OR, 1.06; 95% CI, 0.86–1.32; P = .56), or major bleeding (OR, 1.22; 95% CI, 0.87–1.77; P = .24). In a propensity-matched analysis, LRA was associated with a significant decrease in in-hospital stroke (OR, 0.52; 95% CI, 0.37–0.82; P = .005).
In this large PCI database, the use of LRA is limited as compared with RRA, there is no increased risk of adverse outcomes, and it may be associated with a reduction in PCI-related stroke complications, concluded the investigators in JACC: Cardiovascular Interventions.