Radial artery access for PCI improves clinical outcomes
MedWire News: Use of the radial artery for primary or rescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes, suggest researchers.
Although European guidelines for PCI recommend that radial artery access should be adopted in patients at high risk for bleeding, evidence to support the use of the radial artery as the access site of choice is lacking, say Colin Berry (University of Glasgow, Scotland, UK) and co-authors.
They conducted a retrospective cohort study of 4534 patients who underwent primary or rescue PCI in Scotland between April 2000 and March 2009, and reported their findings in Heart.
Over the 9-year period, 4606 primary or rescue PCIs were performed in Scotland. Use of the radial approach increased significantly from no cases in 2000 to 924 (80.5%) in 2009 (p<0.001).
Patients in whom the radial approach was used were significantly more likely to be male and to have multiple comorbidities including hypertension and left ventricular dysfunction than those in whom the femoral approach was used (p<0.041).
On the other hand they were significantly less likely to have renal impairment, multi-vessel coronary disease, and cardiogenic shock (p<0.017).
Multivariate analysis revealed that use of radial artery access was associated with a significant 1.89-fold increased risk for procedural success (p=0.002) and a lower risk for access site bleeding complications, at an adjusted odds ratio of 0.21 (p=0.002).
Radial artery access was also associated with a 34% reduced risk for myocardial infarction and a 49% reduced risk for mortality within 30 days compared with femoral artery access (p<0.003). These associations remained significant at 9-year follow-up.
"Compared with femoral access, primary and rescue PCI undertaken using radial access had a higher rate of procedural success and a lower risk of peri-procedural, 30-day and 1-year adverse events," the authors note.
"While there will remain individual patients in whom femoral access is preferable, use of the radial approach should be actively encouraged in routine practice," they conclude.
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By Piriya Mahendra