Transradial PCI approach linked to lower mortality than transfemoral
MedWire News: The transradial approach is associated with a lower 2-year mortality rate than the transfemoral approach in patients undergoing percutaneous coronary intervention (PCI), an analysis suggests.
It remains to be determined whether the reduction of mortality associated with the transradial approach is a "spurious finding" or reflects a real long-term advantage, say Marco Valgimigli (University of Ferrara, Italy) and co-authors.
Their analysis included 11,068 patients with acute myocardial infarction (AMI) who underwent PCI using the transfemoral (n=8000) or transradial (n=3068) route between January 2003 and July 2009. Patients were assigned to either group according to the first attempted arterial access site, based on the intention to treat principle.
Antiplatelet treatment was prescribed to patients according to current standards of treatment, including lifelong aspirin for all patients, and at least 1 month of ticlodipine (250 mg twice daily) or clopidogrel (75 mg/day) for patients who underwent stenting.
Differences between the groups in the risk for death at 2 years were compared using propensity score adjustment and matching.
According to analysis of matched pairs, the 2-year risk-adjusted mortality rate was lower for the transradial than the transfemoral group, at 8.8% versus 11.4% (p=0.0250).
The rate of vascular complications or need for blood transfusion was also significantly decreased in the transradial group compared with the transfemoral group, at 1.1% versus 2.5% (p=0.0052).
The difference in mortality between the two groups was not explained by the incidence of myocardial infarction or stroke, which did not differ significantly, note the authors.
"Our study, in keeping with recent evidence, suggests that the risks of transitioning toward the transradial route over the conventional transfemoral approach in [ST segment-elevation myocardial infarction] patients, provided the process is undertaken in a step-wise approach, as part of a global [transradial intervention] program, may be largely outweighed by a lower mortality rate," say the authors.
They conclude in JACC Cardiovascular Interventions: "Large randomized trials are ongoing and will be necessary to confirm this observation."
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By Piriya Mahendra