Transradial Versus Transfemoral Access in Patients Undergoing Rescue Percutaneous Coronary Intervention After Fibrinolytic Therapy

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• 作者：Mitul B. Kadakia ; MD^&lowast ; ; Sunil V. Rao ; MD^&dagger ; ; Lisa McCoy ; MS^&dagger ; ; Paramita S. Choudhuri ; PhD^&dagger ; ; Matthew W. Sherwood ; MD^&dagger ; ; Scott Lilly ; MD ; PhD^&Dagger ; ; Taisei Kobayashi ; MD^&lowast ; ; Daniel M. Kolansky ; MD^&lowast ; ; Robert L. Wilensky ; MD^&lowast ; ; Robert W. Yeh ; MD ; MSc^§ ; ; Jay Giri ; MD ; MPH^&lowast ; ; ^{giri.jay@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：rescue PCI ; STEMI ; transradial access
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2015
• 出版时间：21 December 2015
• 年：2015
• 卷：8
• 期：14
• 页码：1868-1876
• 全文大小：726 K

文摘

The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes.

Background

Transradial access reduces bleeding and mortality in STEMI patients undergoing primary PCI. Little is known about access site choice and outcomes in patients undergoing rescue PCI after receiving full-dose fibrinolytic therapy for STEMI.

Methods

Patients in the National Cardiovascular Data Registry’s CathPCI Registry undergoing rescue PCI for STEMI between 2009 and 2013 were studied. Patients were divided on the basis of access site. Patterns of access use and baseline demographics were noted. Unadjusted and propensity-matched analyses were performed comparing in-hospital bleeding, vascular complications, and mortality outcomes among transradial and transfemoral access patients. The falsification endpoint of gastrointestinal bleeding was specified to assess for persistent unmeasured confounding.

Results

Transradial access was used in 14.2% of cases. In propensity-matched analyses, transradial rescue PCI was associated with significantly less bleeding than transfemoral access (odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.52 to 0.87; p = 0.003), but not mortality (OR: 0.81; 95% CI: 0.53 to 1.25; p = 0.35). Gastrointestinal bleeding was less frequent in the radial group (OR: 0.23; 95% CI: 0.05 to 0.98; p = 0.05).

Conclusions

In a large, “real-world” registry, transradial access was used in a minority of cases and was associated with significantly less bleeding than transfemoral access in patients undergoing rescue PCI. However, given persistent differences in a falsification endpoint, the influence of treatment-selection bias on these results cannot be ruled out. Further studies are needed to determine predictors of bleeding and mortality in this understudied high-risk group.