Comparison of short- and medium-term clinical outcomes between transradial approach and transfemoral approach in a high-volume PCI heart center in China.

Peiyuan He,Xiao Yang,Min Yao,Xinran Tang,Shubin Qiao,Jun Dai,Yang Wang,Haibo Liu,Jue Chen,Yongjian Wu,Wei Li,Jinqing Yuan,Runlin Gao,Bo Xu,Yuejin Yang,Chiara Lazzeri

doi:10.1371/journal.pone.0118491

Peiyuan He, Xiao Yang + Show 14 more

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https://doi.org/10.1371/journal.pone.0118491

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Abstract

BackgroundTransradial approach (TRA) outweighed transfemoral approach (TFA) in acute coronary syndrome patients because the former has better short-term outcomes in high-volume percutaneous coronary intervention (PCI) centers. Our study was one of the limited studies specifically in comparing the short- and medium-term effects of TRA and those of TFA in patients undergoing elective PCIs.MethodsA total of 21,242 patients who underwent elective PCI with stent implantation were included. Using propensity score methodology, 1,634 patient pairs were matched. Major clinical outcomes and PCI-related complications between TRA and TFA were compared.ResultsIn the propensity score-matched patients, the rates of in-hospital net adverse clinical events, which included death, myocardial infarction (MI), target vessel revascularization (TVR), stroke, and major bleeding, were much lower with TRA than with TFA (1.8% vs. 3.9%, P < 0.001). This difference was mainly due to the lower rate of major bleeding (0.6% vs. 1.8%, P < 0.001) and the decreased rate of MI (1.1% vs. 1.9%, P = 0.060). PCI-related dissection and thrombosis were similar between the TRA and TFA groups (both P > 0.05). Meanwhile, one-year incidence rates of major adverse cardiovascular events, which included death, MI, and TVR, were also similar (4.1% vs. 4.9%, P = 0.272) in TRA and TFA. Multivariable regression analyses showed that TRA was an independent predictor of the low rate of in-hospital net adverse clinical events (odds ratio, 0.53; 95% confidence interval, 0.40 to 0.71), but not of major adverse cardiovascular events at one-year follow-up (hazard ratio, 1.01; 95% confidence interval, 0.96 to 1.06).ConclusionsIn patients undergoing elective PCI, TRA patients had lower rates of in-hospital net adverse clinical outcomes compared with TFA patients. TRA might be recommended as a routine approach in high-volume PCI hospitals for elective PCIs.

Highlights

It has been 20 years since the first percutaneous coronary intervention (PCI) through transradial approach (TRA) was successfully performed by Dr Kiemeneij and Laarman.[1]
In the propensity score-matched patients, the rates of in-hospital net adverse clinical events, which included death, myocardial infarction (MI), target vessel revascularization (TVR), stroke, and major bleeding, were much lower with Transradial approach (TRA) than with transfemoral approach (TFA) (1.8% vs. 3.9%, P < 0.001)
PCI-related dissection and thrombosis were similar between the TRA and TFA groups

Summary

Introduction

It has been 20 years since the first percutaneous coronary intervention (PCI) through transradial approach (TRA) was successfully performed by Dr Kiemeneij and Laarman.[1] Since this method has been increasingly adopted because of its superior features (lower vascular complications, shorter hospitalization, and better experience for patients) compared with the transfemoral approach (TFA).[2,3,4,5] The application rate of TRA varies across countries. Transradial approach (TRA) outweighed transfemoral approach (TFA) in acute coronary syndrome patients because the former has better short-term outcomes in high-volume percutaneous coronary intervention (PCI) centers.

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Conclusion