Abstract
BackgroundRadial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding. MethodsPatients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days. ResultsIn the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; Pinteraction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; Pinteraction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant. ConclusionsOur findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because this was not a primary analysis, it should be considered hypothesis generating.
Highlights
Radial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes
Our findings suggest that the outcomes of mortality or new Q-wave myocardial infarction (MI) and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding
15,991 patients randomized in the GLOBAL LEADERS trial
Summary
Radial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. RESUME Contexte : Il a ete demontre que l’accès par l’artère radiale reduit la mortalite et les hemorragies, en particulier chez les patients presentant un syndrome coronarien aigu. Les cardiologues interventionnels qui ont acquis de l’experience en matière d’accès par l’artère femorale prefèrent encore utiliser cette voie lorsqu’ils doivent pratiquer une intervention coronarienne percutanee. On connaît mal Bleeding is one of the strongest periprocedural predictors of mortality in patients receiving percutaneous coronary intervention (PCI).[1] In patients with acute coronary syndromes (ACS), radial access reduces bleeding, vascular complications, and all-cause mortality compared with femoral access.[2,3,4,5]
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