LOW RATE OF CROSSOVER TO TRANSFEMORAL APPROACH WITH SUBSTANTIAL REDUCTION IN VASCULAR COMPLICATIONS AMONG OCTOGENARIANS TREATED WITH PCI VIA THE TRANSRADIAL APPROACH

Abstract

Transradial approach (TR) for coronary angiography and intervention (CA/PCI) is shown to offer significant advantages compared to the transfemoral approach (TF) in general population. However, limited information is available for the safety and efficacy of TR in the elderly, a population with higher rate of subclavian artery calcification and tortousity. A comprehensive literature search of studies comparing TR and TF in the elderly (mean age 82year) was performed. Mantel-Haenszel random effects model was used to compute odds ratio (OR) with 95% confidence intervals (CI). The primary endpoint of this study was composite of vascular complications. The secondary endpoints included access site cross over, myocardial infarction (MI), stroke and in-hospital mortality. A total of 235 studies were reviewed and 9 included in the final analysis. Clinical outcomes of 2315 patients (2 randomized and 7 observational studies) were compared between TR (995 patients, 43%) and TF (1320 patients, 57%). Compared to TF, TR resulted in significant reduction of composite vascular endpoints (4.4 vs. 12.3 %, OR 0.20, p < 0.00001), and individual subtypes, hematoma (2.7 vs. 9.2%, OR 0.25, p<0.001), pseudoaneurysm (0.4 vs. 2.1%, OR 0.28 p=0.05) and blood transfusion (2.3 vs. 2.7%, OR 0.39 p=0.04). The access site crossover was higher for TR approach (10% vs. 3.1%, OR 4.74, p=0.003) with no difference in the rate of MI, stroke and death between the two groups. Analysis of randomized studies only showed similar result. TR efficacy is preserved for CA/PCI in the elderly, significantly reduces important vascular complication compared to TF with an acceptable rate of access site cross over.View Large Image Figure ViewerDownload (PPT)