The Relationship Between Patient Characteristics and Access Site Complications Post PCI: A Cross-Sectional Study

Femoral in the Time of Radial.

The MATRIX trial

Comparison of Additional Versus No Additional Heparin During Therapeutic Oral Anticoagulation in Patients Undergoing Percutaneous Coronary Intervention

Radial artery access for coronary angiography or percutaneous coronary intervention (PCI) reduces the risk of death, bleeding, and vascular complications and is preferred over femoral artery access, leading to a class 1 indication by clinical practice guidelines. However, alternate upper extremity access such as distal radial and ulnar access are not mentioned in the guidelines despite randomized trials. We aimed to evaluate procedural outcomes with femoral, radial, distal radial, and ulnar access sites in patients undergoing coronary angiography or PCI. PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials that compared at least 2 of the 4 access sites in patients undergoing PCI or angiography. Primary outcomes were major bleeding and access site hematoma. Intention-to-treat mixed treatment comparison meta-analysis was performed. From 47 randomized clinical trials that randomized 38 924 patients undergoing coronary angiography or PCI, when compared with femoral access, there was a lower risk of major bleeding with radial access (odds ratio [OR], 0.46 [95% CI, 0.35-0.59]) and lower risk of access site hematoma with radial (OR, 0.34 [95% CI, 0.24-0.48]), distal radial (OR, 0.33 [95% CI, 0.20-0.56]), and ulnar (OR, 0.50 [95% CI, 0.31-0.83]) access. However, when compared with radial access, there was higher risk of hematoma with ulnar access (OR, 1.48 [95% CI, 1.03-2.14]). Data from randomized trials support guideline recommendation of class 1 for the preference of radial access over femoral access in patients undergoing coronary angiography or PCI. Moreover, distal radial and ulnar access can be considered as a default secondary access site before considering femoral access. URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: 42024512365.

In this issue of Circulation , Bertrand et al1 report the results of the Early Discharge after Transradial Stenting of Coronary Arteries (EASY) Study. After receiving a standard bolus of abciximab and undergoing a successful and uncomplicated transradial stent placement, 1005 patients were randomized to a traditional strategy with overnight hospitalization or early discharge after 4 to 6 hours. All patients received aspirin, clopidogrel, and a bolus dose of abciximab before their procedure. Those in the traditional strategy group also received a 12-hour abciximab infusion, whereas those in the early discharge group did not. The goal of the EASY study was to show that stent implantation by the radial approach with only a bolus of abciximab and then early discharge was not inferior to the traditional strategy in terms of effectiveness and safety. The primary composite end point was the 30-day incidence of death, any myocardial infarction, unplanned revascularization, major bleeding, repeat hospitalization, access-site complications, or severe thrombocytopenia. On the basis of their data, the authors concluded that the abbreviated abciximab therapy with same-day discharge was clinically not inferior to the traditional strategy after uncomplicated stent placement. Article p 2636 With healthcare costs increasing, strategies to limit expenditures are popular and deserve careful examination. Accepted cardiology practice has moved toward dramatically shortened hospital stays for diagnostic coronary angiography and percutaneous coronary intervention (PCI) as well as many other procedures. The present study suggests that many patients who undergo PCI could be managed safely as outpatients. Substantial accomplishments in the practice of PCI have resulted in the excellent success and safety of the procedure we now observe, but are we ready for routine outpatient PCI? The use of radial artery access has been well described in the literature. Despite studies demonstrating the feasibility, safety, and acceptance by patients of this …

The aim of this study was to evaluate radiation dose and patient discomfort/pain in radial artery access vs femoral artery access in percutaneous coronary intervention (PCI). Dose-area product (DAP) was measured non-randomised for 114 procedures using femoral access and for 55 using radial access. The patients also responded to a questionnaire concerning discomfort and pain during and after the procedure. The mean DAP was 69.8 Gy cm(2) using femoral access and 70.5 Gy cm(2) using radial access. Separating the access site from confounding factors with a multiple regression, there was a 13% reduction in DAP when using radial access (p=0.038). Procedure times did not differ (p=0.81). Bed confinement was much longer in the femoral access group (448 vs 76 min, p=0.000). With femoral access, there was a significantly higher patient grading for chest (p=0.001) and back pain (p=0.003) during the procedure and for access site (p=0.000) and back pain (p=0.000) after the procedure. Thirty-two femoral access patients (28%) were given morphine-type analgesics in the post-procedure period compared to three radial access patients (5%, p=0.001). DAP does not increase when using radial instead of femoral access and the patients grade discomfort and pain much lower when using radial access. Radial access is thus beneficial to use.

Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial

Radial versus femoral access for elderly patients with acute coronary syndrome undergoing coronary angiography and intervention: insights from the RIVAL trial

Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial

A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches in Women Undergoing Percutaneous Coronary Intervention: The SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) Trial

Comparison between radial versus femoral percutaneous coronary intervention access in Indonesian hospitals, 2017–2018: A prospective observational study of a national registry

A Randomized Comparison of the Transradial and Transfemoral Approaches for Coronary Artery Bypass Graft Angiography and Intervention: The RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention)

BackgroundIn 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry.MethodsThe QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization.ResultsFrom 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009).ConclusionOur data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

Introduction Currently is estimated that at least 90% of the coronary studies are performed through the radial access. However, in patients with prior coronary artery bypass graft surgery (CABG) the femoral access continues to be widely used due to an easier and more successful graft engagement. Evidence of the efficacy and security of the radial approach use in this population is both scarce and controversial. Purpose We aimed to compare radial (right and left) versus femoral access to perform coronary angiography (CA) and/or percutaneous coronary intervention (PCI) after CABG. Methods In this comparative historical cohort study conducted at a national reference center, all CA and PCI performed from January 2012 to October 2022 were eligible for review. Electronic and physical records were examined for demographic and interventional data. Groups were classified for comparison as CA plus PCI, CA only and PCI only. Results We identified 563 patients; radial access was used in 227 (40%). In CA plus PCI group, in only one case existed failure to cannulate bypass grafts by the initial chosen access (from right radial access [RRA] to the left internal mammary artery [LIMA]). The crossover rate for any cause other than graft cannulation failure was 11.3% with right radial access (p = 0.002), 4.2% with left radial access (p = 0.28) and 0% with the femoral route. Fluoroscopy time was greater in RRA compared to femoral, nevertheless left radial access (LRA) had lower fluoroscopy time and contrast volume compared to RRA and femoral access. In the CA only group, failure to cannulate bypass grafts occurred exclusively when the LIMA had to be cannulated from the RRA (8.3% p=0.001); with a crossover rate for any cause other than graft cannulation failure was greater in the radial access compared to femoral (RRA 18.1% p &amp;lt; 0.001; LRA 4.2% p = 0.002; femoral 0.5% P=0.001), LRA had greater fluoroscopy time but the femoral access had greater contrast volume use in relation with a higher number of venous bypass grafts [143.64 mL (±69.36), p = 0.01]. There were 15 cases of PCI only, were fluoroscopy time and contrast volume were greater in LRA (N= 2 none were for treatment of LIMA) and lower in RRA compared to LRA and femoral access. Vascular complications were infrequent in all groups, being minor bleeding in the femoral access the most frequent, with no statistical significance. Conclusion Right and left radial access are feasible to perform coronary angiography and PCI after CABG, compared to the femoral route are associated with less contrast volume despite a greater crossover rate. This analysis suggests that the LRA should be preferred over the RRA when angiography of the LIMA is needed.

Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial