Transradial Intervention Research Articles

Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population.

Background/AimsTransradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI).MethodsA total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%).ResultsAfter propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up.ConclusionsIn our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.

Avulsion of radial artery during coronary angiogram – A case report

Trans-radial intervention increases patient comfort and reduces vascular complications. Trans-radial access has become the preferred choice of patients and cardiologists. Radial artery spasm is commonly encountered during procedure and it depends upon factors like artery anatomy, built of the patient, procedure variables. We report a case of radial artery spasm leading to avulsion in a 69-year old short Asian female during coronary angiogram, which was managed successfully by conservative measures. A brief note of various management procedures like drugs and device are mentioned.

Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis

PurposeThe study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. MethodsA total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27–96 years). ResultsFour cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. ConclusionsTransradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.

TCTAP C-036 Trans-Radial Primary Percutaneous Intervention with No-Flow Complication Post Balloon Angioplasty

TCTAP C-036 Trans-Radial Primary Percutaneous Intervention with No-Flow Complication Post Balloon Angioplasty

Twelve-month clinical outcomes of transradial coronary artery intervention: comparison of the right and left radial artery approach

Introduction. Trans-radial intervention has several advantages such as reduction of bleeding risk, improvement of patients’ convenience, and immediate ambulation as compared with the trans-femoral intervention. In the trans-radial intervention, there are some anatomical and technical differences between right and left radial approach. The aim of this study is to evaluate the impact of the choice of the right or left radial approach on 12-month clinical outcomes in patients undergoing the trans-radial intervention. Methods. A total of 506 consecutive patients who underwent trans-radial intervention were enrolled from Nov 2013 to Oct 2014 in the Lithuanian University of Health Sciences Trans-radial Intervention Registry. The patients were divided into two groups; a right radial approach group and a left radial approach group. To adjust potential confounders, propensity score-matched analysis was performed using the logistic regression model. Results. After propensity score matching, the baseline clinical and angiographic characteristics were balanced between the two groups. However, contrast volumes during the procedure were larger and fluoroscopic times were longer in the right radial approach group, whereas procedure times were longer in the left approach group. Procedural and in-hospital complications were similar between the two groups. The cumulative clinical outcomes up to 12 months, including mortality, recurrent myocardial infarction, repeat revascularisation, stent thrombosis, and MACE, were similar between the two groups. Conclusions. In this study, despite the procedural efficacy including procedural time and contrast volume were increased in the right artery approach, however, 12-month cumulative clinical outcomes were similar between the two groups.

Transradial intervention reduces complications and costs of PCI

Transradial intervention reduces complications and costs of PCI

Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention.

BackgroundRadial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion (RAO) but might be associated with incomplete hemostasis.Methods and ResultsIn total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20‐ and 60‐minute clamp application groups, respectively (P=0.19). The incidence of grade 1 hematoma was higher in the 20‐minute group (6.7% versus 2.5%, P=0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20‐ and 60‐minute groups, respectively (P=0.36). Requirement for clamp retightening (36% versus 16%, P=0.01) was higher among patients who had RAO. Need for clamp retightening was the only independent predictor of RAO (P=0.04).ConclusionsUltrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60‐minute clamp duration is safe and provides good access site hemostasis with low RAO rates.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02269722.

Costs Associated With Access Site and Same-Day Discharge Among Medicare Beneficiaries Undergoing Percutaneous Coronary Intervention: An Evaluation of the Current Percutaneous Coronary Intervention Care Pathways in the United States

ObjectivesThe aim of this study was to examine the independent impact of various care pathways, including those involving transradial intervention (TRI) and same-day discharge (SDD) after elective percutaneous coronary intervention (PCI), on hospital costs. BackgroundPCI is associated with costs of $10 billion annually. Alternative payment models for PCI are being implemented, but few data exist on strategies to reduce costs. Various PCI care pathways, including TRI and SDD, exist, but their association with costs and outcomes is unknown. MethodsIn total, 279,987 PCI patients eligible for SDD in the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims files were analyzed. Hospital costs in 2014 U.S. dollars were estimated using cost-to-charge ratios. Propensity scores for TRI and SDD, with propensity adjustment via inverse probability weighting, was performed. ResultsOf the 279,987 PCI procedures, TRI was used in 9.0% (13.5% of which were SDD), and SDD was used in 5.3% of cases (23.1% of which were TRI). TRI (vs. transfemoral intervention) was associated with lower adjusted costs of $916 (95% confidence interval [CI]: $778 to $1,035), as was SDD ($3,502; 95% CI: $3,486 to $3,902). The adjusted cost associated with TRI and SDD was $13,389 (95% CI: $13,161 to $13,607), while the cost associated with transfemoral intervention and non-same-day discharge was $17,076 (95% CI: $16,999 to $17,147), a difference of $3,689 (95% CI: $3,486 to $3,902; p < 0.0001). Shifting current practice from transfemoral intervention non-same-day discharge to TRI SDD by 30% could potentially save a hospital performing 1,000 PCIs each year $1 million and the country $300 million annually. ConclusionsAmong Medicare beneficiaries, TRI with SDD was independently associated with fewer complications and lower in-hospital costs. These findings have important implications for changing the current PCI care pathways to improve outcomes and reduce costs.

Safety and efficacy of transradial coronary angiography and intervention in patients older than 80 years: from the Korean Transradial Intervention Prospective Registry.

BackgroundRadial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younger patients. This study was conducted to investigate the feasibility and safety of transradial coronary angiography or intervention in the elderly.MethodsA total of 6132 patients from Korean Transradial Intervention Prospective Registry at 20 centers were analyzed. Patients were divided into the non-elderly group (n = 5667) and the elderly (≥ 80 years) group (n = 465). Using propensity score matching, the elderly group (n = 465) was compared with one-to-one matched the non-elderly group (n = 465).ResultsAfter propensity score matching, mean age was 64.3 ± 10.3 years in the non-elderly group and 83.5 ± 3.3 years in the elderly group. There was no difference of procedural characteristics, procedural and fluoroscopic times. Access site cross-over rate was not different between the non-elderly group and elderly group (7.5% vs. 6.2%, P = 0.074). Bleeding complications occurred similarly in two groups (2.6% of the non-elderly group vs. 1.9% of the elderly group, P = 0.660). Access site complications were 1.9% of the non-elderly group and 0.9% of the elderly group (P = 0.263). Both of in hospital death and cardiovascular death for one year were also similar between two groups.ConclusionsTransradial angiography or intervention was safe and feasible in elderly patients. Complication rates and clinical outcomes in elderly patients were comparable with those in non-elderly patients.

CRT-200.24 Association between Arterial Access Site and Anticoagulation Strategy on Major Bleeding and Mortality in Patients Undergoing Percutaneous Coronary Intervention: a Historical Cohort Analysis in the Veteran Population

Studies have shown a reduction in major bleeding with trans-radial intervention (TRI) compared with trans-femoral intervention (TFI), and with use of bivalirudin compared with heparin + glycoprotein IIb/IIIa inhibitors (GPI). We compared major bleeding and mortality in Veterans stratified by

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China: A Retrospective Analysis.

Objective To compare hospital costs and clinical outcomes between transradial intervention (TRI) and transfemoral intervention (TFI) in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention (PCI) in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting (IPW) model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 (95%CI: CNY4419-10 420). Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay (1.9 days, 95%CI: 1.1-2.7 days), shorter post-procedural stay (0.7 days, 95%CI: 0.3-1.1 days), and fewer major adverse cardiac events (adjusted odds ratio = 0.47, 95%CI: 0.31-0.73). There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI (P>0.05). Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

Evaluation of Learning Curve of Trans- Radial Percutaneous Coronary Angioplasty in Stemi- A Single Centre, Observational Study

Background: Percutaneous Transluminal Coronary Angioplasty (PTCA) through radial route is known to have a steep learning curve. The impact of this results in hesitation of performing PTCA through radial route by conventional femoral access operators. Objective: This study was designed to evaluate the difficulties and problems related to learning of radial PTCA by a team trained with PTCA by femoral route. Methods: In this prospective longitudinal study, over duration of 6 months we enrolled consecutive patients of acute STEMI (ST segment elevation myocardial infarction). All patients presenting within the window period of primary PTCA (up to 12 hours from onset of chest pain) or patients with ongoing chest pain or new ECG changes or hemodynamic compromise beyond 12 hours after the onset of chest pain were considered eligible for primary PTCA and were enrolled for transradial intervention. Thrombolysed patients were excluded. The team members involved in the study was trained for trans-femoral PTCA and was doing transfemoral PTCA for both primary and elective cases for 3 years to 6 years. Results: Over duration of 6 months, primary PTCA was performed in total of 30 patients of acute STEMI. Success rate of the trans-radial PTCA procedure was 97%. Cross-over rate to trans-femoral PTCA was 3%. The mortality rate was 3%, which was the incidence of radial artery stenosis. Conclusion: The study documents the ease of PTCA through trans-radial route even with operators trained with conventional femoral approach. Although our data is exclusively from primary PTCA in STEMI, but it can be applicable to routine elective PTCA also.

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.

Effects of radial versus femoral artery access in patients with acute myocardial infarction: Alarge centre prospective registry.

AimThis study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access.MethodsThis is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison.ResultsRetrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77 % of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7 % vs. 6.7 %, p < 0.001), and Killip class (Killip 1: 10.8 % vs. 17.3 %, p < 0.001). 30-day mortality rates were 1.7 % in the transradial group and 4.6 % in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95 % CI: 0.29–1.07, p = 0.08).ConclusionThis registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.

Incidence and predictors of bleeding complications after percutaneous coronary intervention

BackgroundBleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. MethodsWe studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database – Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients’ characteristics alone. In model 2, we added patients’ clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). ResultsOverall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. ConclusionsThe incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients’ characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.

Nursing care of transradial angiography and intervention in a tertiary hospital in Shanghai: a best practice implementation project.

Coronary heart disease is common in the general population and is estimated to cause as many deaths worldwide as cancer. Percutaneous coronary angiography and intervention is the most common method in the diagnosis and treatment of coronary heart disease. To achieve best practice in the nursing care of transradial angiography and intervention, there is an urgent need for clinical knowledge. This aim of this project was to improve clinical nursing care for transradial angiography and intervention in Zhongshan Hospital, Shanghai. Seven criteria identified from evidence by the Joanna Briggs Institute were audited in the coronary care unit of Zhongshan Hospital, Shanghai. Twenty-three nurses and 80 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over six months. This best practice implementation project improved the rates of written discharge instructions and radial artery patency assessment at the first post-procedure from 0% to 100%. Implementation rates for pre-procedural checklist as well as the radial artery patency assessment before discharge were 100% at baseline. Pre-procedural checklists including adequate criteria reached 78%, up from 0%. The implementation rate for regular monitoring of vital signs recorded for the first two hours post-procedure reached 22% from 0%. The implementation rate for details of discharge instructions, including procedure review, limitation of physical activity, general physical status, comorbidities, medication reconciliation and follow-up appointment improved from 36.6% to 100%. Barriers to implementation were identified as: (1) the structured pre-procedural checklist not being ready, (2) nurses lacking knowledge regarding discharge education for transradial angiography and intervention, (3) heavy clinical workload and lack of time, and (4) nurses lacking awareness and enthusiasm for implementing discharge education. This project achieved significant improvements in establishing evidence-based practice in nursing care of transradial angiography and intervention for patients. Strategies for sustaining best practice should continue to be developed in the future.

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention.

Background:The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI.Methods:We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis.Results:Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2–5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004).Conclusion:Distal puncture sites (0–1 cm away from the radius styloid process) can lead to a higher rate of RAO.Trial Registration:ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China.

BackgroundTransradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world.Methods and ResultsUsing data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single‐vessel disease, and less likely to undergo PCI for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI‐related costs (adjusted difference −¥5162 [−$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post‐PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina.ConclusionsAmong patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.

Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome and Anemia

Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13g/dl for men and <12g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p= 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p= 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p= 0.042). Inconclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.

Comparison of Frequency of Bleeding and Major Adverse Cardiac Events After Transradial Versus Transfemoral Intervention in the Recent Antiplatelet Era

The transradial approach is increasingly used for percutaneous coronary intervention (PCI), and we therefore aimed to compare the clinical outcomes after transradial intervention (TRI) and transfemoral intervention (TFI) in all patients undergoing PCI. Among 6,973 patients enrolled in a nationwide, prospective, multicenter registry (February 2013 to September 2013), 1,860 underwent TRI (n= 1,445, 77.7%) and TFI (n= 415, 22.3%). Bleeding and major adverse cardiac events (MACE; death, myocardial infarction, revascularization, or stent thrombosis) were compared. Bleeding occurred in 42 patients (2.3%) and was significantly less likely in the TRI versus TFI group (overall cohort: 1.5% vs 4.8%, p= 0.001; propensity score-matched: n= 728, 2.7% vs 5.2%, p= 0.048). Multivariate regression revealed that TRI was negatively associated with bleeding (odds ratio 0.42, 95% CI 0.21 to 0.83, p= 0.013). MACE occurred in 152 patients (8.2%). Kaplan-Meier estimates showed higher MACE-free survival rates in the TRI versus TFI group (overall cohort: 93.3% vs 86.7%, log-rank p= 0.026; propensity score-matched: 91.8% vs 86.5%, log-rank p= 0.04). Cox proportional analysis demonstrated that TRI independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p= 0.024). In conclusion, TRI is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI.