Kinnaird, T, Anderson, R, Gallagher, S, Sirker, A, Ludman, P, De Belder, M, Copt, S, Oldroyd, K, Curzen, N, Banning, A and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2018) Access site and outcomes for unprotected left main stem PCI: an analysis of the British Cardiovascular Intervention Society database. JACC: Cardiovascular Interventions, 11 (24). pp. 2480-2491.

[img] Text
Unprotected Left main radial vs femoral final for JACC 3rd resubmission clean.docx - Accepted Version
Restricted to Repository staff only until 17 December 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (64kB)
[img] Text
Unprotected Left main access tables final post stats.docx - Supplemental Material
Restricted to Repository staff only until 17 December 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (29kB)
[img] Text
Unprotected LMS access figures_2.pdf - Supplemental Material
Restricted to Repository staff only until 17 December 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (130kB)
[img] Text
Supplementary Figure 2.pdf - Supplemental Material
Restricted to Repository staff only until 17 December 2019.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (145kB)

Abstract

Objectives
Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, temporal trends, predictors, and outcomes of radial access (RA) versus femoral access (FA) for unprotected left main stem percutaneous coronary intervention (LMS-PCI) were studied.

Background
Data on arterial access site for LMS-PCI are poorly defined.

Methods
Data were analyzed from 19,482 LMS-PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes.

Results
The frequency of FA use fell from 77.7% in 2007 to 31.7% in 2014 (p < 0.001 for trend). In the most contemporary study years (2012 to 2014), the strongest associates of FA use for unprotected LMS-PCI were renal disease, PCI for restenosis, chronic total occlusion intervention, and female sex. Use of intravascular imaging and chronic anticoagulation were associated with a higher likelihood of RA use. Complexity of the PCI procedure in the RA cohort increased significantly during the study period. Length of stay was shorter (2.6 ± 9.2 vs. 3.6 ± 9.0; p < 0.001) and same day discharge greater (43.0% vs. 26.6%; p < 0.001) with RA use. After propensity matching, RA use was associated with significant reductions in in-hospital events including access site arterial complications, major bleeding, and major adverse cardiovascular events. Conversion to RA for LMS-PCI was associated with similar reductions in the whole patient cohort. RA use was not associated with lower 12-month mortality.

Conclusions
In contemporary practice, the radial artery is the predominant access site for unprotected LMS-PCI, and its use is associated with shorter length of stay, less vascular complications, and less major bleeding than femoral access.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) will be available online via Elsevier at https://www.sciencedirect.com/journal/jacc-cardiovascular-interventions - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: access site choiceaccess site complicationsbleedingleft main arterynational databasepercutaneous coronary intervention
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 13 Sep 2018 15:44
Last Modified: 18 Jan 2019 14:45
URI: http://eprints.keele.ac.uk/id/eprint/5311

Actions (login required)

View Item View Item