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Increased radial access is not associated with worse femoral outcomes for PCI in the United Kingdom

Hulme, William; Sperrin, Matthew; Kontopantelis, Evangelos; Ratib, Karim; Ludman, Peter; Sirker, Alex; Kinnaird, Tim; Curzen, Nick; Shing Kwok, Chun; De Belder, Mark; Nolan, James; Mamas, Mamas

Authors

William Hulme

Matthew Sperrin

Evangelos Kontopantelis

Karim Ratib

Peter Ludman

Alex Sirker

Tim Kinnaird

Nick Curzen

Chun Shing Kwok

Mark De Belder



Abstract

Background—
The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach.

Methods and Results—
Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235?250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97–1.02; P=0.472 per 0.1 increase in proportion), and similarly recent femoral volume (per 100 procedures) was not found to be significant (odds ratio, 1.00; 95% confidence interval, 0.98–1.01; P=0.869). The in-hospital vascular complication rate was 1.0%, and this outcome was not significantly associated with recent femoral proportion after risk-adjustment (odds ratio, 0.97; 95% confidence interval, 0.94–1.00; P=0.060 per 0.1 increase in proportion).

Conclusions—
The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.

Journal Article Type Article
Acceptance Date Dec 8, 2016
Online Publication Date Feb 14, 2017
Publication Date 2017-02
Publicly Available Date Mar 29, 2024
Journal Circulation: Cardiovascular Interventions
Print ISSN 1941-7640
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 10
Issue 2
Pages 4279
DOI https://doi.org/10.1161/CIRCINTERVENTIONS.116.004279
Keywords England, percutaneous coronary intervention, mortality, odds ratio, catheterization
Publisher URL http://doi.org/10.1161/CIRCINTERVENTIONS.116.004279

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