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Hulme, W, Sperrin, M, Kontopantelis, E, Ratib, K, Ludman, P, Sirker, A, Kinnaird, T, Curzen, N, Kwok, CS, Debelder, M, Nolan, J and Mamas, M (2017) Increased radial access is not associated with worse femoral outcomes for PCI in the United Kingdom. Circulation: Cardiovascular Interventions, 10 (2). 004279. ISSN 1941-7632
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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.
Item Type: | Article |
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Additional Information: | The final version of this article and all relevant information related to it, including copyrights, can be found on the publisher website. |
Uncontrolled Keywords: | England, percutaneous coronary intervention, mortality, odds ratio, catheterization |
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: | 12 Dec 2016 13:06 |
Last Modified: | 22 Aug 2022 10:15 |
URI: | https://eprints.keele.ac.uk/id/eprint/2611 |