The transradial approach (TRA) for
percutaneous coronary intervention (PCI) recently emerged as a safer vascular access with a similar rate of
MACE but a lower success rate requiring crossover to another approach when compared to the transfemoral approach (TFA).
METHODS AND RESULTS: In our hospital the introduction of the TRA in November 2003 resulted in a progressive decline of TFA use. Over the five years of conversion to TRA, from 2002 (100% TFA) to 2007 (98% TRA),
major adverse cardiac events (
MACE) and all in-hospital vascular and
bleeding events, related or not to vascular access, were prospectively collected to assess performances of each approach in the specific setting of PCI (
percutaneous coronary interventions). Data of 1,928 TFA and 1,672 TRA for a total of 3,600 consecutive PCI procedures are reported. PCI success rate was unchanged by TRA (96.1% versus 95.3% for TFA, NS). TRA was associated with a reduction in the rate of post-PCI
myocardial infarction (2.3% versus 3.6% for TFA, p=0.023) and with a significant reduction of
MACE (3.8% versus 5.2% for TFA, p=0.041). TRA use was also associated with a marked reduction of
blood transfusion and surgery for post-PCI
bleeding (0.2% versus 1.5% for TFA, p<0.001), despite more frequent prescription of downstream
glycoprotein IIb/IIIa inhibitors (23.7% versus 7.4% for TFA, p<0.001). Thus, TRA resulted in a rapid and significant reduction of all major in-hospital adverse events, cardiac as well as non-cardiac, pooled in a "Net Adverse Clinical Event (NACE) index" of non-desirable events: death,
myocardial infarction,
stroke, urgent CABG surgery, surgery for
bleeding and vascular events and
blood transfusion. Such events occurred in 4.1% of TRA (n=69) as compared to 7% of TFA (n=134) (p<0.001), accounting for a 41% relative reduction of this NACE index by TRA. By multivariate analysis, TRA was related to a better in-hospital outcome (OR 0.64, 95% confidence interval [CI] 0.47-0.87; p=0.005).
CONCLUSIONS: TRA for PCI provides the same success rate as TFA but significantly reduces post hoc related complications.