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Original research article
Analysis of safety outcomes for radial versus femoral access for percutaneous coronary intervention from a large clinical registry
  1. David R Dobies1,
  2. Kimberly R Barber2 and
  3. Amanda L Cohoon3
  1. 1Regional Cardiology Associates, Grand Blanc, Michigan, USA
  2. 2Genesys Regional Medical Center, Office of Research, Grand Blanc, Michigan, USA
  3. 3Genesys Regional Medical Center, Cardiac Cath Laboratory, Grand Blanc, Michegan, USA
  1. Correspondence to Professor Kimberly R Barber; kbarber{at}genesys.org

Abstract

Objective Using a multisite, contemporary registry of 58 862 percutaneous coronary intervention (PCI) procedures in a national healthcare system, the present study compared radial access with femoral access on safety and efficacy outcomes.

Methods This is a real-world, large-scale, retrospective study using clinical data from a 137-hopsital System and reported to a multisite clinical registry. All patients undergoing a cardiac catheterisation procedure were included in this database. The primary end points were major bleeding and radiation exposure. Multivariate logistic regression modelling was used to compare access groups.

Results Femoral access (n=55 729) accounted for 94.7% and radial access (n=3137) for 5.3%. There were fewer bleeding events in the radial group (n=28, 0.9%) than those in the femoral group (n=1234, 2.2%) in the unadjusted analysis. For patients receiving bivalirudin, bleeding occurred in 337 patients (1.6%), and there was no difference in rates between radial access (n=13, 1.1%) and femoral access (n=327, 1.7%) (OR=0.65, CI 0.40 to 1.22, p=0.19). The radial technique resulted in higher radiation exposure in each case, but particularly for procedures involving prior coronary artery bypass graft history and non-ST-elevated myocardial infarction patients. The mean fluoroscopy time among femoral access procedures was 15.68 min (SD=11.7) versus 19.86 min (SD=13.8) for radial access procedures (p<0.0001).

Conclusions Radial access for PCI is associated with higher fluoroscopy times but not with less major bleeding when bivalirudin is used. Our analysis, combined with other study findings, suggest that the safest route for PCI may be the use of femoral access with bivalirudin.

  • CORONARY ARTERY DISEASE
  • Radiation Exposure
  • Bleeding Complications
  • percutaneous coronary intervention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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