The use of radial PCI in the U.S. increased 13-fold between 2007 and 2012, according to an analysis published June 11 in Circulation. But operators appeared less likely to apply the approach in patients at high risk of bleeding and vascular complications, a subgroup that might benefit the most.
Adoption of radial PCI has been anemic in the U.S. compared with other countries. Dmitriy N. Feldman, MD, PhD, of Weill Cornell Medical College, New York Presbyterian Hospital in New York City, and colleagues observed a push beginning in 2007 in the U.S. to train operators in the radial access approach. They wanted to see if and how that initiative had changed practice patterns and outcomes.
Using the National Cardiovascular Data Registry’s CathPCI Registry, they identified 2,820,874 procedures between January 2007 and September 2012 and grouped them by femoral or radial access site. They calculated rates by quarter, including subgroup analyses, and compared procedural outcomes between the femoral and radial groups.
Overall, 6.8 percent of PCIs used the radial approach. But between the first quarter of 2007 and the third quarter of 2012, the radial use rate grew from 1.2 percent to 16.1 percent. Fluoroscopy times were longer with radial, at 14.2 minutes compared with 11.1 minutes for femoral. The two approaches had similar success rates: 94.7 percent for radial and 93.81 percent for femoral.
The radial approach had lower rates of vascular complications and bleeding complications (0.16 percent vs. 0.45 percent and 2.67 percent vs. 6.08 percent, respectively). That was consistent across subgroups. High-risk groups had the greatest bleeding risk reduction.
“[T]he greatest benefit of r-PCI [radial PCI] in terms of the absolute reduction of bleeding and vascular complications is seen in high-risk groups of patients aged ≥75 years, women, and patients with ACS [acute coronary syndrome], where paradoxically the use and growth of r-PCI are the lowest,” Feldman et al wrote.
They emphasized that their findings showed similar efficacy for both approaches with radial access PCI offering safety advantages over the femoral approach. “However, its continued preferential use in younger patients, men, and those with lower-risk clinical features presents an opportunity to possibly improve overall PCI safety by increasing its application to higher-risk patients.”
Improvements in radial PCI in recent years include growing expertise and experience among operators and smaller profile devices. They proposed that the difference in fluoroscopy time between the two approaches may diminish as operators gain more experience.
“Once the operators overcome the learning curve associated with the radial technique and select patients with greater propensity for bleeding and vascular complications, greater adoption of r-PCI in women, older patients, and those with ACS may ultimately confer significant survival advantage owing to high risk of vascular and bleeding complications in those groups,” they suggested.
Limitations included the study being retrospective and observational. The CathPCI Registry enrolls about 70 percent of hospitals and may not be representative of the nation, and it does not include data on unsuccessful attempts at access and crossovers.
For more on radial access PCI, please read “ A Left-handed Complement to PCI” in Cardiovascular Business.