JACC: Transradial PCI cuts mortality, vascular events
“Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty,” according to background information from the article.
To better understand whether the transradial approach could reduce major bleeding outcomes and other adverse events, Marco Valgimigli, MD, PhD, of the Institute of Cardiology at the University of Ferrara in Ferrara, Italy, and colleagues evaluated 11,068 STEMI patients who underwent either transfemoral or transradial interventions. The researchers reported two-year risk adjusted mortality rates during the REAL (a propensity score-adjusted and -matched analysis from the REgistro regionale AngiopLastiche dell’Emilia-Romagna) multicenter registry.
Patients undergoing PCI in a region of northern Italy between Jan. 1, 2003, and July 30, 2009, were identified. Of the 11,068 patients included in the study, 8,000 were treated for acute MI via the transfemoral approach and 3,068 were treated with the transradial approach. Those who underwent PCI via the transradial approach saw lower two-year, risk-adjusted mortality compared with those who underwent the procedure transfemorally, 8.8 percent versus 11.4 percent, respectively.
Additionally, the researchers reported that vascular complications occurred in 1.1 percent of the transradial patients compared with 2.5 percent in the transfemoral patients at 30 days. These rates at two years were 4.9 percent vs. 6.9 percent, respectively. Between one and 24 months these rates were 3.9 percent versus 4.5 percent, respectively.
“The rates of myocardial infarction or stroke did not differ at two years in patients who underwent TRI [transradial] as compared with the transfemoral group, yet both composites of death or myocardial infarction, and death, myocardial infarction, or stroke were lower in the transradial group at two years, entirely driven by the observed difference in mortality between groups,” Valgimigli et al wrote.
The authors said adopting the transradial approach into practice may be a long process, particularly in the STEMI population. While nearly 10 of the 12 regional sites in northern Italy launched a transradial program during the study period, the authors said several hundreds of PCI cases over a three-year time period were deemed necessary to make the transradial approach the prevalent access site to treat STEMI patients.
“[T]he crossover from the radial to the femoral access site peaked at almost 8 percent in 2006 and subsequently declined to a much more acceptable 3 percent rate, despite a progressive TRI increase over time,” the authors wrote.
“[B]ased on a substantial reduction in the length of hospitalization as well as in access-site bleeding and vascular complications, the widespread adoption of TRI may dramatically impact the economic burden of ACS [acute coronary syndrome] in Western countries,” they concluded.