OBJECTIVES: This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy. BACKGROUND: The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared. METHODS: Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method. RESULTS: Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively. CONCLUSIONS: In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.
OBJECTIVES: This study intended to compare outcomes between transradial (TR) and transfemoral (TF) percutaneous revascularization in high-risk coronary anatomy. BACKGROUND: The feasibility, efficacy and safety between TR and TF methods of percutaneous coronary revascularization for unprotected left main coronary artery (UPLM]) disease have not been compared. METHODS: Among 821 consecutive patients with UPLM disease treated with percutaneous revascularization by either TR (n = 353) or TF (n = 468) vascular access, procedural outcomes, resource use, in-hospital bleeding, and late clinical events were compared according to vascular access method. RESULTS: Clinical and angiographic characteristics were similar between groups, except that TR patients less commonly presented with unstable angina and had less UPLM bifurcation disease requiring treatment with 2 stents. No significant differences were observed between TR and TF methods for procedural success (97% TF vs. 96% TR, p = 0.57) or total procedural time. However, duration of hospital stay and in-hospital occurrence of Thrombosis In Myocardial Infarction (TIMI) major or minor bleeding (0.6% vs. 2.8%, p = 0.02) were significantly lower with TR access. Using propensity score modeling (254 matched pairs), over a mean follow-up period of 17 months, rates of cardiovascular death (1.2% vs. 2.0%, p = 0.48), nonfatal myocardial infarction (4.7% vs. 2.4%, p = 0.16), stent thrombosis (0.8% vs. 2.8%, p = 0.10) and any target vessel revascularization (6.0% vs. 6.7%, p = 0.72) did not statistically differ among TR and TF groups, respectively. CONCLUSIONS: In contrast to TF vascular access, TR percutaneous coronary revascularization for UPLM disease is feasible and associated with similar procedural success, abbreviated hospitalization, reduced bleeding, and comparable late-term clinical safety and efficacy.
Authors: Xin Zheng; Jeptha P Curtis; Shuang Hu; Yongfei Wang; Yuejin Yang; Frederick A Masoudi; John A Spertus; Xi Li; Jing Li; Kumar Dharmarajan; Nicholas S Downing; Harlan M Krumholz; Lixin Jiang Journal: JAMA Intern Med Date: 2016-04 Impact factor: 21.873
Authors: Thomas A Meijers; Adel Aminian; Koen Teeuwen; Marleen van Wely; Thomas Schmitz; Maurits T Dirksen; Rene J van der Schaaf; Juan F Iglesias; Pierfrancesco Agostoni; Joseph Dens; Paul Knaapen; Sudhir Rathore; Jan Paul Ottervanger; Jan-Henk E Dambrink; Vincent Roolvink; A T Marcel Gosselink; Renicus S Hermanides; Niels van Royen; Maarten A H van Leeuwen Journal: BMJ Open Date: 2020-07-20 Impact factor: 2.692