Edward L Hannan1, Louise Szypulski Farrell2, Gary Walford3, Peter B Berger4, Nicholas J Stamato5, Ferdinand J Venditti6, Alice K Jacobs7, David R Holmes8, Samin Sharma9, Spencer B King10. 1. University at Albany, State University of New York, Albany, New York. Electronic address: elh03@health.state.ny.us. 2. University at Albany, State University of New York, Albany, New York. 3. Johns Hopkins University, Baltimore, Maryland. 4. Geisinger Medical Center, Danville, Pennsylvania. 5. United Health Services, Binghamton, New York. 6. Albany Medical Center, Albany, New York. 7. Boston Medical Center, Boston, Massachusetts. 8. Mayo Clinic, Rochester, Minnesota. 9. Mount Sinai Hospital, New York, New York. 10. St. Joseph's Health System, Atlanta, Georgia.
Abstract
OBJECTIVES: This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in common practice. BACKGROUND:Radial access for PCI has been studied considerably, but mostly in clinical trials. METHODS:All patients undergoing PCI for STEMI in 2009 to 2010 in New York were studied to determine the frequency and the patient-level predictors of radial access. Differences in in-hospital/30-day mortality between radial and femoral access were also studied. RESULTS:Radial access increased from 4.9% in the first quarter of 2009 to 11.9% in the last quarter of 2010. Significant independent predictors were higher body surface area, non-Hispanic ethnicity, Caucasian race, stable hemodynamic state, ejection fraction <30% and ≥50% onset of STEMI from 12 to 23 h before the index procedure, and peripheral vascular disease. Mortality was not related to access site after adjustment for covariates (for radial vs. femoral access, adjusted odds ratio: 0.86, 95% confidence interval: 0.59 to 1.25), but the radial access site was trending toward lower mortality for the 9 hospitals that used it for more than 10% of their patients (adjusted odds ratio: 0.61, 95% confidence interval: 0.36 to 1.02). CONCLUSIONS: The use of a radial access site for PCI in STEMI patients increased between 2009 and 2010, but was still infrequent in 2010, and was used for lower-risk STEMI patients. There was no significant difference in mortality by access site, but there was a trend toward a mortality advantage for patients with a radial access site among hospitals that used it relatively frequently.
RCT Entities:
OBJECTIVES: This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in common practice. BACKGROUND: Radial access for PCI has been studied considerably, but mostly in clinical trials. METHODS: All patients undergoing PCI for STEMI in 2009 to 2010 in New York were studied to determine the frequency and the patient-level predictors of radial access. Differences in in-hospital/30-day mortality between radial and femoral access were also studied. RESULTS: Radial access increased from 4.9% in the first quarter of 2009 to 11.9% in the last quarter of 2010. Significant independent predictors were higher body surface area, non-Hispanic ethnicity, Caucasian race, stable hemodynamic state, ejection fraction <30% and ≥50% onset of STEMI from 12 to 23 h before the index procedure, and peripheral vascular disease. Mortality was not related to access site after adjustment for covariates (for radial vs. femoral access, adjusted odds ratio: 0.86, 95% confidence interval: 0.59 to 1.25), but the radial access site was trending toward lower mortality for the 9 hospitals that used it for more than 10% of their patients (adjusted odds ratio: 0.61, 95% confidence interval: 0.36 to 1.02). CONCLUSIONS: The use of a radial access site for PCI in STEMI patients increased between 2009 and 2010, but was still infrequent in 2010, and was used for lower-risk STEMI patients. There was no significant difference in mortality by access site, but there was a trend toward a mortality advantage for patients with a radial access site among hospitals that used it relatively frequently.
Authors: Ahmad H S Mustafa; Eric Holroyd; Rob Butler; Doug Fraser; Magdi El-Omar; James Nolan; Mamas A Mamas Journal: Curr Cardiol Rep Date: 2015-05 Impact factor: 2.931
Authors: Amit P Amin; Samantha Miller; Brandon Rahn; Mary Caruso; Andrew Pierce; Katrine Sorensen; Howard Kurz; Alan Zajarias; Richard Bach; Jasvindar Singh; John M Lasala; Hemant Kulkarni; Patricia Crimmins-Reda Journal: J Am Heart Assoc Date: 2018-11-06 Impact factor: 5.501