M Bilal Iqbal1, Aruna Arujuna1, Charles Ilsley1, Andrew Archbold1, Tom Crake1, Sam Firoozi1, Sundeep Kalra1, Charles Knight1, Pitt Lim1, Iqbal S Malik1, Anthony Mathur1, Pascal Meier1, Roby D Rakhit1, Simon Redwood1, Mark Whitbread1, Dan Bromage1, Krishna Rathod1, Andrew Wragg1, Philip MacCarthy1, Miles Dalby2. 1. From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.). 2. From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.). m.dalby@rbht.nhs.uk.
Abstract
BACKGROUND: Compared with transfemoral access, transradial access (TRA) for percutaneous coronary intervention is associated with reduced risk of bleeding and vascular complications. Studies suggest that TRA may reduce mortality in patients with ST-segment-elevation myocardial infarction. However, there are few data on the effect of TRA on mortality, specifically, in patients with non-ST-segment-elevation myocardial infarction. METHODS AND RESULTS: We analyzed 10 095 consecutive patients with non-ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention between 2005 and 2011 in all 8 tertiary cardiac centers in London, United Kingdom. TRA was a predictor for reduced bleeding (odds ratio=0.21; 95% confidence interval [CI]: 0.08-0.57; P=0.002), access-site complications (odds ratio=0.47; 95% CI: 0.23-0.95; P=0.034), and 1-year mortality (hazard ratio [HR]=0.72; 95% CI: 0.54-0.94; P=0.017). Between 2005 and 2007, TRA did not appear to reduce mortality at 1 year (HR=0.81; 95% CI: 0.51-1.28; P=0.376), whereas between 2008 and 2011, TRA conferred survival benefit at 1 year (HR=0.65; 95% CI: 0.46-0.92; P=0.015). The mortality benefit with TRA at 1 year was not seen at the low-volume centers (HR=0.80; 95% CI: 0.47-1.38; P=0.428) but specifically seen in the high volume radial centers (HR=0.70; 95% CI: 0.51-0.97; P=0.031). In propensity-matched analyses, TRA remained a predictor for survival at 1 year (HR=0.60; 95% CI: 0.42-0.85; P=0.005). Instrumental variable analysis demonstrated that TRA conferred mortality benefit at 1-year with an absolute mortality reduction of 5.8% (P=0.039). CONCLUSIONS: In this analysis of patients with non-ST-segment-elevation myocardial infarction, TRA appears to be a predictor for survival. Furthermore, the evolving learning curve, experience, and expertise may be important factors contributing to the prognostic benefit conferred with TRA.
BACKGROUND: Compared with transfemoral access, transradial access (TRA) for percutaneous coronary intervention is associated with reduced risk of bleeding and vascular complications. Studies suggest that TRA may reduce mortality in patients with ST-segment-elevation myocardial infarction. However, there are few data on the effect of TRA on mortality, specifically, in patients with non-ST-segment-elevation myocardial infarction. METHODS AND RESULTS: We analyzed 10 095 consecutive patients with non-ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention between 2005 and 2011 in all 8 tertiary cardiac centers in London, United Kingdom. TRA was a predictor for reduced bleeding (odds ratio=0.21; 95% confidence interval [CI]: 0.08-0.57; P=0.002), access-site complications (odds ratio=0.47; 95% CI: 0.23-0.95; P=0.034), and 1-year mortality (hazard ratio [HR]=0.72; 95% CI: 0.54-0.94; P=0.017). Between 2005 and 2007, TRA did not appear to reduce mortality at 1 year (HR=0.81; 95% CI: 0.51-1.28; P=0.376), whereas between 2008 and 2011, TRA conferred survival benefit at 1 year (HR=0.65; 95% CI: 0.46-0.92; P=0.015). The mortality benefit with TRA at 1 year was not seen at the low-volume centers (HR=0.80; 95% CI: 0.47-1.38; P=0.428) but specifically seen in the high volume radial centers (HR=0.70; 95% CI: 0.51-0.97; P=0.031). In propensity-matched analyses, TRA remained a predictor for survival at 1 year (HR=0.60; 95% CI: 0.42-0.85; P=0.005). Instrumental variable analysis demonstrated that TRA conferred mortality benefit at 1-year with an absolute mortality reduction of 5.8% (P=0.039). CONCLUSIONS: In this analysis of patients with non-ST-segment-elevation myocardial infarction, TRA appears to be a predictor for survival. Furthermore, the evolving learning curve, experience, and expertise may be important factors contributing to the prognostic benefit conferred with TRA.
Authors: Piotr Rola; Jan Jakub Kulczycki; Adrian Włodarczak; Mateusz Barycki; Szymon Włodarczak; Marek Szudrowicz; Łukasz Furtan; Artur Jastrzębski; Maciej Pęcherzewski; Maciej Lesiak; Adrian Doroszko Journal: Int J Environ Res Public Health Date: 2022-07-25 Impact factor: 4.614