Mitul B Kadakia1, Sunil V Rao2, Lisa McCoy2, Paramita S Choudhuri2, Matthew W Sherwood2, Scott Lilly3, Taisei Kobayashi1, Daniel M Kolansky1, Robert L Wilensky1, Robert W Yeh4, Jay Giri5. 1. Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 2. Duke Clinical Research Institute, Durham, North Carolina. 3. Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio. 4. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts. 5. Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: giri.jay@gmail.com.
Abstract
OBJECTIVES: The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes. BACKGROUND: Transradial access reduces bleeding and mortality in STEMI patients undergoing primary PCI. Little is known about access site choice and outcomes in patients undergoing rescue PCI after receiving full-dose fibrinolytic therapy for STEMI. METHODS: Patients in the National Cardiovascular Data Registry's CathPCI Registry undergoing rescue PCI for STEMI between 2009 and 2013 were studied. Patients were divided on the basis of access site. Patterns of access use and baseline demographics were noted. Unadjusted and propensity-matched analyses were performed comparing in-hospital bleeding, vascular complications, and mortality outcomes among transradial and transfemoral access patients. The falsification endpoint of gastrointestinal bleeding was specified to assess for persistent unmeasured confounding. RESULTS: Transradial access was used in 14.2% of cases. In propensity-matched analyses, transradial rescue PCI was associated with significantly less bleeding than transfemoral access (odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.52 to 0.87; p = 0.003), but not mortality (OR: 0.81; 95% CI: 0.53 to 1.25; p = 0.35). Gastrointestinal bleeding was less frequent in the radial group (OR: 0.23; 95% CI: 0.05 to 0.98; p = 0.05). CONCLUSIONS: In a large, "real-world" registry, transradial access was used in a minority of cases and was associated with significantly less bleeding than transfemoral access in patients undergoing rescue PCI. However, given persistent differences in a falsification endpoint, the influence of treatment-selection bias on these results cannot be ruled out. Further studies are needed to determine predictors of bleeding and mortality in this understudied high-risk group.
OBJECTIVES: The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes. BACKGROUND: Transradial access reduces bleeding and mortality in STEMI patients undergoing primary PCI. Little is known about access site choice and outcomes in patients undergoing rescue PCI after receiving full-dose fibrinolytic therapy for STEMI. METHODS:Patients in the National Cardiovascular Data Registry's CathPCI Registry undergoing rescue PCI for STEMI between 2009 and 2013 were studied. Patients were divided on the basis of access site. Patterns of access use and baseline demographics were noted. Unadjusted and propensity-matched analyses were performed comparing in-hospital bleeding, vascular complications, and mortality outcomes among transradial and transfemoral access patients. The falsification endpoint of gastrointestinal bleeding was specified to assess for persistent unmeasured confounding. RESULTS: Transradial access was used in 14.2% of cases. In propensity-matched analyses, transradial rescue PCI was associated with significantly less bleeding than transfemoral access (odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.52 to 0.87; p = 0.003), but not mortality (OR: 0.81; 95% CI: 0.53 to 1.25; p = 0.35). Gastrointestinal bleeding was less frequent in the radial group (OR: 0.23; 95% CI: 0.05 to 0.98; p = 0.05). CONCLUSIONS: In a large, "real-world" registry, transradial access was used in a minority of cases and was associated with significantly less bleeding than transfemoral access in patients undergoing rescue PCI. However, given persistent differences in a falsification endpoint, the influence of treatment-selection bias on these results cannot be ruled out. Further studies are needed to determine predictors of bleeding and mortality in this understudied high-risk group.
Authors: Jay Shavadia; Robert Welsh; Anthony Gershlick; Yinggan Zheng; Kurt Huber; Sigrun Halvorsen; Phillipe G Steg; Frans Van de Werf; Paul W Armstrong Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501
Authors: Peter K Henke; Yeo Jung Park; Sachinder Hans; Paul Bove; Robert Cuff; Andris Kazmers; Theodore Schreiber; Hitinder S Gurm; P Michael Grossman Journal: PLoS One Date: 2016-11-11 Impact factor: 3.240
Authors: José M De la Torre Hernández; Mario Sadaba Sagredo; Miren Telleria Arrieta; Federico Gimeno de Carlos; Elena Sanchez Lacuesta; Juan A Bullones Ramírez; Javier Pineda Rocamora; Victoria Martin Yuste; Tamara Garcia Camarero; Mariano Larman; Jose R Rumoroso Journal: BMC Cardiovasc Disord Date: 2017-08-01 Impact factor: 2.298