Muhammad Asrar Ul Haq1, It Meng Tsay2, Diem T Dinh3, Angela Brennan3, David Clark4, Nicholas Cox5, Richard Harper6, Voltaire Nadurata7, Nick Andrianopoulos3, Christopher Reid8, Stephen J Duffy9, Jeffrey Lefkovits3, William J van Gaal10. 1. Department of Cardiology, Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia. 2. Department of Cardiology, Northern Hospital, Melbourne, Australia. 3. Department of Epidemiology and Preventive Medicine, Monash University, Australia. 4. Department of Cardiology, Austin Health, Melbourne, Australia. 5. Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Australia; Cardiology Unit, Western Health, Melbourne, Australia. 6. Department of Cardiology, Monash Health, Melbourne, Australia. 7. Department of Cardiology, Bendigo Hospital, Melbourne, Australia. 8. Department of Epidemiology and Preventive Medicine, Monash University, Australia; School of Public Health, Curtin University, Perth, Australia. 9. Cardiology General Services, The Alfred Hospital, Melbourne, Australia. 10. Department of Cardiology, Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia. Electronic address: William.vangaal@nh.org.au.
Abstract
BACKGROUND: Trans-radial access for percutaneous coronary intervention (PCI) has been associated with lower vascular complication rates and improved outcomes. We assessed the current uptake of trans-radial PCI in Victoria, Australia, and evaluated if patients were selected according to baseline bleeding risk in contemporary clinical practise, and compared selected clinical outcomes. METHODS: PCI data of all patients between 1st January 2013 and 31st December 2014 were analysed using The Victorian Cardiac Outcomes Registry (VCOR). Propensity-matched analysis was performed to compare the clinical outcomes. RESULTS: 11,711 procedures were analysed. The femoral route was the predominant access site (66%). Patients undergoing trans-radial access PCI were younger (63.9±11.6 vs. 67.2±11.8; p<0.001), had a higher BMI (28.9±5.5 vs. 28.5±5.2; p<0.001), more likely to be male (80.0 vs. 74.9%;p<0.001), less likely to have presented with cardiogenic shock (0.9 vs. 2.8%; p<0.001) or have the following comorbidities: diabetes (19.8 vs. 23.1%; p<0.001), peripheral vascular disease (2.9 vs. 4.3%; p=0.005) or renal impairment (13.6 vs. 22.1%; p<0.001). The radial group had less bleeding events (3.2 vs. 4.6%; p<0.001) and shorter hospital length of stay (3.1±4.7 vs. 3.3±3.9; p=0.006). There was no significant difference in mortality (1.0 vs. 1.4%; p=0.095). CONCLUSIONS: Trans-femoral approach remains the dominant access site for PCI in Victoria. The choice of route does not appear to be selected by consideration of bleeding risk. The radial route is associated with improved clinical outcomes of reduced bleeding and length of stay consistent with previous findings, and this supports the efficacy and safety of trans-radial PCI in real-world clinical practise.
BACKGROUND: Trans-radial access for percutaneous coronary intervention (PCI) has been associated with lower vascular complication rates and improved outcomes. We assessed the current uptake of trans-radial PCI in Victoria, Australia, and evaluated if patients were selected according to baseline bleeding risk in contemporary clinical practise, and compared selected clinical outcomes. METHODS: PCI data of all patients between 1st January 2013 and 31st December 2014 were analysed using The Victorian Cardiac Outcomes Registry (VCOR). Propensity-matched analysis was performed to compare the clinical outcomes. RESULTS: 11,711 procedures were analysed. The femoral route was the predominant access site (66%). Patients undergoing trans-radial access PCI were younger (63.9±11.6 vs. 67.2±11.8; p<0.001), had a higher BMI (28.9±5.5 vs. 28.5±5.2; p<0.001), more likely to be male (80.0 vs. 74.9%;p<0.001), less likely to have presented with cardiogenic shock (0.9 vs. 2.8%; p<0.001) or have the following comorbidities: diabetes (19.8 vs. 23.1%; p<0.001), peripheral vascular disease (2.9 vs. 4.3%; p=0.005) or renal impairment (13.6 vs. 22.1%; p<0.001). The radial group had less bleeding events (3.2 vs. 4.6%; p<0.001) and shorter hospital length of stay (3.1±4.7 vs. 3.3±3.9; p=0.006). There was no significant difference in mortality (1.0 vs. 1.4%; p=0.095). CONCLUSIONS: Trans-femoral approach remains the dominant access site for PCI in Victoria. The choice of route does not appear to be selected by consideration of bleeding risk. The radial route is associated with improved clinical outcomes of reduced bleeding and length of stay consistent with previous findings, and this supports the efficacy and safety of trans-radial PCI in real-world clinical practise.
Authors: Nicolas W Shammas; Gail A Shammas; Susan Jones-Miller; Mileah Rose Gumpert; Miranda Jade Gumpert; Christine Harb; Majid Z Chammas; W John Shammas; Rommy A Khalafallah; Amy Barzgari; Bassel Bou Dargham; Ghassan E Daher; Rayan Jo Rachwan; Andrew N Shammas Journal: Ther Clin Risk Manag Date: 2017-03-30 Impact factor: 2.423
Authors: Peter Lee; Angela Brennan; Diem Dinh; Dion Stub; Jeffrey Lefkovits; Christopher M Reid; Ella Zomer; Ken Chin; Danny Liew Journal: Clin Cardiol Date: 2022-02-22 Impact factor: 3.287
Authors: Hoa T T Vu; Richard Norman; Ngoc M Pham; Hung M Pham; Hoai T T Nguyen; Quang N Nguyen; Loi D Do; Rachel R Huxley; Crystal M Y Lee; Tu M Hoang; Christopher M Reid Journal: Lancet Reg Health West Pac Date: 2021-03-02