Sung Gyun Ahn1, Jun-Won Lee1, Young Jin Youn1, Seung-Hwan Lee1, Jang Hyun Cho2, Woong Chol Kang3, Jong-Pil Park4, Won-Yong Shin5, Seong-Hoon Lim6, Yu Jeong Choi7, Kyungsoo Kim8, Do-Sun Lim9, Woojung Chun10, Ju Han Kim11, Junghan Yoon1. 1. Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea. 2. Department of Cardiology, St. Carollo Hospital, Republic of Korea. 3. Department of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. 4. Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea. 5. Department of Cardiology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Republic of Korea. 6. Division of Cardiovascular disease, College of Medicine, Dankook University Hospital, Cheonan, Republic of Korea. 7. Eulji University School of Medicine, Division of Cardiology, Eulji Medical Center, Daejeon, Republic of Korea. 8. Department of Cardiology, Hanyang University Hospital, Seoul, Republic of Korea. 9. Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea. 10. Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea. 11. Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Republic of Korea.
Abstract
OBJECTIVES: We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced. BACKGROUND: The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern. METHODS: Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in-hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all-cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed. RESULTS: The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55-0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33-0.60) and nonfatal MI (OR 0.66, 95% CI 0.54-0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59-0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST-elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all). CONCLUSIONS: Compared to TFI, TRI had favorable composite in-hospital outcomes. TRI benefits were pronounced in high-risk clinical settings and in high PCI volume centers.
OBJECTIVES: We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced. BACKGROUND: The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern. METHODS: Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in-hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all-cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed. RESULTS: The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55-0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33-0.60) and nonfatal MI (OR 0.66, 95% CI 0.54-0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59-0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST-elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all). CONCLUSIONS: Compared to TFI, TRI had favorable composite in-hospital outcomes. TRI benefits were pronounced in high-risk clinical settings and in high PCI volume centers.
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