A Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Elderly Patients Based on a Propensity Score Analysis
Restricted accessResearch articleFirst published online May, 2015
A Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Elderly Patients Based on a Propensity Score Analysis
The transradial approach (TRA) has been used as access site for percutaneous coronary intervention (PCI) for years. However, no large sample study has evaluated the effect of TRA in elderly patients. A total of 1098 elderly patients (age ≥ 75 years) who underwent PCI by TRA or transfemoral approach were recruited. A 1:1 matched propensity score analysis was performed to minimize bias. The rates of major adverse cardiovascular events that included death, myocardial infarction (MI), and target vessel revascularization during hospitalization (1.3% vs 6.6%, P = .014) and at 1-year follow-up (6.0% vs 13.9%, P = .019) were significantly lower in the TRA group. Transradial approach was also associated with lower rates of in-hospital MI (1.3% vs 5.3%, P = .046), access-site complications (3.3% vs 9.9%, P = .018), and major bleeding (1.3% vs 5.3%, P = .046). In conclusion, TRA showed better safety in elderly patients; it should be considered as a preferred route for elderly patients.
BertrandOFBélislePJoyalD. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J. 2012;163(4):632–648.
2.
CooperCJEl-ShiekhRACohenDJ. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J. 1999;138(3):430–436.
3.
BurzottaFTraniCMazzariMA. Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures. Am Heart J. 2012;163(2):230–238.
4.
PiperWDMalenkaDJRyanTJJr. Predicting vascular complications in percutaneous coronary interventions. Am Heart J. 2003;145(6):1022–1029.
5.
AssaliARMoustaphaASdringolaS. The dilemma of success: percutaneous coronary interventions in patients ≥75 years of age-successful but associated with higher vascular complications and cardiac mortality. Catheter Cardiovasc Interv. 2003;59(2):195–199.
6.
FeldmanDNGadeCLSlotwinerAJ. Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (< 60, 60 to 80, and> 80 years) (from the New York State Angioplasty Registry). Am J Cardiol. 2006;98(10):1334–1339.
7.
ZiakasAKlinkePMildenbergerR. Comparison of the radial and the femoral approaches in percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2003;91(5):598–600.
8.
KoutouzisMMatejkaGOlivecronaGGripLAlbertssonP. Radial vs. femoral approach for primary percutaneous coronary intervention in octogenarians. Cardiovasc Revasc Med. 2010;11(2):79–83.
9.
LouvardYBenamerHGarotP. Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS study). Am J Cardiol. 2004;94(9):1177–1180.
10.
AchenbachSRopersDKallertL. Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age. Catheter Cardiovasc Interv. 2008;72(5):629–635.
11.
JaffeRHongTSharieffW. Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians. Catheter Cardiovasc Interv. 2007;69(6):815–820.
12.
YanZXZhouYJZhaoYX. Safety and feasibility of transradial approach for primary percutaneous coronary intervention in elderly patients with acute myocardial infarction. Chin Med J (Engl). 2008;121(9):782–786.
13.
MehranRRaoSVBhattDL. STANDARDIZED bleeding definitions for cardiovascular clinical trials a consensus report from the bleeding academic research consortium. Circulation. 2011;123(23):2736–2747.
14.
KleinLWBlockPBrindisRG. Percutaneous coronary interventions in octogenarians in the American college of cardiology-national cardiovascular data registry development of a nomogram predictive of in-hospital mortality. J Am Coll Cardiol. 2002;40(3):394–402.
15.
AgostoniPBiondi-ZoccaiGGde BenedictisML. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44(2):349–356.
RomagnoliEBiondi-ZoccaiGSciahbasiA. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome the RIFLE-STEACS (radial versus femoral randomized investigation in ST-elevation acute coronary syndrome) study. J Am Coll Cardiol. 2012;60(24):2481–2489.
18.
MehtaSRJollySSCairnsJ. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol. 2012;60(24):2490–2499.
19.
PortoISelvanayagamJBVan GaalWJ. Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, Thrombolysis in Myocardial Infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation. 2006;114(7):662–669.
20.
SinghMRihalCSLennonRJGarrattKNMathewVHolmesDRJr. Prediction of complications following nonemergency percutaneous coronary interventions. Am J Cardiol. 2005;96(7):907–912.
21.
SueroJAMarsoSPJonesPG. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol. 2001;38(2):409–414.
22.
JollySSAmlaniSHamonMYusufSMehtaSR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009;157(1):132–140.
23.
ManoukianSVFeitFMehranR. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes an analysis from the ACUITY trial. J Am Coll Cardiol. 2007;49(12):1362–1368.
24.
NdrepepaGBergerPBMehilliJ. Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol. 2008;51(7):690–697.
25.
NdrepepaGNeumannFJSchulzS. Incidence and prognostic value of bleeding after percutaneous coronary intervention in patients older than 75 years of age. Catheter Cardiovasc Interv. 2014;83(2):182–189.
