The Association Of Arterial Access Site At Angioplasty With Transfusion And Mortality The M.O.R.T.A.L Study: (Mortality benefit of Reduced Transfusion After PCI via the Arm or Leg)

¹ Morriston Regional Heart Centre, United Kingdom
² Victoria Heart Institute Foundation, Canada
³ Child and Youth Development Trajectories Research Unit, University of British Columbia, Vancouver, Canada
⁴ St Paul's Hospital, Vancouver Coastal Health, Canada
⁵ Department of Pathology and Laboratory Medicine, University of British Columbia, Canada

^* To whom correspondence should be addressed. E-mail: alexander.chase{at}swansea-tr.wales.nhs.uk.

Accepted 6 February 2008

	Abstract

Context Bleeding and transfusion following percutaneous coronary intervention are known predictors of mortality. Trans-radial arterial access reduces bleeding and transfusion related to femoral access complications although its association with mortality is unknown.

Objective To determine the association of arterial access site (radial or femoral) with transfusion and mortality in unselected percutaneous coronary interventions.

Design, Setting and Patients By data linkage of 3 prospectively collated Provincial registries, we analysed 38,872 procedures in 32,822 patients in British Columbia. The association between access site, transfusion and outcomes was assessed by logistic regression, propensity score matching and probit regression.

Main Outcome Measures 30 day and 1 year mortality.

Results 1,134 (3.5%) patients had at least one blood transfusion. Transfused patients had a significantly increased 30 day and 1 year mortality, adjusted odds ratio (OR) 95% Confidence Interval (CI) 4.01 (3.08 - 5.22) and 3.58 (2.94-4.36) respectively. By probit regression the absolute increase in risk of death at 1 year (ARR) associated with receiving a transfusion was 6.78%. The number needed to treat was 14.74 (prevention of 15 transfusions required to "avoid" one death). Radial access halved transfusion rate. After adjustment for all variables radial access was associated with a significant reduction in 30 day and 1 year mortality, odds ratio 0.64 (0.49-0 .82) and 0.83 (0.71-.98) respectively (all p < .001).

Conclusions In a registry of all-comers to PCI, trans-radial access was associated with a halving of transfusion rate and a reduction in 30 day and 1 year mortality.