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Heart 2009;95:476-482 doi:10.1136/hrt.2008.150714
  • Original article
  • Interventional cardiology

Major improvement of percutaneous cardiovascular procedure outcomes with radial artery catheterisation: results from the PREVAIL study

  1. C Pristipino1,
  2. C Trani2,
  3. M S Nazzaro3,
  4. A Berni4,
  5. G Patti5,
  6. R Patrizi6,
  7. B Pironi7,
  8. P Mazzarotto8,
  9. G Gioffrè9,
  10. G G L Biondi-Zoccai10,
  11. G Richichi1,
  12. on behalf of the Prospective REgistry of Vascular Access in Interventions in Lazio region (PREVAIL) study group
  1. 1
    San Filippo Neri Hospital, Rome, Italy
  2. 2
    Catholic University, Rome, Italy
  3. 3
    San Camillo Hospital, Rome, Italy
  4. 4
    Sant’ Andrea Hospital, Rome, Italy
  5. 5
    Campus Biomedico University, Rome, Italy
  6. 6
    Policlinico Casilino Hospital, Rome, Italy
  7. 7
    Madre G Vannini Hospital, Rome, Italy
  8. 8
    San Carlo Hospital, Rome, Italy
  9. 9
    Sant’ Eugenio Hospital, Rome, Italy
  10. 10
    San Giovanni Battista “Molinette” University Hospital, Turin, Italy
  1. Dr Christian Pristipino, Via Bogorose 5, 00189 Rome, Italy; pristipino.c{at}libero.it
  • Accepted 28 October 2008
  • Published Online First 26 November 2008

Abstract

Objective: To obtain a “snapshot” view of access-specific percutaneous cardiovascular procedures outcomes in the real world.

Design: Multicentre, prospective study performed over a 30-day period.

Setting: Nine hospitals with invasive cardiology facilities, reflecting the contemporary state of healthcare.

Patients: Unselected consecutive sample of patients undergoing any percutaneous cardiovascular procedure requiring an arterial access.

Interventions: Percutaneous cardiovascular procedures by radial or femoral access

Main outcome measures: The primary outcome was the combined incidence of in-hospital (a) major and minor haemorrhages; (b) peri-procedural stroke; and (c) entry-site vascular complications. The secondary outcome was the combined incidence of in-hospital death and myocardial infarction/reinfarction. For analysis purposes, outcomes were allocated to arterial access-determined study arms on an intention-to treat basis. Multivariable analysis adjusted using propensity score was performed to correct for selection bias related to arterial site.

Results: A total of 1052 patients were enrolled: 509 underwent radial access and 543 femoral access. In both groups, 40% underwent a coronary angioplasty. Relative to femoral access, radial access was associated with a lower incidence both of primary (4.2% vs 1.96%, p = 0.03, respectively) and secondary endpoints (3.1% vs 0.6%, p = 0.005, respectively). Multivariate analysis, adjusted for procedural and clinical confounders, confirmed that intention-to-access via the radial route was significantly and independently associated with a decreased risk both of primary (OR 0.37, 95% CI 0.16 to 0.84) and secondary endpoints (OR 0.14, 95% CI 0.03 to 0.62).

Conclusions: Our study indicates strikingly better outcomes of percutaneous cardiovascular procedures with radial access versus femoral access in contemporary, real-world clinical settings.

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