Article Text

PDF
Original article
Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients
  1. Cathy Johnman1,
  2. Jill P Pell1,
  3. Daniel F Mackay1,
  4. Miles Behan2,
  5. Rachel Slack1,
  6. Keith G Oldroyd3,
  7. Colin Berry4
  1. 1Public Health, University of Glasgow, Glasgow, UK
  2. 2Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
  4. 4BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor Colin Berry, Scottish Senior Fellow in Translational Medicine, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, 126 University Place, University of Glasgow, Glasgow G12 8TA, Scotland, UK; colin.berry{at}glasgow.ac.uk

Abstract

Objective To assess short-term and medium-term outcomes following radial and femoral artery access for primary or rescue percutaneous coronary intervention (PCI).

Design Retrospective cohort study.

Setting Scotland-wide.

Patients All 4534 patients undergoing primary or rescue PCI in Scotland between April 2000 and March 2009 using the Scottish Coronary Revascularisation Register.

Intervention Primary or rescue PCI.

Main outcome measures Procedural success; peri-procedural complications; 30-day and 1-year mortality, myocardial infarction or stroke and long-term mortality.

Results Use of the radial approach increased from no cases in 2000 to 924 (80.5%) in 2009 (p<0.001). Patients in whom the radial approach was used were more likely to be male (p=0.041) and to have multiple comorbidities (p<0.001), including hypertension (p<0.001) and left ventricular dysfunction (p<0.001). They were less likely to have renal impairment (p=0.017), multi-vessel coronary disease (p=0.001) and cardiogenic shock (p<0.001). In multivariable analyses, use of radial artery access was associated with greater procedural success (adjusted OR 1.89, 95% CI 1.26 – 2.82, p=0.002) and a lower risk of any complications (adjusted OR 0.67, 95% CI 0.51 – 0.87, p=0.001) or access site bleeding complications (adjusted OR 0.21, 0.08 – 0.56, p=0.002), as well as a lower risk of myocardial infarction (adjusted OR 0.66, 95% CI 0.51–0.87, p=0.003) or death within 30 days (adjusted OR 0.51, 95% CI 0.04 – 0.52, p<0.001). The differences in myocardial infarction and death remained significant up to 9 years of follow-up.

Conclusion Use of the radial artery for primary or rescue PCI is associated with improved clinical outcomes.

  • Percutaneous coronary interventions
  • myocardial infarction
  • radial
  • femoral
  • outcomes
  • cardiac remodelling
  • MRI
  • microvascular
  • aortic valve disease
  • intravascular ultrasound
  • interventional cardiology

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.