Objective: To obtain a ‘snapshot’ view of access-specific percutaneous cardiovascular procedures outcomes in the real world.
Design: Multicenter, prospective study performed over a 30-day period.
Setting: Nine hospitals with invasive cardiology facilities, reflecting the contemporary state of health care.
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/re-infarction. 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 1,052 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. 2.0%, 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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