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Major improvement of percutaneous cardiovascular procedures outcomes with radial artery catheterisation. Results from the PREVAIL study.
  1. Christian Pristipino (pristipino.c{at}libero.it)
  1. S. Filippo Neri Hospital, Italy
    1. Carlo Trani
    1. Catholic University, Italy
      1. Marco S Nazzaro
      1. S. Camillo Hospital, Italy
        1. Andrea Berni
        1. S. Andrea Hospital, Italy
          1. Giuseppe Patti
          1. Campus Biomedico University, Italy
            1. Roberto Patrizi
            1. Policlinico Casilino Hospital, Italy
              1. Bruno Pironi
              1. Madre G. Vannini Hospital, Italy
                1. Pietro Mazzarotto
                1. S. Carlo Hospital, Italy
                  1. Gaetano Gioffrè
                  1. S. Eugenio Hospital, Italy
                    1. Giuseppe GL Biondi-Zoccai
                    1. Molinette Hospital, Italy
                      1. Giuseppe Richichi
                      1. S. Filippo Neri Hospital, Italy

                        Abstract

                        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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