PT  - JOURNAL ARTICLE
AU  - C Pristipino
AU  - C Trani
AU  - M S Nazzaro
AU  - A Berni
AU  - G Patti
AU  - R Patrizi
AU  - B Pironi
AU  - P Mazzarotto
AU  - G Gioffrè
AU  - G G L Biondi-Zoccai
AU  - G Richichi
TI  - Major improvement of percutaneous cardiovascular procedure outcomes with radial artery catheterisation: results from the PREVAIL study
AID  - 10.1136/hrt.2008.150714
DP  - 2009 Mar 15
TA  - Heart
PG  - 476--482
VI  - 95
IP  - 6
4099  - http://heart.bmj.com/content/95/6/476.short
4100  - http://heart.bmj.com/content/95/6/476.full
SO  - Heart2009 Mar 15; 95
AB  - 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 accessMain 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.