Coronary artery disease
Comparison of Access-Related Bleeding Complications in Women Versus Men Undergoing Percutaneous Coronary Catheterization Using the Radial Versus Femoral Artery

https://doi.org/10.1016/j.amjcard.2006.12.038Get rights and content

Women constitute a high-risk population for bleeding, which is a major prognostic predictor after percutaneous coronary catheterization procedures. We prospectively followed 3,261 consecutive percutaneous coronary procedures performed by radial artery catheterization (RAC) or femoral artery catheterization (FAC). The primary study objective was to determine the relative incidences of in-hospital major and minor puncture-related hemorrhages. Secondary objectives were to (1) identify predictors of major bleeds and (2) estimate how often a second, alternative access site is required for catheterization. In women, no major bleeding occurred after 299 RAC procedures performed, whereas 25 major bleeding episodes occurred after 601 FAC procedures (p = 0.0008). Women who underwent RAC also had a significantly lower incidence of minor hemorrhages than women who underwent FAC (19 of 299, 6.4%, vs 237 of 601, 39.4%, respectively, p = 0.00001). On multivariate analysis, independent predictors of major bleeding were FAC (odds ratio [OR] 27.4, 95% confidence interval [CI] 3.8 to 199.9), use of glycoprotein IIb/IIIa inhibitors (OR 5.6, 95% CI 2.7 to 11.9), female gender (OR 4.5, 95% CI 2.2 to 9.0), age >70 years (OR 2.4, 95% CI 1.2 to 4.8), and an acute coronary syndrome setting (OR 2.4, 95% CI 1.1 to 5.0). Women who underwent RAC were more likely to require a second access site than men (14% vs 1.7%), but operators less selective in RAC use successfully completed the procedure by radial approach in >90% of patients. In conclusion, extensive RAC was more effective at preventing access-related bleeding complications in women than FAC.

Section snippets

Methods

The primary study objective was to determine the incidence of in-hospital puncture-related major and minor hemorrhages. Secondary study objectives were to (1) identify predictors of major hemorrhage and (2) determine how often a second, alternative access site is required during radial procedures.

The study was performed in the Interventional Cardiology Unit of San Filippo Neri Hospital (Rome, Italy), a high-volume center performing >2,000 coronary procedures per year, with 35% of total activity

Results

During the observation period, 2,919 patients underwent 3,261 interventional and/or diagnostic procedures; 2,079 men underwent 2,361 procedures and 838 women underwent 900 procedures (1.1 procedures/patient in men and women). Overall, 1,703 of 3,261 (52%) RAC procedures were performed, but radial artery access was used less frequently in women than in men (299 of 900, 33%, vs 1,404 of 2,361, 59%, respectively, p <0.00001).

Table 1 presents a comparison of the women’s characteristics at the time

Discussion

Several previous randomized studies6 have demonstrated a dramatic decrease in entry site complications with RAC versus the traditional femoral artery approach. This prospective registry represents the largest published study on the influence of gender on arterial approach-rated complications. Our data show, for the first time in the “real world,” that RAC is associated with a lower incidence of major bleeds and up to an 84% decrease in minor bleeding in women, a high-risk population for

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    Two cardiovascular studies assessed the outcomes in females and males undergoing either transradial or transfemoral access [26,27]. In the first study [26], no major bleeding occurred after 299 transradial procedures, whereas 25 major bleeding episodes occurred after 601 transfemoral procedures (p = 0.0008). Also, women who underwent transradial access had a significantly lower incidence of minor hemorrhages than those undergoing transfemoral access (p = 0.00001) [26].

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