Comparison of Frequency of Bleeding and Major Adverse Cardiac Events After Transradial Versus Transfemoral Intervention in the Recent Antiplatelet Era

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• 作者：Jeong Cheon Choe ; MD^a ; Kwang Soo Cha ; MD ; PhD^a ; ^{chakws1@hanmail.net" class="auth_mail" title="E-mail the corresponding author} ; ^{chakws@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Jong Hyun Choi ; MD^a ; Bo Won Kim ; MD^a ; Jin Sup Park ; MD^a ; Hye Won Lee ; MD^a ; Jun-Hyok Oh ; MD^a ; Jung Hyun Choi ; MD^a ; Han Cheol Lee ; MD^a ; Taek Jong Hong ; MD ; PhD^a ; Young Jin Youn ; MD^b ; Seung Hwan Lee ; MD ; PhD^b ; Byung Ryul Cho ; MD ; PhD^c ; Doo Il Kim ; MD ; PhD^d ; Kyoo Rok Han ; MD ; PhD^e ; Myung Ho Jeong ; MD ; PhD^f ; Junghan Yoon ; MD ; PhD^b ; the Korea Transradial Coronary Intervention (KOTRI) Prospective Registry Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 May 2016
• 年：2016
• 卷：117
• 期：10
• 页码：1588-1595
• 全文大小：1187 K

文摘

The transradial approach is increasingly used for percutaneous coronary intervention (PCI), and we therefore aimed to compare the clinical outcomes after transradial intervention (TRI) and transfemoral intervention (TFI) in all patients undergoing PCI. Among 6,973 patients enrolled in a nationwide, prospective, multicenter registry (February 2013 to September 2013), 1,860 underwent TRI (n = 1,445, 77.7%) and TFI (n = 415, 22.3%). Bleeding and major adverse cardiac events (MACE; death, myocardial infarction, revascularization, or stent thrombosis) were compared. Bleeding occurred in 42 patients (2.3%) and was significantly less likely in the TRI versus TFI group (overall cohort: 1.5% vs 4.8%, p = 0.001; propensity score–matched: n = 728, 2.7% vs 5.2%, p = 0.048). Multivariate regression revealed that TRI was negatively associated with bleeding (odds ratio 0.42, 95% CI 0.21 to 0.83, p = 0.013). MACE occurred in 152 patients (8.2%). Kaplan–Meier estimates showed higher MACE-free survival rates in the TRI versus TFI group (overall cohort: 93.3% vs 86.7%, log-rank p = 0.026; propensity score–matched: 91.8% vs 86.5%, log-rank p = 0.04). Cox proportional analysis demonstrated that TRI independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p = 0.024). In conclusion, TRI is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI.