LB-1
Temporal Trends and Clinical Outcomes with Radial Versus Femoral Arterial Access for Percutaneous Coronary Intervention in the United States
Presenter
Reza Fazel, M.D., FSCAI, Beth Israel Deaconess Medical Center, Westwood, MA
Reza Fazel, M.D., FSCAI1, Sunil V. Rao, MD, FSCAI2, David J. Cohen, M.D., FSCAI3, Eric Secemsky, MD, MSc, FSCAI4, Rajesh V. Swaminathan, M.D., FSCAI5, Pratik Manandhar, MS6, Jennifer A Rymer, MD, MBA, MHS7, Daniel Wojdyla, PhD6 and Robert W. Yeh, M.D., FSCAI8, (1)Beth Israel Deaconess Medical Center, Westwood, MA, (2)NYU Langone Health, Chapel Hill, NC, (3)St. Francis Hospital, New York, NY, (4)Beth Israel Deaconess Medical Center, Newton, MA, (5)Durham VA Health Care System, Durham, NC, (6)Duke Clinical Research Institute, Durham, NC, (7)Duke University Hospital, Chapel Hill, NC, (8)Beth Israel Deaconess Medical Center, Boston, MA
Keywords: Complications and Vascular Access, Management, and Closure
Background:
Radial access for percutaneous coronary intervention (PCI) is recommended by clinical practice guidelines because of superior outcomes compared with femoral access. Historically, the adoption of radial access in the United States has lagged behind much of the rest of the world, but contemporary data on access site selection across the spectrum of clinical presentations and its association with outcomes are lacking. Methods:
We conducted a retrospective cohort study from the National Cardiovascular Data Registry’s CathPCI Registry including PCIs performed between January 1, 2013 and June 30, 2022. The comparative safety of radial versus femoral access for PCI was evaluated using instrumental variable analysis exploiting operator variation in access preferences. Results:
Overall, 2,244,115 PCI procedures were performed during the study period, of which 61.6% (n= 1,381,913) were performed via radial access, increasing from 23.9% in 2013 to 68.2% in 2022. This increase was seen in all geographic regions and across the full spectrum of presentations, with the largest relative increase seen in patients with ST-segment elevation myocardial infarction. In instrumental variable analyses, radial access was associated with lower in-hospital mortality (absolute risk difference [ARD] -0.15%, 95% CI -0.20 to -0.10, P< 0.001), major access site bleeding (ARD -0.64%, 95% CI -0.68 to -0.60, P< 0.001) and other major vascular complications (ARD -0.21%, 95% CI -0.23 to -0.18, P< 0.001) but a higher risk of ischemic stroke (ARD 0.05%, 95% CI 0.03 to 0.08, P< 0.001). There was no association with the falsification endpoint of gastrointestinal or genitourinary bleeding (ARD 0.00%, 95% CI -0.03, 0.03, P= 0.89). Conclusions:
Over the past decade, use of radial access for PCI has increased 2.8-fold in the United States and now represents the dominant form of access across all procedural indications. Based on instrumental variable analysis-- a technique that can be used to support causal inference-- radial access was associated with lower rates of in-hospital mortality, major access bleeding, and other major vascular complications compared with femoral access but a slightly higher risk of ischemic stroke.