Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program. Issue 2 (30th November 2021)

• Record Type: Journal Article
• Authors: Bhardwaj, Bhaskar; Gunzburger, Elise; Valle, Javier A.; Grunwald, Gary K.; Plomondon, Mary E.; Vidovich, Mladen I.; Aggarwal, Kul; Karuparthi, Poorna Raj
• Is Part Of: Catheterization and cardiovascular interventions. Volume 99:Issue 2(2022)
• Page Start: 480
• Page End: 488
• Publication Date: 2021-11-30
• Subjects: complex coronary interventions -- left main percutaneous interventions -- transfemoral access -- transradial access -- Veterans Affairs health care; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30024
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM‐PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system. Background: TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM‐PCI remain less studied. Methods: All LM‐PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients' baseline characteristics and procedure‐related variables were compared by access site. Both short‐ and long‐term clinical outcomes were analyzed using propensity score matching. Results: A total of 4004 LM‐PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM‐PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1‐year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding. Conclusion: Use of TRA for LM‐PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1‐year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM‐PCI.