Access Site Practice and Procedural Outcomes in Relation to Clinical Presentation in 439,947 Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom

作者：Ratib Karim; Mamas Mamas A; Anderson Simon G; Bhatia Gurbir; Routledge Helen; De Belder Mark; Ludman Peter F; Fraser Douglas; Nolan James^*

来源：JACC: Cardiovascular Interventions , 2015, 8(1): 20-29.

DOI：10.1016/j.jcin.2014.06.026

• acute coronary syndromes
• access site
• femoral
• outcomes
• percutaneous coronary intervention
• radial

OBJECTIVES This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population.
BACKGROUND Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice.
METHODS Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice. Patients were categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 30-day mortality, major adverse cardiac events, bleeding, and arterial access site complications was studied.
RESULTS Data from 210,260 TRA and 229,687 transfemoral access procedures were analyzed. Following multivariate analysis, TRA was independently associated with a reduction in bleeding in all presenting syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was associated with reduced major adverse cardiac events only in patients with unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared with a transfemoral access (TFA) with a vascular closure device in a propensity matched cohort.
CONCLUSIONS In this large study, TRA is associated with reduced percutaneous coronary intervention-related complications in all patient groups and may reduce major adverse cardiac events and mortality in ACS patients. TRA is superior to transfemoral access with closure devices. Use of TRA may lead to important patient benefits in routine practice. TRA should be considered the preferred access site for percutaneous coronary intervention.

• 出版日期2015-1