COMPARATIVE EFFECTIVENESS OF RADIAL AND FEMORAL APPROACHES TO PERCUTANEOUS CORONARY INTERVENTION ON LONG-TERM OUTCOMES: A REPORT FROM THE NHLBI DYNAMIC REGISTRY

A214.E2024 JACC March 9, 2010 Volume 55, issue 10A

i2 SUMMIT COMPARATIVE EFFECTIVENESS OF RADIAL AND FEMORAL APPROACHES TO PERCUTANEOUS CORONARY INTERVENTION ON LONG-TERM OUTCOMES: A REPORT FROM THE NHLBI DYNAMIC REGISTRY i2 Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 16, 2009, 9:30 a.m.-10:30 a.m.

Session Title: Endovascular and New Technologies Abstract Category: Vascular Access, Closure Devices and Complications Presentation Number: 2505-457 Authors: Sunil V. Rao, Faith Selzer, Eric D. Peterson, Suresh R. Mulukutla, Joon S. Lee, Howard A. Cohen, David O. Williams, Alice K. Jacobs, Sheryl F. Kelsey, Oscar C. Marroquin, The University of Pittsburgh, Pittsburgh, PA, The Duke Clinical Research Institute, Durham, NC Background: Bleeding is associated with long-term mortality in patients undergoing percutaneous coronary intervention (PCI). The radial approach can decrease bleeding, but its impact on survival is unclear. Methods: Patients undergoing PCI in Waves 1-5 of the NHLBI Dynamic Registry (N=10917) were grouped by access site [femoral (N=10578) vs. radial (N=339)]. Baseline characteristics, major entry site complications (MES), transfusion (Tx), 1-year major adverse cardiac events (MACE), & 1-year mortality were compared. Multivariable Cox regression was used to determine the association between radial approach and outcomes after adjusting for confounders using femoral approach as the reference. Results: Compared with femoral approach, patients undergoing radial approach were more often white & nonsmokers, but less often had prior CABG & prior MI. Unadjusted rates of MES and 1-year MACE were significantly lower among radial patients, while rates of Tx & 1-year mortality trended lower (Table). After adjustment, radial approach was associated with significantly lower risk of MES (hazard ratio 0.06, 95% CI 0.01-0.43), and a nonsignificant trend for lower risk of 1-year MACE (HR 0.67, 95% CI 0.59-1.05) and mortality (HR 0.84, 95% CI 0.43-1.64). Conclusions: The radial approach to PCI was associated with significantly lower MES and a trend for reduced 1-year MACE and mortality. A randomized trial is needed to determine if the lower complication rate among radial patients translates to improved survival. Unadjusted rates of major entry site complications, transfusion, 1-yr MACE, & 1-yr mortality Radial

Femoral

P-Value

MES

0.3%

4.4%

< 0.01

Transfusion

0.5%

1.9%

0.07

1-year MACE

15.2%

22.0%

< 0.01

1-year mortality

2.9%

4.8%

0.11