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Radial Versus Femoral Access in Patients With ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Abstracts
Introduction: Wollongong Hospital is the tertiary referral hospital for the Illawarra-Shoalhaven catchment area, the third largest region in NSW, which has an ageing population with 11.7% aged greater than 70 in 2013. This population is at high risk of acute coronary syndrome requiring percutaneous intervention. Two recent landmark randomised multi-centre trials (RIVAL, MATRIX) showed that in ACS patients undergoing invasive management, radial as compared with femoral access reduced adverse clinical events, through a reduction in vascular complications, major bleeding and all-cause mortality. Similar outcomes were identified in elderly patients with lower rates of major bleeding or access site complications but higher rates of access site crossover with radial compared to femoral access. Methods: We conducted a retrospective analysis of radial access coronary cases performed in Wollongong Hospital from July 2010 to July 2014. There were 999 cases recorded during this period; 127 of these were performed in octogenarians. Results: When comparing radial access in octogenarians to all cases, there were comparable success rates (87% vs 90%), total TR band application times (average 48 minutes for both) but less post procedure bruising (7.1% vs 16.9%). In unsuccessful cases, there were more cases where an abnormal arterial anatomy was documented in the elderly population (56% vs 24%). However there were less cases of radial artery spasm or dissection (0% vs 23%). Conclusion: In conclusion, our experience has shown that radial approach cardiac catheterisation by experienced operators is as beneficial in the very elderly as in younger patients with comparable complication rates. http://dx.doi.org/10.1016/j.hlc.2016.06.446 445 Radial Arterial Access Reduces Access Site Complications and Unplanned Admissions in Outpatient Angiography and Percutaneous Intervention B. Lambert ∗ , J. Weaver, M. Sader St George Hospital, Kogarah, Australia Aims: To assess the impact of arterial access site on unplanned admission after outpatient angiogram or percutaneous coronary intervention within our institution. Methods: We conducted a retrospective cohort study of all patients undergoing coronary angiogram or percutaneous coronary intervention (PCI) in our institution between 1st July 2014 and 30th June 2015. Results: In total 1250 procedures were identified. Of these, 547 were conducted on an outpatient basis (493 angiograms and 54 planned PCI, including 11 CTOs). The intended arterial access site was radial in 414 (75%). Of these, 16 patients (3.9%) crossed over to femoral during the procedure. As such, 149 patients had a femoral puncture, while 398 (72.2%) had a radial puncture exclusively. 55 (10.1%) patients required admission post-procedure. Patients were more likely to be admitted with femoral compared to exclusive radial arterial access (32/149, 21.5%
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v 23/398, 6%, p<0.0001). This remained true for patients undergoing planned PCI (14/33, 42% v 1/21, 4.8%, p=0.0026), and for elective angiography (18/116, 15.5% v 22/377, 6.1%, p=0.0013). Admission rates increased with age, but were not affected by gender. Reasons for admission were categorised as access site related (10: 8 femoral, 2 radial), PCI related (34: 22 femoral, 12 radial), patient frailty (1: femoral), inpatient bypass surgery (8 radial), or unspecified (2: 1 femoral, 1 radial). Conclusion: Outpatient PCI reduces costs and improves timely access to admission. When cardiac catheterisation is conducted in an outpatient setting radial arterial access reduces access site complications and the need for admission. http://dx.doi.org/10.1016/j.hlc.2016.06.447 446 Radial Versus Femoral Access in Patients With ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention G. Femia ∗ , T. Fetahovic, F. Zaky, W. Mckenzie, A. Yeung, Nguyen-T. Dang, P. Shetty, A. Lee Wollongong Hospital, Wollongong, Australia Background: Radial access during primary percutaneous coronary intervention has been shown to reduce bleeding complications but in patients with ST segment elevation myocardial infarctions (STEMIs), there are concerns about prolonged reperfusion times. We examined patients with STEMIs undergoing primary cardiac catheterisation (no thrombolysis) between May 2013 and May 2015. We compared reperfusion times, access failure, target vessel revascularisation and vascular complications including bleeding between femoral and radial access. Patients were excluded if they did not undergo coronary intervention, had previous coronary artery bypass surgery or required intra-aortic balloon pump. Results: In total, 190 patients underwent catheterisation and after excluding 49 patients, 141 patients underwent primary percutaneous coronary intervention; 112 femoral and 29 radial. Patient characteristics and initial TIMI flow were similar between the groups. The median time from arrival in the catheterisation laboratory to first device was 26 minutes (25th%–75th%, 20–33) for the femoral group and 22 minutes (25th%–75th %, 16–33) for the radial group (P = NS). There were three procedures with failed primary access; two (6.9%) radial and one (0.9%) femoral (p = 0.11). There were three patients that required a second procedure due to acute stent thrombosis; two (1.8%) femoral and one (3.4%) radial (p =0.50). There were seven vascular complications; five (4.5%) femoral and two (6.9%) radial (p = 0.63). Conclusion: In our experience, not withstanding the small number of procedures, radial access for the management of STEMIs by experienced operators did not result in longer reperfusion times or increased procedural complications. http://dx.doi.org/10.1016/j.hlc.2016.06.448
Introduction: Wollongong Hospital is the tertiary referral hospital for the Illawarra-Shoalhaven catchment area, the third largest region in NSW, which has an ageing population with 11.7% aged greater than 70 in 2013. This population is at high risk of acute coronary syndrome requiring percutaneous intervention. Two recent landmark randomised multi-centre trials (RIVAL, MATRIX) showed that in ACS patients undergoing invasive management, radial as compared with femoral access reduced adverse clinical events, through a reduction in vascular complications, major bleeding and all-cause mortality. Similar outcomes were identified in elderly patients with lower rates of major bleeding or access site complications but higher rates of access site crossover with radial compared to femoral access. Methods: We conducted a retrospective analysis of radial access coronary cases performed in Wollongong Hospital from July 2010 to July 2014. There were 999 cases recorded during this period; 127 of these were performed in octogenarians. Results: When comparing radial access in octogenarians to all cases, there were comparable success rates (87% vs 90%), total TR band application times (average 48 minutes for both) but less post procedure bruising (7.1% vs 16.9%). In unsuccessful cases, there were more cases where an abnormal arterial anatomy was documented in the elderly population (56% vs 24%). However there were less cases of radial artery spasm or dissection (0% vs 23%). Conclusion: In conclusion, our experience has shown that radial approach cardiac catheterisation by experienced operators is as beneficial in the very elderly as in younger patients with comparable complication rates. http://dx.doi.org/10.1016/j.hlc.2016.06.446 445 Radial Arterial Access Reduces Access Site Complications and Unplanned Admissions in Outpatient Angiography and Percutaneous Intervention B. Lambert ∗ , J. Weaver, M. Sader St George Hospital, Kogarah, Australia Aims: To assess the impact of arterial access site on unplanned admission after outpatient angiogram or percutaneous coronary intervention within our institution. Methods: We conducted a retrospective cohort study of all patients undergoing coronary angiogram or percutaneous coronary intervention (PCI) in our institution between 1st July 2014 and 30th June 2015. Results: In total 1250 procedures were identified. Of these, 547 were conducted on an outpatient basis (493 angiograms and 54 planned PCI, including 11 CTOs). The intended arterial access site was radial in 414 (75%). Of these, 16 patients (3.9%) crossed over to femoral during the procedure. As such, 149 patients had a femoral puncture, while 398 (72.2%) had a radial puncture exclusively. 55 (10.1%) patients required admission post-procedure. Patients were more likely to be admitted with femoral compared to exclusive radial arterial access (32/149, 21.5%
S191
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v 23/398, 6%, p<0.0001). This remained true for patients undergoing planned PCI (14/33, 42% v 1/21, 4.8%, p=0.0026), and for elective angiography (18/116, 15.5% v 22/377, 6.1%, p=0.0013). Admission rates increased with age, but were not affected by gender. Reasons for admission were categorised as access site related (10: 8 femoral, 2 radial), PCI related (34: 22 femoral, 12 radial), patient frailty (1: femoral), inpatient bypass surgery (8 radial), or unspecified (2: 1 femoral, 1 radial). Conclusion: Outpatient PCI reduces costs and improves timely access to admission. When cardiac catheterisation is conducted in an outpatient setting radial arterial access reduces access site complications and the need for admission. http://dx.doi.org/10.1016/j.hlc.2016.06.447 446 Radial Versus Femoral Access in Patients With ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention G. Femia ∗ , T. Fetahovic, F. Zaky, W. Mckenzie, A. Yeung, Nguyen-T. Dang, P. Shetty, A. Lee Wollongong Hospital, Wollongong, Australia Background: Radial access during primary percutaneous coronary intervention has been shown to reduce bleeding complications but in patients with ST segment elevation myocardial infarctions (STEMIs), there are concerns about prolonged reperfusion times. We examined patients with STEMIs undergoing primary cardiac catheterisation (no thrombolysis) between May 2013 and May 2015. We compared reperfusion times, access failure, target vessel revascularisation and vascular complications including bleeding between femoral and radial access. Patients were excluded if they did not undergo coronary intervention, had previous coronary artery bypass surgery or required intra-aortic balloon pump. Results: In total, 190 patients underwent catheterisation and after excluding 49 patients, 141 patients underwent primary percutaneous coronary intervention; 112 femoral and 29 radial. Patient characteristics and initial TIMI flow were similar between the groups. The median time from arrival in the catheterisation laboratory to first device was 26 minutes (25th%–75th%, 20–33) for the femoral group and 22 minutes (25th%–75th %, 16–33) for the radial group (P = NS). There were three procedures with failed primary access; two (6.9%) radial and one (0.9%) femoral (p = 0.11). There were three patients that required a second procedure due to acute stent thrombosis; two (1.8%) femoral and one (3.4%) radial (p =0.50). There were seven vascular complications; five (4.5%) femoral and two (6.9%) radial (p = 0.63). Conclusion: In our experience, not withstanding the small number of procedures, radial access for the management of STEMIs by experienced operators did not result in longer reperfusion times or increased procedural complications. http://dx.doi.org/10.1016/j.hlc.2016.06.448