Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients

Heart. 2012 Apr;98(7):552-7. doi: 10.1136/heartjnl-2011-301032. Epub 2012 Feb 15.

Abstract

Objective: To assess short-term and medium-term outcomes following radial and femoral artery access for primary or rescue percutaneous coronary intervention (PCI).

Design: Retrospective cohort study.

Setting: Scotland-wide.

Patients: All 4534 patients undergoing primary or rescue PCI in Scotland between April 2000 and March 2009 using the Scottish Coronary Revascularisation Register.

Intervention: Primary or rescue PCI.

Main outcome measures: Procedural success; peri-procedural complications; 30-day and 1-year mortality, myocardial infarction or stroke and long-term mortality.

Results: Use of the radial approach increased from no cases in 2000 to 924 (80.5%) in 2009 (p<0.001). Patients in whom the radial approach was used were more likely to be male (p=0.041) and to have multiple comorbidities (p<0.001), including hypertension (p<0.001) and left ventricular dysfunction (p<0.001). They were less likely to have renal impairment (p=0.017), multi-vessel coronary disease (p=0.001) and cardiogenic shock (p<0.001). In multivariable analyses, use of radial artery access was associated with greater procedural success (adjusted OR 1.89, 95% CI 1.26 - 2.82, p=0.002) and a lower risk of any complications (adjusted OR 0.67, 95% CI 0.51 - 0.87, p=0.001) or access site bleeding complications (adjusted OR 0.21, 0.08 - 0.56, p=0.002), as well as a lower risk of myocardial infarction (adjusted OR 0.66, 95% CI 0.51-0.87, p=0.003) or death within 30 days (adjusted OR 0.51, 95% CI 0.04 - 0.52, p<0.001). The differences in myocardial infarction and death remained significant up to 9 years of follow-up.

Conclusion: Use of the radial artery for primary or rescue PCI is associated with improved clinical outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / methods*
  • Cardiac Catheterization / methods*
  • Coronary Angiography
  • Electrocardiography
  • Female
  • Femoral Artery
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Radial Artery
  • Retrospective Studies
  • Scotland / epidemiology
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome