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JACC Cardiovasc Interv. 2017 Nov 27;10(22):2258-2265. doi: 10.1016/j.jcin.2017.07.049.

Impact of Access Site Practice on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Thrombolysis for ST-Segment Elevation Myocardial Infarction in the United Kingdom: An Insight From the British Cardiovascular Intervention Society Dataset.

Author information

1
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. Electronic address: doctorrashid7@gmail.com.
2
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
3
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom.
4
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
5
Farr Institute, University of Manchester, Manchester, United Kingdom.
6
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom; School of Computing, Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom.
7
Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
8
Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom.

Abstract

OBJECTIVES:

This study sought to examine the relationship between access site practice and clinical outcomes in patients requiring percutaneous coronary intervention (PCI) following thrombolysis for ST-segment elevation myocardial infarction (STEMI).

BACKGROUND:

Transradial access (TRA) is associated with better outcomes in patients requiring PCI for STEMI. A significant proportion of STEMI patients may receive thrombolysis before undergoing PCI in many countries across the world. There are limited data around access site practice and its associated outcomes in this cohort of patients.

METHODS:

The author used the British Cardiovascular Intervention Society dataset to investigate the outcomes of patients undergoing PCI following thrombolysis between 2007 and 2014. Patients were divided into TRA and transfemoral access groups depending on the access site used. Multiple logistic regression and propensity score matching were used to study the association of access site with in-hospital and long-term mortality, major bleeding, and access site-related complications.

RESULTS:

A total of 10,209 patients received thrombolysis and PCI during the study time. TRA was used in 48% (n = 4,959) of patients; 3.3% (n = 336) patients died in hospital, 1.6% (n = 165) of patients experienced major bleeding, 4.2% (n = 437) experienced major adverse cardiac events (MACE), and 4.6% (n = 468) experienced 30-day mortality. After multivariate adjustment, TRA was associated with significantly reduced odds of in-hospital mortality (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.42 to 0.83; p = 0.002), major bleeding (OR: 0.45; 95% CI: 0.31 to 0.66; p < 0.001), MACE (OR: 0.72; 95% CI: 0.55 to 0.94; p = 0.01), and 30-day mortality (OR: 0.72; 95% CI: 0.55 to 0.94; p = 0.01).

CONCLUSIONS:

TRA is associated with decreased odds of bleeding complications, mortality, and MACE in patients undergoing PCI following thrombolysis and should be preferred access site choice in this cohort of patients.

KEYWORDS:

PCI; TFA; TRA; percutaneous coronary intervention; rescue PCI; thrombolysis; transfemoral access; transradial access

PMID:
29169494
DOI:
10.1016/j.jcin.2017.07.049
[Indexed for MEDLINE]
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