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

Johnman, C., Pell, J.P. , Mackay, D.F. , Behan, M., Slack, R., Oldroyd, K. and Berry, C. (2012) Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients. Heart, 98(7), pp. 552-557. (doi:10.1136/heartjnl-2011-301032)

Johnman, C., Pell, J.P. , Mackay, D.F. , Behan, M., Slack, R., Oldroyd, K. and Berry, C. (2012) Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients. Heart, 98(7), pp. 552-557. (doi:10.1136/heartjnl-2011-301032)

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Abstract

<p><b>Objective:</b> To assess short-term and medium-term outcomes following radial and femoral artery access for primary or rescue percutaneous coronary intervention (PCI).</p> <p><b>Design:</b> Retrospective cohort study.</p> <p><b>Setting:</b> Scotland-wide.</p> <p><b>Patients:</b> All 4534 patients undergoing primary or rescue PCI in Scotland between April 2000 and March 2009 using the Scottish Coronary Revascularisation Register.</p> <p><b>Intervention:</b> Primary or rescue PCI.</p> <p><b>Main outcome measures:</b> Procedural success; peri-procedural complications; 30-day and 1-year mortality, myocardial infarction or stroke and long-term mortality.</p> <p><b>Results:</b> 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.</p> <p><b>Conclusion:</b> Use of the radial artery for primary or rescue PCI is associated with improved clinical outcomes.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Oldroyd, Dr Keith and Johnman, Dr Cathy and Berry, Professor Colin and Pell, Professor Jill and Mackay, Dr Daniel
Authors: Johnman, C., Pell, J.P., Mackay, D.F., Behan, M., Slack, R., Oldroyd, K., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:15 February 2012

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