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

Rashid, Muhammad; Rushton, Claire A.; Kwok, Chun Shing; Kinnaird, Tim; Kontopantelis, Evangelos; Olier, Ivan; Ludman, Peter; De Belder, Mark A.; Nolan, James; Mamas, Mamas

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.

Citation

Rashid, M., Rushton, C. A., Kwok, C. S., Kinnaird, T., Kontopantelis, E., Olier, I., …Mamas, M. (2017). 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. JACC. Cardiovascular interventions, 10(22), 2258 -2265. https://doi.org/10.1016/j.jcin.2017.07.049

• Journal Article Type: Article
• Acceptance Date: Jul 24, 2017
• Publication Date: Nov 27, 2017
• Journal: JACC: Cardiovascular Interventions
• Print ISSN: 1876-7605
• Volume: 10
• Issue: 22
• Pages: 2258 -2265
• DOI: https://doi.org/10.1016/j.jcin.2017.07.049
• Keywords: PCI, percutaneous coronary intervention, rescue PCI, TFA, thrombolysis, TRA, transfemoral access, transradial access
• Publisher URL: http://doi.org/10.1016/j.jcin.2017.07.049