Incidence, determinants and outcomes of left and right radial access use in patients undergoing percutaneous coronary intervention in the United Kingdom, a national perspective using the British Cardiovascular Intervention Society (BCIS) dataset

de Belder, M; Nolan, J; Mamas, M; Kinnaird, T; Ludman, P; Potts, JE; Kontopantelis, E; Lawson, C; Kwok, CS; Bertrand, O; Shoaib, A; Rashid, M

Abstract

Objectives
The authors sought to determine the relationships between left radial access (LRA) or right radial access (RRA) and clinical outcomes using the British Cardiovascular Intervention Society (BCIS) database.

Background
LRA has been shown to offer procedural advantages over RRA in percutaneous coronary intervention (PCI) although few data exist from a national perspective around its use and association with clinical outcomes.

Methods
The authors investigated the relationship between use of LRA or RRA and clinical outcomes of in-hospital or 30-day mortality, major adverse cardiovascular events (MACE), in-hospital stroke, and major bleeding complications in patients undergoing PCI between 2007 and 2014.

Results
Of 342,806 cases identified, 328,495 (96%) were RRA and 14,311 (4%) were LRA. Use of LRA increased from 3.2% to 4.6% from 2007 to 2014. In patients undergoing a repeat PCI procedure, the use of RRA dropped to 72% at the second procedure and was even lower in females (65%) and patients >75 years of age (70%). Use of LRA (compared with RRA) was not associated with significant differences in in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 0.90 to 1.57; p = 0.20), 30-day mortality (OR: 1.17, 95% CI: 0.93 to 1.74; p = 0.16), MACE (OR: 1.06, 95% CI: 0.86 to 1.32; p = 0.56), or major bleeding (OR: 1.22, 95% CI: 0.87 to 1.77; p = 0.24). In propensity match analysis, LRA was associated with a significant decrease in in-hospital stroke (OR: 0.52, 95% CI: 0.37 to 0.82; p = 0.005).

Conclusions
In this large PCI database, use of LRA is limited compared with RRA but conveys no increased risk of adverse outcomes, but may be associated with a reduction in PCI-related stroke complications.

Citation

de Belder, M., Nolan, J., Mamas, M., Kinnaird, T., Ludman, P., Potts, J., …Rashid, M. (2018). Incidence, determinants and outcomes of left and right radial access use in patients undergoing percutaneous coronary intervention in the United Kingdom, a national perspective using the British Cardiovascular Intervention Society (BCIS) dataset. JACC. Cardiovascular interventions, 11(11), 1021-1033. https://doi.org/10.1016/j.jcin.2018.01.252

• Journal Article Type: Article
• Acceptance Date: Jan 14, 2018
• Publication Date: May 16, 2018
• Journal: JACC: Cardiovascular Interventions
• Print ISSN: 1876-7605
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 11
• Pages: 1021-1033
• DOI: https://doi.org/10.1016/j.jcin.2018.01.252
• Keywords: 30-day mortality; in-hospital mortality; in-hospital stroke; left radial access; MACE; major adverse cardiovascular event(s); major bleeding; right radial access; successive PCI
• Publisher URL: https://doi.org/10.1016/j.jcin.2018.01.252