Complex high‐risk percutaneous coronary intervention types, trends, and outcomes according to vascular access site

Shamkhani, Warkaa; Moledina, Saadiq; Rashid, Muhammad; Mamas, Mamas A.

Abstract

Background
Radial access is associated with improved outcomes following percutaneous coronary intervention (PCI); however, its role in complex, high-risk percutaneous coronary intervention (CHiP) remains poorly studied.

Methods
We studied retrospectively all registered patients's records from the British Cardiovascular Intervention Society dataset and compared the baseline characteristics, trends and outcomes of CHiP procedures performed electively between January 2006 and December 2017 according to the access site.

Results
Out of 137,785 CHiP procedures, 61,825 (44.9%) were undertaken via transradial access (TRA). TRA use increased over time (14.6% in 2006 to 67% in 2017). The TRA patients were older, with a greater prevalence of previous stroke, hypertension, peripheral vascular disease, and smokers. TRA was used more frequently in most CHiP procedures (elderly (51.6%), chronic renal failure (52.6%), poor left ventricular (LV) function (47.6%), left main PCI (48.0%), treatment for severe vascular calcification (50.3%); although transfemoral access (TFA) was used more commonly in those with prior history of coronary artery bypass graft surgery, and PCI to a chronic total occlusion and LV support patients. Following adjustment for differences in clinical and procedural characteristics, TFA was independently associated with higher odds for mortality [adjusted odds ratio (aOR): 1.3 (1.1–1.7)], major bleeding [aOR: 2.9 (2.3–3.4)], and MACCE (following propensity score matching) [aOR: 1.2 (1.1–1.4)]. The same was found with multiple accesses: mortality [aOR: 2.1 (1.5–2.8)], major bleeding [aOR: 5.5 (4.3–6.9)], and MACCE [aOR: 1.4 (1.2–1.7)].

Conclusion
TRA has become the predominant access site for CHiP procedures and is associated with significantly lower mortality, major bleeding and MACCE odds than TFA.

• Journal Article Type: Article
• Acceptance Date: Sep 13, 2023
• Online Publication Date: Sep 26, 2023
• Deposit Date: Oct 2, 2023
• Publicly Available Date: Oct 2, 2023
• Journal: Catheterization and Cardiovascular Interventions
• Print ISSN: 1522-1946
• Electronic ISSN: 1522-726X
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 102
• Issue: 5
• Pages: 803-813
• DOI: https://doi.org/10.1002/ccd.30846
• Keywords: stable angina, complex PCI, radial access, high‐risk PCI