Comparison between radial and femoral approach for percutaneous coronary intervention in patients aged 80 years or older.

OBJECTIVE: To compare safety and efficacy between the radial and femoral approach for percutaneous coronary intervention (PCI) in patients aged 80 years and older.

METHOD: Two hundred sixty-eight elderly patients (80-97 years old, 176 men) who underwent elective PCI between May 2003 and May 2007 were included in this study: the femoral (hereinafter referred to as the Femoral Approach Group) approach was used on 156 patients and radial (Radial Approach Group) on 112 patients. Clinical and procedural characteristics and the incidence of in-hospital major adverse cardiac events (MACE, including cardiac death, nonfatal myocardial infarction, and target lesion revascularization) were compared between the 2 groups.

RESULTS: Procedural success rate was similar and >95% for both approaches. The radial approach was associated with longer cannulation (3.0 ± 2.8 minutes vs. 2.0 ± 1.9 minutes, P < 0.001), fluoroscopy time (23 ± 15 minutes vs. 19 ± 12 minutes, P = 0.03) and higher rate of crossover to an alternative access site (9.8% vs. 3.8%, P = 0.02) compared with the femoral approach, while ambulation time (5 ± 2 hours vs. 20 ± 4 hours, P < 0.001), and rates of access site bleeding (2.7% vs. 9.6%, P = 0.004), hematoma (4.5% vs. 10.9%, P = 0.006), or any vascular complication (7.1% vs. 23.7%, P < 0.001) were significantly reduced with the radial approach as opposed to femoral. Multivariate regression identifies the radial approach (OR = 0.25, CI = 0.09-0.75) as an independent negative predictor of postprocedural vascular complications.

CONCLUSION: When compared to the femoral approach, PCI with the radial approach significantly reduces rates of vascular complications in high-risk populations of patients aged 80 years and older. However, efficacy and procedural success rates were similar for both groups whereas cannulation and fluoroscopy time longer and puncture failure rate higher with the radial approach than femoral.