[Comparison of radial versus femoral approach for percutaneous coronary intervention in octogenarians with acute coronary syndrome]

Lei Gao, Yuqi Liu, Qiao Xue, Jinwen Tian, Yu Wang
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2014 July 8, 94 (26): 2025-9

OBJECTIVE: To evaluate the prognostic effects of radial artery access (RA) versus femoral artery access (FA) in octogenarians undergoing percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS).

METHODS: From January 2008 to January 2013, 279 octogenarians with ACS underwent PCI. PCI was performed through RA in 125 patients and FA in another 154. Clinical and procedural characteristics, combined endpoints including death, acute myocardial infarction, stroke, and major bleeding, and peripheral vascular complications were obtained from both groups.

RESULTS: The clinical baseline characteristics of two patient groups, including target vessel location, lesion type, number of implanted stents, fluoroscopy duration and utilization of contrast media had no statistical difference.Femoral approach was associated with a higher rate of ST elevation myocardial infarction (STEMI) than radial approach (27.9% vs 11.2%, χ² = 11.868, P < 0.05). Procedural rate of success, fluoroscopy duration and utilization of contrast media were equivalent with both approaches. Radial approach was associated with a higher crossover rate (10.4% vs 3.9%, χ² = 4.599, P < 0.05) to alternate access site compared with the femoral approach.No difference in combined endpoint during 30 days after PCI including death, acute myocardial infarction, stroke and major bleeding was found between two groups (P > 0.05).However, ambulation time (4.2 ± 0.9 vs 19.3 ± 4.1h, t = 40.381, P < 0.01), incidence of access site bleeding (2.4% vs 7.8%, χ² = 3.943, P < 0.05), hematoma (2.4% vs 9.1%, χ² = 5.398, P < 0.05), pseudoaneurysm (0.0% vs 5.2%, χ² = 4.950, P < 0.05) and vascular complications (4.8% vs 19.5%, χ² = 13.231, P < 0.01) were significantly lowered in radial approach group. Multivariate regression analysis identified radial approach as an independent negative predictor of postprocedural vascular complications (OR = 0.329, 95% CI: 0.124-0.517, P < 0.05).Female gender (OR = 1.955, 95% CI: 1.326-2.248, P < 0.05) and utilization of glycoprotein IIb/IIIa receptor antagonist (OR = 2.787, 95% CI: 2.435-3.071, P < 0.01) were independent predictors of postprocedural vascular complications.

CONCLUSIONS: Compared with femoral approach, radial approach significantly reduces the vascular complications of PCI in octogenarians with ACS.However, PCI through RA is not associated with reduced combined endpoint at 30 days in octogerians with ACS.

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