麻豆传媒

LAS VEGAS -- The use of transradial access for percutaneous coronary intervention (PCI) is growing, but at a slower pace for the patients who might benefit most from the approach, a study of Michigan hospitals showed.

Among patients undergoing PCI for indications other than ST-segment elevation myocardial infarction (STEMI), the rate of transradial access increased from 2.2% in early 2010 to 27.5% by the middle of 2013, according to Michael Howe, MD, a fellow at the in Ann Arbor.

The increase among patients with STEMI was more gradual, from less than 1% to 14.2% over the same span, he reported at the Society for Cardiovascular Angiography and Interventions meeting here.

He and his colleagues also found that the risk of dying in the hospital was no different between patients who underwent transradial procedures and those who underwent transfemoral procedures, but that the risk of major bleeding and the need for transfusion were significantly lower with the transradial approach.

That suggests that transradial access should be used more in patients with STEMI, who have a higher risk of bleeding compared with other patients undergoing PCI and would derive the most benefit from the approach, Howe said.

"I think there should be an emphasis on doing more cases radially and becoming more comfortable with it," he said, adding that "there's a push for it even now in fellowship."

"As providers get more comfortable with the technique, I think that they'll feel more comfortable doing it in a more time-critical setting like STEMI," he said.

To examine trends in the use of transradial access in a real-world setting, Howe and his colleagues looked at data from 44 Michigan hospitals participating in the (BMC2). After patients presenting with shock or after cardiac arrest were excluded, the analysis included 108,060 PCIs; 13.7% were performed in patients with STEMI.

Overall, 6.72% of the patients with STEMI underwent the procedure with transradial access, with an increase seen over time.

After propensity matching and multivariate adjustment, use of the transradial versus transfemoral approach was associated with a lower rate of major bleeding (2.92% versus 5.62%; OR 0.53, 95% CI 0.33-0.84) and transfusion (3.42% versus 5.3%; OR 0.54, 95% CI 0.35-0.84).

There were, however, no differences between the two groups in the rates of in-hospital mortality (1.51% versus 2.34%; OR 0.59, 95% CI 0.30-1.16) or contrast-induced nephropathy (4% versus 4.8%, P=0.46).

In a separate analysis, the researchers also looked into the association between patients' predicted risk of bleeding and the likelihood of undergoing PCI with transradial access using the same cohort.

Bleeding occurred in 2.21% of the patients, but it was more common in those who underwent their procedure using the transfemoral approach (2.42% versus 0.74%, P<0.001).

However, the findings uncovered a "radial paradox" in which the patients with the highest predicted risk of bleeding -- according to the National Cardiovascular Data Registry clinical risk algorithm -- were least likely to undergo a transradial procedure (P<0.001 for trend).

That trend was consistent across patients with STEMI and other indications for PCI.

"Further research and quality improvement efforts are warranted to rectify this risk-treatment paradox," Howe and his colleagues concluded.

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