More than Half of PCI Cases in the United Kingdom Use Transradial Access

Percutaneous coronary intervention (PCI) performed via transfemoral access has risen to more than half of PCI procedures in the United Kingdom compared with those performed via transradial, according to results from an observational database study presented at TCT 2012.

Karim Ratib, MD, of the University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom, and colleagues analyzed data from the British Cardiovascular Intervention Society database. From January 2006 to December 2012, 370,238 PCI procedures were conducted transfemorally (n = 223,476; 60.4%) or transradially (n = 124,616; 33.7%).

Transradial access use rose from 17.1% to 50.8% over the study period. The proportion of PCI procedures for ACS also increased from 47% to 61%.

Patients who were treated transradially had better outcomes with regard to 30-day mortality and cardiogenic shock (see Table).

Table. Access Site Outcomes After PCI Procedures

In multivariate analysis, the 30-day survival advantage for patients treated via transradial access remained after excluding patients in cardiogenic shock and those receiving intra-aortic balloon pump therapy (HR 0.65; 95% CI 0.60-0.70; P<.0001).

Ratib told TCT Daily that the push away from transfemoral and toward transradial access has been driven by a desire to reduce complications. “This is of particular importance with the increase in PCI for acute patients,” he said. “These patients are at increased risk of bleeding due to several factors, including the use of more potent antithrombotic drugs.” Transradial access can reduce the need for blood transfusions as well as cut back on access site bleeding, he said, both of which have been associated with increased mortality.

“In our everyday practice we see the immediate benefits of radial access,” Ratib noted. “Hemostasis is easily achieved and patients walk out of the cath lab, decreasing the burden on nursing resources and improving patient comfort.”

This study was limited by its observational design, Ratib acknowledged, and selection bias could have affected the results. Still, he added that the cohort’s large size provides encouraging indication that the majority of PCI procedures can be performed successfully with transradial access.

And notably, Ratib said, the trend toward transradial PCI continued into 2011 when 57% of procedures were performed this way. “There will always be a need for transfemoral access,” he concluded. “[But] patient preference, reduced cost, and fewer access site complications will continue to drive the increase in radial access.”

Disclosures:
Dr. Ratib reports no relevant conflicts of interest.