At a Transradial PCI Center, Transfemoral Patients Undergo More Complex Procedures, Have Poorer Outcomes

San Francisco, CA—At a high-volume, predominantly transradial PCI center, the small subset of patients who continue to undergo PCI via transfemoral access tends to have more challenging clinical and procedural characteristics than those who receive the default approach. Transfemoral patients are also more likely to experience vascular complications and have higher short-term mortality, according to a prospective study presented at TCT 2013.

Researchers led by Shantu S. Bundhoo,MD, of University Hospital of Wales, Cardiff, United Kingdom, analyzed 5,379 patients who underwent PCI at their center between January 2009 and December 2012. Only 10.4% of patients (n = 561) underwent PCI via the transfemoral route; the rest received a transradial procedure. 

Transfemoral patients were more often female and older and weighed less than their transradial counterparts. They were also more likely to have had prior PCI or CABG.

In addition, transfemoral patients had a higher rate of cardiogenic shock (7% vs. 1%) and were more likely to need an intra-aortic balloon pump (6.5% vs. 0.5%; both P<.0001) compared with transradial patients. The transfemoral approach was also associated with more complex procedures, including use of rotational atherectomy (4.1% vs. 0.7%), saphenous vein graft (SVG) PCI (9.1% vs. 3.0%), and chronic occlusion PCI (21.1% vs. 6.8%; all P<.0001). 

PCI success was less common with the transfemoral vs. the transradial approach (88.2% vs. 94.6%) despite a similar number of vessels treated and lesions attempted.

Given their adverse characteristics, it is unsurprising that transfemoral patients had worse outcomes than transradial patients, showing higher rates of in-hospital mortality, vascular complications, and bleeding (Table 1).

Bundhoo told TCT Daily that the reason women are overrepresented in the transfemoral group is that they tend to have smaller radial arteries, while older patients are more common because their  subclavian vessels are more likely to be  tortuous. In addition, operators may opt for transfemoral PCI for leaner patients simply due to ease of access to the femoral arteries, he noted

Over time various changes in practice will likely result in a further decline in the number of transfemoral procedures performed, Bundhoo predicted. These changes include the use of catheters better suited for the radial artery, a gradual shift toward transradial SVG PCI using a variety of guide catheters, and avoidance of intra-aortic balloon pumps.

However, although “the proportion of patients undergoing transfemoral PCI will gradually decrease, it will never be zero,” Bundhoo commented.

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