Transradial PCI Reduces Bleeding in High-Risk ACS Patients

MIAMI BEACH, FLA.—A retrospective registry study from 16 centers in South Korea suggests that transradial PCI results in a significantly lower rate of in-hospital major bleeding than the transfemoral approach in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) at high risk for bleeding.

Keun-Ho Park, MD, of Chonnam National University Hospital in Gwangju, South Korea, presented data on 995 patients who had moderate to very high CRUSADE bleeding scores. The score considers baseline patient characteristics (female sex, history of diabetes, peripheral vascular disease), clinical variables on admission (heart rate, systolic blood pressure, signs of CHF) and admission laboratory values (hematocrit, calculated creatinine clearance) to estimate the patient’s likelihood of having an in-hospital major bleeding event.

Overall, 402 patients underwent transradial PCI while 593 underwent PCI via a transfemoral approach. In-hospital bleeding and need for blood transfusion were reduced in the transradial group while in-hospital mortality remained similar (see Table).

MACE at 1 year was also equivalent between groups. Transradial PCI was an independent predictor of in-hospital major bleeding (OR 0.305; 95% CI 0.109-0.851; P=.003).

Radial lessens risks

Higher CRUSADE bleeding scores correlated with higher rates of in-hospital major bleeding in both groups. However, patients with a high CRUSADE bleeding score showed a trend for a lower incidence of in-hospital major bleeding when treated transradially vs. transfemorally (4.3% vs. 9.9%; P=.073). A similar finding was seen in patients with a very high bleeding score (15.7% vs. 24.4%; P=.134).

In subgroup analyses, transradial PCI significantly reduced the incidence of in-hospital major bleeding in patients at high to very high bleeding risk, compared with those at moderate risk (OR 0.364; 95% CI 0.71-0.77; P=.009), Park told TCT Daily.

“The higher the risk of bleeding, the greater the efficacy of [transradial PCI] in patients with NSTE-ACS,” he said. “When patients with NSTE-ACS at high bleeding risk undergo PCI, [the transradial approach] should be considered to reduce bleeding complications.”

Patients who experienced in-hospital major bleeding also had higher rates of in-hospital and 1-year mortality than those without such bleeding (3.1% vs. 15.0%; P<.001 and 7.2% vs. 30.0%; P<.001, respectively).

Baseline characteristics and mean CRUSADE bleeding scores between treatment groups were similar, although smoking status and past history of MI and heart failure were more common in the transradial group while a history of CABG was more common in the transfemoral group.