Bleeding, vascular complication rates lower when transradial PCI replaces transfemoral PCI

Reuters Health - 20/05/2021 - Transradial percutaneous coronary intervention produces less access-site bleeding and fewer vascular complications than transfemoral PCI when used in cases of complex coronary lesions where large-bore guiding catheters are required, results from the COLOR study suggest.

A composite of those two outcomes was seen in 3.6% of patients with transradial access (TRA) versus 19.1% with conventional femoral access (P<0.001).

"Both individual components of this primary endpoint did show a significant difference in favor of TRA. With regard to bleeding, the observed difference was driven by a reduction in BARC type 2, which is defined as any actional bleeding," the study authors, led by Dr. Thomas Meijers of the Isala Heart Center in the Netherlands, write in JACC: Cardiovascular Interventions.

The access site made no significant difference in the odds of surgical success, procedural duration, radiation dose, or the amount of contrast volume used.

The findings were also presented at the annual meeting of the European Association of Percutaneous Cardiovascular Interventions.

In a linked editorial, Drs. Marco Valgimigli and Antonio Landi of the Cardiocentro Ticino Institute in Lugano, Switzerland, emphasized that it's important to have expertise with radial access.

"Consequently, upfront selection of access site in complex interventions remains essential and should balance the benefit of bleeding avoidance with the operator’s proficiency with RA to perform complex PCI," they said.

Despite its known drawbacks, the femoral artery is still the preferred entry point for complex PCI such as chronic total occlusion and heavily calcified lesions because it's easier to accommodate the larger catheters.

COLOR was undertaken because of a lack of a randomized comparison between the two techniques.

It involved 388 patients. Radial access was done with a 7-F Glidesheath Slender.

The procedural success rates were 89% with transradial access and 86% with transfemoral access (P=0.29). Crossover rates were 3.6% in the group assigned to the transradial procedure and 2.6% in the transfemoral group.

When a secondary access site was used, the rates of any bleeding connected to that site were 33.3% with femoral and 8.3% for radial (P<0.001).

The rates of major adverse cardiovascular events (MACE) at discharge were not statistically different between the two groups at 2.6% with femoral and 3.1% with radial; P=0.76. All the events were periprocedural myocardial infarctions.

MACE outcomes at 30 days remained at 2.6% with femoral and were 6.7% with radial (P=0.06).

"Regarding vascular complications requiring intervention, pseudoaneurysm was the most frequent complication, which is frequently associated with large-bore femoral access," the researchers said.

SOURCE: https://bit.ly/3hKR15g and https://bit.ly/2RykjcJ JACC: Cardiovascular Interventions, online May 18, 2021.

By Reuters Staff



Posted on 20 May, 20211 June, 2021