Transradial access compared with femoral puncture closure devices in percutaneous coronary procedures.
BACKGROUND
Transradial access (RA) is associated with less complications and is preferred by patients. Vascular closure devices (VCDs) may improve discomfort and may reduce complications associated with transfemoral access. Aim was to evaluate complications and discomfort associated with percutaneous coronary procedures employing RA or VCDs.


METHODS
We enrolled 1492 consecutive patients who underwent percutaneous coronary procedures with RA (604 procedures), femoral approach with manual compression (MC) (276 procedures), or with either Angioseal (311 procedures) or Starclose (301 procedures) closure device. Discomfort was assessed using procedure-specific questions. Major vascular complications were evaluated during hospitalization.


RESULTS
RA significantly reduced major complications (0.7%) compared to either the MC (2.9%, p=0.03) or the VCDs (Starclose 2.7%, Angioseal 3.9%, p=0.003). There were no significant differences in major complications between MC and either the Angioseal or the Starclose. At multivariate analysis the RA was predictor of reduced complications (OR 0.26, 95% CI 0.08-0.85, p=0.03 vs MC, and OR 0.19, 95% CI 0.07-0.57, p=0.003 vs VCDs). The RA was associated with a significant reduction in procedural discomfort with 44.2% of patients referring no discomfort (p<0.0001). Starclose and Angioseal were better tolerated than MC (27.8%, 29.3% and 8.9% patients respectively without discomfort, p<0.0001).


CONCLUSIONS
RA is associated with a significant reduction in major vascular complications compared to femoral approach even if two different VCDs are employed. VCDs are better tolerated than MC but the RA was associated with the lowest discomfort.
Sciahbasi
Alessandro
A
U.O. Cardiologia, Policlinico Casilino, ASL RMB, Rome, Italy. alessandro.sciahbasi@fastwebnet.it
Fischetti
Dionigi
D
Picciolo
Amedeo
A
Patrizi
Roberto
R
Sperduti
Isabella
I
Colonna
Giuseppe
G
Summaria
Francesco
F
Montinaro
Antonio
A
Lioy
Ernesto
E
D000368:Aged; D000704:Analysis of Variance; D006328:Cardiac Catheterization / Q000295:instrumentation*; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011677:Punctures; D011788:Quality of Life; D017534:Radial Artery; D016896:Treatment Outcome