Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age.
OBJECTIVE
The transradial (TR) approach has potentially lower complication rates than transfemoral (TF) approach coronary angiography. However, it may be technically more challenging, especially in elderly patients with alterations in vascular anatomy. We thus determined success rates, procedural data, and complication rates of TR angiography in comparison to the TF approach in elderly patients in a randomized, prospective trial.


RESULTS
Four hundred consecutive patients >or=75 years with known or suspected coronary artery disease were included in the study. After exclusion of 93 patients with contraindications to the radial approach, 152 patients were randomized to the TR and 155 to TF coronary angiography and intervention. In 13 patients randomized to TR, cross-over to TF was necessary (9%). Total examination time was significantly longer for the TR approach (18.1 vs. 15.0 min, P = 0.009), but no difference was found for fluoroscopy time, number of catheters used, or amount of contrast agent. The rate of major complications (bleeding requiring surgery or transfusion, stroke) was 0% for TR and 3.2% for TF approach (P < 0.001). Minor complications occurred in 1.3% versus 5.8% of patients (P < 0.001).


CONCLUSIONS
In elderly patients, TR coronary angiography and intervention has a high technical success rate and lower complication rates than the TF approach.
Achenbach
Stephan
S
Department of Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany.
Ropers
Dieter
D
Kallert
Lisa
L
Turan
Nesrin
N
Krähner
Robert
R
Wolf
Tobias
T
Garlichs
Christoph
C
Flachskampf
Frank
F
Daniel
Werner G
WG
Ludwig
Josef
J
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017534:Radial Artery; D011829:Radiation Dosage; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media