title: Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience.
abstract: BACKGROUND
  Studies evaluating the efficacy and safety of the transradial approach for percutaneous coronary intervention (PCI) were carried out mainly before the widespread use of stents and glycoprotein (GP) IIb/IIIa inhibitors. We sought to determine the association between the choice of the vascular access site and procedural complications after PCI performed with routine stenting and GP IIb/IIIa inhibition.
  
  
  METHODS
  The data source was a prospective registry of 13,499 consecutive cases of PCI at the University Health Network, Toronto, Canada, from April 2000 to September 2006. Logistic regression was used to calculate the probability of selection to the radial access group. Using propensity score methodology, 3,198 patients with femoral access were randomly matched to 3,198 patients with radial access based on clinical, angiographic, and procedural characteristics. Multivariable logistic regression analysis was used to identify the independent predictors of access site-related complications. Major adverse cardiac event was defined as death, myocardial infarction, abrupt vessel closure, or coronary artery bypass surgery.
  
  
  RESULTS
  Use of the transradial approach was associated with fewer vascular access complications (1.5% vs 0.6%, P<.001) and a shorter length of hospital stay. Multivariable analysis revealed transradial access (OR 0.39, 95% CI 0.2-0.7) to be an independent predictor of lower risk, whereas primary PCI (OR 4.36, 95% CI 1.4, 13), recent myocardial infarction (OR 2.0 95% CI 1.2, 3.4), age (per 10 years increase: OR 1.37, 95% CI 1.1-1.7) and female gender (0R 2.78 95% CI 1.7, 4.6) were independent predictors of a higher risk of access site complications.
  
  
  CONCLUSIONS
  Use of transradial access for PCI is safe and is independently associated with a reduced rate of in-hospital access site complications and reduced length of hospital stay.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jonas
authors.initials: J
authors.lastname: Eichhöfer
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.forename: John R
authors.initials: JR
authors.lastname: Ross
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.forename: Paul
authors.initials: P
authors.lastname: Daly
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.forename: Brenda
authors.initials: B
authors.lastname: Ridley
authors.forename: Leonard
authors.initials: L
authors.lastname: Schwartz
authors.forename: Alan
authors.initials: A
authors.lastname: Barolet
authors.forename: Vladimír
authors.initials: V
authors.lastname: Dzavík
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017534:Radial Artery; D012042:Registries; D015607:Stents
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex