Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry.
OBJECTIVE
Our goal was to compare trends in the prevalence and outcomes of the radial and femoral approaches to percutaneous coronary intervention (PCI) in contemporary clinical practice.


BACKGROUND
There are few current data on the use and outcomes of the radial approach to PCI (r-PCI) in clinical practice.


METHODS
Data from 593,094 procedures in the National Cardiovascular Data Registry (606 sites; 2004 to 2007) were analyzed to evaluate trends in use and outcomes of r-PCI. Logistic regression was used to evaluate the adjusted association between r-PCI and procedural success, bleeding complications, and vascular complications. Outcomes in elderly patients, women, and patients with acute coronary syndrome were specifically examined.


RESULTS
Although the proportion of r-PCI procedures has recently increased, it only accounts for 1.32% of total procedures (n = 7,804). Compared with the femoral approach, the use of r-PCI was associated with a similar rate of procedural success (adjusted odds ratio: 1.02 [95% confidence interval: 0.93 to 1.12]) but a significantly lower risk for bleeding complications (odds ratio: 0.42 [95% confidence interval: 0.31 to 0.56]) after multivariable adjustment. The reduction in bleeding complications was more pronounced among patients <75 years old, women, and patients undergoing PCI for acute coronary syndrome.


CONCLUSIONS
The use of r-PCI is rare in contemporary clinical practice, but it is associated with a rate of procedural success similar to the femoral approach and with lower rates of bleeding and vascular complications, even among high-risk groups. These results suggest that wider adoption of r-PCI in clinical practice may improve the safety of PCI.
Rao
Sunil V
SV
The Duke Clinical Research Institute, Durham, North Carolina, USA. sunil.rao@duke.edu
Ou
Fang-Shu
FS
Wang
Tracy Y
TY
Roe
Matthew T
MT
Brindis
Ralph
R
Rumsfeld
John S
JS
Peterson
Eric D
ED
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D017534:Radial Artery; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology