title: Transradial vs femoral percutaneous coronary intervention for left main disease in octogenarians.
abstract: BACKGROUND
  Little data is available on the immediate and late results of transradial percutaneous coronary intervention (PCI) compared to standard femoral approach in high-risk patients. Our objective was to compare our experience in > 80 years old patients undergoing left main PCI with transradial and femoral approach.
  
  
  METHODS
  This was a retrospective analysis of octogenarians patients treated for left main PCI in our center. In-hospital and late results were assessed
  
  
  RESULTS
  From 2002 to 2008, one hundred and three octogenarians underwent PCI for left main disease. Ninety (87%) patients were treated by transradial approach and 13 (13%) by femoral approach. Patients were older in the radial group (85 +/- 3 years vs 82 + 3 years, p = 0.0067). All patients were pretreated with aspirin and clopidogrel. Patients received heparin-only in 90% of transradial cases and 85% of femoral cases (p = 0.63), bivalirudin in 0% vs 15% (p = 0.63) and platelets glycoprotein IIb/IIIa inhibitors in 33% vs 23% (p = 0.54), respectively. Patients received 3 +/- 2 stents in both groups with no difference in the rate of drug eluting stents (44% vs 69%, p = 0.14). Angiographic success was obtained in 98% vs 92% (p = 0.34) respectively with similar fluoroscopic time, procedure duration and contrast volume. Procedures were performed in 5-6Fr in 93% of transradial cases and 85% of femoral cases (p = 0.14). At 30 days, deaths (6% vs 15%, p = 0.21), myocardial infarction (12% vs 15%, p = 0.67) and revascularization (1% vs 0%, p = 1.00) were similar in transradial and femoral cases, respectively. Bleeding requiring transfusion occurred in 14% of radial cases compared to 23% in femoral cases (p = 0.42). Access site complications, mostly hematoma occurred less frequently after transradial than femoral approach (6% vs 31%, p = 0.014). At follow-up, cardiac death (17% vs 150%, p = 1.00), MI (23% vs 23%, p = 1.00) and revascularization (11% vs 0%, p = 0.35) remained similar in both groups.
  
  
  CONCLUSIONS
  The majority of octogenarians with left main disease can be treated by transradial approach with similar acute and long-term results as with femoral approach but with less risk of bleeding and access site complications.
authors.affiliation: Quebec Heart-Lung Institute, Quebec, Canada. olivier.bertrand@crhl.ulaval.ca
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002406:Catheterization, Peripheral / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D017534:Radial Artery; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014665:Vasodilator Agents