title: Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes.
abstract: OBJECTIVE
  The aim of the present study was to examine the impact of the transradial approach (TRA), in comparison to the transfemoral approach (TFA), on PCI-related bleeding and patient outcomes in acute coronary syndrome patients who underwent PCI in the OASIS-5 trial.
  
  
  RESULTS
  The primary outcome (death, myocardial infarction, refractory ischaemia) at nine days was similar in both groups (7.1% in 872 TRA and 7.7% in 7,013 TFA). Major bleeding was significantly lower in patients who underwent PCI with TRA by comparison to TFA (1.6% vs 3.5%, p<0.003, respectively). No difference between patients treated by fondaparinux or enoxaparin was noted for ischaemic events at nine days according to the access site. The rate of major bleeding at nine days was markedly reduced with fondaparinux when compared to enoxaparin for both access sites (from 4.8% to 2.3%, HR 0.48 [0.37-0.62], p< 0.0001 for TFA and from 2.4 to 0.9%, HR 0.36 [0.11- 1.16], p<0.08 for TRA).
  
  
  CONCLUSIONS
  TRA is associated with substantial decrease of PCI-related bleeding in current contemporary pharmacological environment in comparison to TFA. Even in the context of low access site complication rate provided by TRA, fondaparinux was effective in reducing major bleeding.
authors.affiliation: Univ. Caen, INSERM U744, Caen, France. hamon-m@chu-caen.fr
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
authors.forename: Shamir
authors.initials: S
authors.lastname: Mehta
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: David
authors.initials: D
authors.lastname: Faxon
authors.forename: Prafulla
authors.initials: P
authors.lastname: Kerkar
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Rupprecht
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D017534:Radial Artery; D016896:Treatment Outcome