title: Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007-2012).
abstract: BACKGROUND
  Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI.
  
  
  RESULTS
  We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49-0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31-0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation.
  
  
  CONCLUSIONS
  There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.
authors.affiliation: Weill Cornell Medical College, New York Presbyterian Hospital, Department of Medicine, Greenberg Division of Cardiology, 520 E 70th St, Starr-434 Pavilion, New York, NY 10021, USA. dnf9001@med.cornell.edu
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: Dmitri V
authors.initials: DV
authors.lastname: Baklanov
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
authors.forename: Robert N
authors.initials: RN
authors.lastname: Piana
authors.forename: William B
authors.initials: WB
authors.lastname: Hillegass
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: Ian C
authors.initials: IC
authors.lastname: Gilchrist
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D017534:Radial Artery / Q000293:injuries; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: hemmorhage; percutaneous coronary intervention; radial artery; vascular complication