title: The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk.
abstract: The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
authors.affiliation: Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Keun-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Sang Sik
authors.initials: SS
authors.lastname: Jung
authors.forename: Moo Hyun
authors.initials: MH
authors.lastname: Kim
authors.forename: Hyoung-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Keum Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Kyoo Rok
authors.initials: KR
authors.lastname: Han
authors.forename: Byung Ryul
authors.initials: BR
authors.lastname: Cho
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.forename: Byung Ok
authors.initials: BO
authors.lastname: Kim
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Hyon
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Shin
authors.forename: Hyunmin
authors.initials: H
authors.lastname: Choe
authors.forename: Jang-Whan
authors.initials: JW
authors.lastname: Bae
authors.forename: Hee Yeol
authors.initials: HY
authors.lastname: Kim
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000473:pathology*; D000368:Aged; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Acute Coronary Syndrome; Hemorrhage; Radial Artery