title: Radial versus femoral approach comparison in percutaneous coronary intervention with intraaortic balloon pump support: the RADIAL PUMP UP registry.
abstract: BACKGROUND
  The role of intraaortic balloon pump (IABP) during percutaneous coronary intervention (PCI) in high-risk acute patients remains debated. Device-related complications and the more complex patient management could explain such lack of clinical benefit. We aimed to assess the impact of transradial versus transfemoral access for PCI requiring IABP support on vascular complications and clinical outcome.
  
  
  METHODS
  We retrospectively analyzed 321 consecutive patients receiving IABP support during transfemoral (n = 209) or transradial (n = 112) PCI. Thirty-day net adverse clinical events (NACEs) (composite of postprocedural bleeding, cardiac death, myocardial infarction, target lesion revascularization, and stroke) were the primary end point, with access-related bleeding and hospital stay as secondary end points.
  
  
  RESULTS
  Cardiogenic shock and hemodynamic instability were the most common indications for IABP support. Cumulative 30-day NACE rate was 50.2%, whereas an access site-related bleeding occurred in 14.3%. Patients undergoing transfemoral PCI had a higher unadjusted rate of NACEs when compared with the transradial group (57.4% vs 36.6%, P < .01), mainly due more access-related bleedings (18.7% vs 6.3%, P < .01). Such increased risk of NACEs was confirmed after propensity score adjustment (hazard ratio 0.57 [0.4-0.9], P = .007), whereas hospital stay appeared comparable in the 2 groups.
  
  
  CONCLUSIONS
  In this observational registry, high-risk patients undergoing PCI and requiring IABP support appeared to have fewer NACEs if transradial access was used instead of transfemoral, mainly due to fewer access-related bleedings. Given the inherent limitations of this retrospective work, including the inability to adjust for unknown confounders, further controlled studies are warranted to confirm or refute these findings.
authors.affiliation: Policlinico Casilino, Rome, Italy; SS. Filippo e Nicola Hospital, Avezzano, Italy. Electronic address: enromagnoli@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Maria
authors.initials: M
authors.lastname: De Vita
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Francesco
authors.initials: F
authors.lastname: Summaria
authors.forename: Roberto
authors.initials: R
authors.lastname: Patrizi
authors.forename: Chiara
authors.initials: C
authors.lastname: Lanzillo
authors.forename: Valerio
authors.initials: V
authors.lastname: Lucci
authors.forename: Caterina
authors.initials: C
authors.lastname: Cavazza
authors.forename: Fabio
authors.initials: F
authors.lastname: Tarantino
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery; D012189:Retrospective Studies; D016896:Treatment Outcome