title: Radial versus femoral access is associated with reduced complications and mortality in patients with non-ST-segment-elevation myocardial infarction: an observational cohort study of 10,095 patients.
abstract: BACKGROUND
  Compared with transfemoral access, transradial access (TRA) for percutaneous coronary intervention is associated with reduced risk of bleeding and vascular complications. Studies suggest that TRA may reduce mortality in patients with ST-segment-elevation myocardial infarction. However, there are few data on the effect of TRA on mortality, specifically, in patients with non-ST-segment-elevation myocardial infarction.
  
  
  RESULTS
  We analyzed 10 095 consecutive patients with non-ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention between 2005 and 2011 in all 8 tertiary cardiac centers in London, United Kingdom. TRA was a predictor for reduced bleeding (odds ratio=0.21; 95% confidence interval [CI]: 0.08-0.57; P=0.002), access-site complications (odds ratio=0.47; 95% CI: 0.23-0.95; P=0.034), and 1-year mortality (hazard ratio [HR]=0.72; 95% CI: 0.54-0.94; P=0.017). Between 2005 and 2007, TRA did not appear to reduce mortality at 1 year (HR=0.81; 95% CI: 0.51-1.28; P=0.376), whereas between 2008 and 2011, TRA conferred survival benefit at 1 year (HR=0.65; 95% CI: 0.46-0.92; P=0.015). The mortality benefit with TRA at 1 year was not seen at the low-volume centers (HR=0.80; 95% CI: 0.47-1.38; P=0.428) but specifically seen in the high volume radial centers (HR=0.70; 95% CI: 0.51-0.97; P=0.031). In propensity-matched analyses, TRA remained a predictor for survival at 1 year (HR=0.60; 95% CI: 0.42-0.85; P=0.005). Instrumental variable analysis demonstrated that TRA conferred mortality benefit at 1-year with an absolute mortality reduction of 5.8% (P=0.039).
  
  
  CONCLUSIONS
  In this analysis of patients with non-ST-segment-elevation myocardial infarction, TRA appears to be a predictor for survival. Furthermore, the evolving learning curve, experience, and expertise may be important factors contributing to the prognostic benefit conferred with TRA.
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: M Bilal
authors: MB
authors: Iqbal
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Aruna
authors: A
authors: Arujuna
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Charles
authors: C
authors: Ilsley
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Andrew
authors: A
authors: Archbold
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Tom
authors: T
authors: Crake
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Sam
authors: S
authors: Firoozi
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Sundeep
authors: S
authors: Kalra
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Charles
authors: C
authors: Knight
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Pitt
authors: P
authors: Lim
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Iqbal S
authors: IS
authors: Malik
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Anthony
authors: A
authors: Mathur
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Pascal
authors: P
authors: Meier
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Roby D
authors: RD
authors: Rakhit
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Simon
authors: S
authors: Redwood
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Mark
authors: M
authors: Whitbread
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Dan
authors: D
authors: Bromage
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Krishna
authors: K
authors: Rathod
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Andrew
authors: A
authors: Wragg
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.).
authors: Philip
authors: P
authors: MacCarthy
authors: From the Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., A. Arujuna, C.I., M.D.); UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (A. Archbold, C.K., A.M., D.B., K.R., A.W.); St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and London Ambulance Service, London, United Kingdom (M.W.). m.dalby@rbht.nhs.uk.
authors: Miles
authors: M
authors: Dalby
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015331:Cohort Studies; D004562:Electrocardiography; D005263:Femoral Artery / Q000601:surgery; D008131:London; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D017534:Radial Artery / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D006113:United Kingdom
keywords: bleeding; femoral; mortality; radial