title: Predictors and outcomes associated with radial versus femoral access for intervention in patients with acute coronary syndrome in a real-world setting: results from the Acute Coronary Syndrome Israeli Survey (ACSIS) 2010.
abstract: BACKGROUND
  Use of transradial intervention (TRI) is becoming more popular, and recent studies suggest an advantage for TRI in high-risk patients presenting with acute coronary syndrome (ACS). The aim of our study was to describe current utilization and outcomes of transradial intervention (TRI) in real-world patients presenting with ACS.
  
  
  METHODS
  Data were derived from the ACS Israeli Survey (ACSIS 2010), a nationwide prospective survey of patients presenting with ACS over a 2-month period. Follow-up was continued for up to 1 year.
  
  
  RESULTS
  Of 1815 ACS patients undergoing coronary angiography, 613 (34%) underwent TRI, which was more likely to be employed among patients with lower-risk characteristics. Patients undergoing TRI had significantly lower 30-day mortality and in-hospital bleeding. On multivariate analysis, the risk of in-hospital major bleeding was reduced by 60% in patients undergoing TRI (P=.04). However, no significant differences in other components of major adverse cardiac events or mortality were demonstrated at 30 days. All-cause mortality at 1 year was significantly lower among patients who underwent TRI. However, after multivariate adjustment, this effect was no longer significant.
  
  
  CONCLUSIONS
  In our study of real-world patients, better TRI outcomes are related largely to lower baseline risk of patients allocated to this approach, suggesting that TRI may be underutilized in high-risk ACS patients.
authors.affiliation: Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel 52621. paulfefer@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Sharon
authors.initials: S
authors.lastname: Gannot
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: David
authors.initials: D
authors.lastname: Meerkin
authors.forename: Liudmila
authors.initials: L
authors.lastname: Bubyr
authors.forename: Natalie
authors.initials: N
authors.lastname: Gavrielov
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000601:surgery; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006306:Health Surveys; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D017534:Radial Artery / Q000601:surgery*; D020379:Risk Adjustment; D018570:Risk Assessment