title: Transradial versus transfemoral intervention for the treatment of left main coronary bifurcations: results from the COBIS (COronary BIfurcation Stenting) II Registry.
abstract: OBJECTIVE
  We compared clinical outcomes of transradial (TR) and transfemoral (TF) percutaneous coronary interventions (PCI) in patients with left main coronary artery (LMCA) bifurcation lesions.
  
  
  BACKGROUND
  The use of TR approach is growing as an alternative to the routine use of the TF approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of LMCA bifurcation lesions.
  
  
  METHODS
  Between January 2003 and December 2009, a total of 853 patients undergoing PCI using drug-eluting stent (DES) implantation for LMCA bifurcation lesions were enrolled from 18 centers in Korea. We classified patients into the TR group (n = 212) and TF group (n = 641) according to the vascular approach. The primary outcome was major adverse cardiac event (MACE) rate, including composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 483 propensity-score matched patients.
  
  
  RESULTS
  There were no significant differences between TR and TF approaches for procedural success in the main vessel (98.6% vs. 99.7%; P=.07) and side branches (90.6% vs. 94.4%; P=.05). Thrombolysis in Myocardial Infarction major or minor bleeding occurred less frequently in the TR group than in the TF group (2.4% vs. 9.4%; P=.01). Over a median follow-up of 35 months, MACE rate did not significantly differ between TR and TF groups (9.9% vs. 14.5%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.49-1.29; P=.36). These results were consistent after propensity-score matched analysis.
  
  
  CONCLUSIONS
  TR-PCI is a safe and effective vascular approach, even in patients with LMCA bifurcation lesions undergoing PCI with DES implantation.
authors.affiliation: Sungkyunkwan University, Cardiology, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, South Korea. sh1214.choi@samsung.com.
authors.forename: Seungmin
authors.initials: S
authors.lastname: Chung
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000601:surgery*; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome