Underutilization of Radial Access in Patients Undergoing Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
BACKGROUND
The purpose of this study was to evaluate the frequency and temporal trends in use of transradial access (TRA) for percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction (STEMI). The use of TRA has been associated with less bleeding and improved clinical outcomes in patients undergoing PCI for STEMI.


RESULTS
The frequency of TRA compared with transfemoral access for patients undergoing PCI for STEMI or other indications (non-ST-segment-elevation myocardial infarction, unstable angina, and non-acute coronary syndrome) in The Blue Cross Blue Shield of Michigan Cardiovascular Consortium database between 2010 and 2013 was evaluated. Propensity matching was used to assess the relationship of TRA with in-hospital clinical end points of major bleeding, transfusion, and death. The TRA cohort of patients was stratified into deciles based on their predicted bleeding risk and compared with PCI indication. Of 122,728 PCI procedures, 17,912 (14.6%) were via TRA. Among patients with STEMI cases, 8.3% of the PCI cases were performed via TRA. The use of TRA increased over the study period although the growth was slower for STEMI than for other indications, P<0.001. The use of TRA for PCI in STEMI was associated with a lower rate of bleeding (11.7% versus 20.0%; P<0.001) and vascular complications (0.7% versus 2.6%; P=0.001), but no mortality difference (1.25% versus 2.33%; P=0.175). There was a strong negative association between the predicted risk of bleeding and the use of TRA (P<0.001).


CONCLUSIONS
The use of radial access for PCI in STEMI is increasing but at a slower pace than for patients with other indications. TRA was associated with a reduction in bleeding and transfusion, but there is a strong negative correlation between the predicted risk of bleeding and actual use of TRA in STEMI.
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.).
Michael J
MJ
Howe
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.).
Milan
M
Seth
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.).
Arthur
A
Riba
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.).
George
G
Hanzel
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.).
Mark
M
Zainea
From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.). hgurm@med.umich.edu.
Hitinder S
HS
Gurm
D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans; D002406:Catheterization, Peripheral / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D017534:Radial Artery; D012042:Registries
ST-segment–elevation myocardial infarction; percutaneous coronary intervention; radial artery catheter