title: Effect of access site, gender, and indication on clinical outcomes after percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society (BCIS).
abstract: BACKGROUND
  Gender is a strong predictor of periprocedural major bleeding complications after percutaneous coronary intervention (PCI). The access site represents an important site of such bleeding complications, which has driven adoption of the transradial access (TRA) use during PCI, although female gender is an independent predictor of transradial PCI failure. This study sought to define gender differences in access site practice and study associations between access site choice and clinical outcomes for PCI over a 6-year period, through the analysis of the British Cardiovascular Intervention Society observational database.
  
  
  RESULTS
  In-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial reinfarction and target vessel revascularization), in-hospital bleeding complications, and 30-day mortality were studied based on gender and access site choice (transfemoral access, TRA) in 412,122 patients who underwent PCI between 2007 and 2012 in the United Kingdom. Use of TRA increased in both genders over time, although this lagged behind in women (21% in 2007 to 58% in 2012) compared with men (24% in 2007 to 64% in 2012). In both men and women, TRA was independently associated with a lower in-hospital major adverse cardiovascular event (odds ratio [OR] 0.82, 95% CI 0.76-0.90; OR 0.75, 95% CI 0.66-0.84), in-hospital major bleeding (OR 0.54, 95% CI 0.44-0.66; OR 0.26, 95% CI 0.20-0.33), and 30-day mortality (OR 0.80, 95% CI 0.73-0.89; OR 0.82, 95% CI 0.71-0.94), respectively.
  
  
  CONCLUSIONS
  Where possible, TRA should be considered as the preferred access site choice for PCI, particularly in women in whom the greatest reductions bleeding end points were observed across all indications.
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Farr Institute, University of Manchester, Manchester, United Kingdom.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kunadian
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.affiliation: Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Mathew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Farr Institute, University of Manchester, Manchester, United Kingdom; Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care, Keele University, Staffordshire, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D017534:Radial Artery; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology