title: Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes.
abstract: BACKGROUND
  Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF.
  
  
  METHODS
  The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions.
  
  
  RESULTS
  A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P < 0.0001) and at 1 year (37.6% vs 5.0%, P < 0.0001). Shock and MB were highly predictive of 30 day and 12 month mortality.
  
  
  CONCLUSIONS
  In a default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group.
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Muezz
authors.initials: M
authors.lastname: Uddin
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Shantu
authors.initials: S
authors.lastname: Bundhoo
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Rito
authors.initials: R
authors.lastname: Mitra
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: Cardiff Metropolitan University, Cardiff CF5 2YB, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Morris
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017534:Radial Artery / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom