title: Transradial Versus Transfemoral Access in Patients Undergoing Rescue Percutaneous Coronary Intervention After Fibrinolytic Therapy.
abstract: OBJECTIVE
  The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes.
  
  
  BACKGROUND
  Transradial access reduces bleeding and mortality in STEMI patients undergoing primary PCI. Little is known about access site choice and outcomes in patients undergoing rescue PCI after receiving full-dose fibrinolytic therapy for STEMI.
  
  
  METHODS
  Patients in the National Cardiovascular Data Registry's CathPCI Registry undergoing rescue PCI for STEMI between 2009 and 2013 were studied. Patients were divided on the basis of access site. Patterns of access use and baseline demographics were noted. Unadjusted and propensity-matched analyses were performed comparing in-hospital bleeding, vascular complications, and mortality outcomes among transradial and transfemoral access patients. The falsification endpoint of gastrointestinal bleeding was specified to assess for persistent unmeasured confounding.
  
  
  RESULTS
  Transradial access was used in 14.2% of cases. In propensity-matched analyses, transradial rescue PCI was associated with significantly less bleeding than transfemoral access (odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.52 to 0.87; p = 0.003), but not mortality (OR: 0.81; 95% CI: 0.53 to 1.25; p = 0.35). Gastrointestinal bleeding was less frequent in the radial group (OR: 0.23; 95% CI: 0.05 to 0.98; p = 0.05).
  
  
  CONCLUSIONS
  In a large, "real-world" registry, transradial access was used in a minority of cases and was associated with significantly less bleeding than transfemoral access in patients undergoing rescue PCI. However, given persistent differences in a falsification endpoint, the influence of treatment-selection bias on these results cannot be ruled out. Further studies are needed to determine predictors of bleeding and mortality in this understudied high-risk group.
authors.affiliation: Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mitul B
authors.initials: MB
authors.lastname: Kadakia
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lisa
authors.initials: L
authors.lastname: McCoy
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Paramita S
authors.initials: PS
authors.lastname: Choudhuri
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Sherwood
authors.affiliation: Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio.
authors.forename: Scott
authors.initials: S
authors.lastname: Lilly
authors.affiliation: Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Taisei
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kolansky
authors.affiliation: Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wilensky
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: giri.jay@gmail.com.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
mesh_terms: D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D057216:Propensity Score; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: STEMI; rescue PCI; transradial access