title: Comparison of Frequency of Bleeding and Major Adverse Cardiac Events After Transradial Versus Transfemoral Intervention in the Recent Antiplatelet Era.
abstract: The transradial approach is increasingly used for percutaneous coronary intervention (PCI), and we therefore aimed to compare the clinical outcomes after transradial intervention (TRI) and transfemoral intervention (TFI) in all patients undergoing PCI. Among 6,973 patients enrolled in a nationwide, prospective, multicenter registry (February 2013 to September 2013), 1,860 underwent TRI (n = 1,445, 77.7%) and TFI (n = 415, 22.3%). Bleeding and major adverse cardiac events (MACE; death, myocardial infarction, revascularization, or stent thrombosis) were compared. Bleeding occurred in 42 patients (2.3%) and was significantly less likely in the TRI versus TFI group (overall cohort: 1.5% vs 4.8%, p = 0.001; propensity score-matched: n = 728, 2.7% vs 5.2%, p = 0.048). Multivariate regression revealed that TRI was negatively associated with bleeding (odds ratio 0.42, 95% CI 0.21 to 0.83, p = 0.013). MACE occurred in 152 patients (8.2%). Kaplan-Meier estimates showed higher MACE-free survival rates in the TRI versus TFI group (overall cohort: 93.3% vs 86.7%, log-rank p = 0.026; propensity score-matched: 91.8% vs 86.5%, log-rank p = 0.04). Cox proportional analysis demonstrated that TRI independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p = 0.024). In conclusion, TRI is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI.
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jeong Cheon
authors.initials: JC
authors.lastname: Choe
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea. Electronic address: chakws1@hanmail.net.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Bo Won
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Han Cheol
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Youn
authors.affiliation: Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea.
authors.forename: Byung Ryul
authors.initials: BR
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Inje University Haeundae Paik Hospital, Busan, South Korea.
authors.forename: Doo Il
authors.initials: DI
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
authors.forename: Kyoo Rok
authors.initials: KR
authors.lastname: Han
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea.
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D057216:Propensity Score; D011446:Prospective Studies; D017534:Radial Artery; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors