title: Prevalence and outcomes of trans-radial access for percutaneous coronary intervention in contemporary practise.
abstract: BACKGROUND
  Trans-radial access for percutaneous coronary intervention (PCI) has been associated with lower vascular complication rates and improved outcomes. We assessed the current uptake of trans-radial PCI in Victoria, Australia, and evaluated if patients were selected according to baseline bleeding risk in contemporary clinical practise, and compared selected clinical outcomes.
  
  
  METHODS
  PCI data of all patients between 1st January 2013 and 31st December 2014 were analysed using The Victorian Cardiac Outcomes Registry (VCOR). Propensity-matched analysis was performed to compare the clinical outcomes.
  
  
  RESULTS
  11,711 procedures were analysed. The femoral route was the predominant access site (66%). Patients undergoing trans-radial access PCI were younger (63.9±11.6 vs. 67.2±11.8; p<0.001), had a higher BMI (28.9±5.5 vs. 28.5±5.2; p<0.001), more likely to be male (80.0 vs. 74.9%;p<0.001), less likely to have presented with cardiogenic shock (0.9 vs. 2.8%; p<0.001) or have the following comorbidities: diabetes (19.8 vs. 23.1%; p<0.001), peripheral vascular disease (2.9 vs. 4.3%; p=0.005) or renal impairment (13.6 vs. 22.1%; p<0.001). The radial group had less bleeding events (3.2 vs. 4.6%; p<0.001) and shorter hospital length of stay (3.1±4.7 vs. 3.3±3.9; p=0.006). There was no significant difference in mortality (1.0 vs. 1.4%; p=0.095).
  
  
  CONCLUSIONS
  Trans-femoral approach remains the dominant access site for PCI in Victoria. The choice of route does not appear to be selected by consideration of bleeding risk. The radial route is associated with improved clinical outcomes of reduced bleeding and length of stay consistent with previous findings, and this supports the efficacy and safety of trans-radial PCI in real-world clinical practise.
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asrar Ul Haq
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia.
authors.forename: It Meng
authors.initials: IM
authors.lastname: Tsay
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Diem T
authors.initials: DT
authors.lastname: Dinh
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Brennan
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Clark
authors.affiliation: Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Australia; Cardiology Unit, Western Health, Melbourne, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cox
authors.affiliation: Department of Cardiology, Monash Health, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Harper
authors.affiliation: Department of Cardiology, Bendigo Hospital, Melbourne, Australia.
authors.forename: Voltaire
authors.initials: V
authors.lastname: Nadurata
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia; School of Public Health, Curtin University, Perth, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.affiliation: Cardiology General Services, The Alfred Hospital, Melbourne, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.affiliation: Department of Cardiology, Northern Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Australia. Electronic address: William.vangaal@nh.org.au.
authors.forename: William J
authors.initials: WJ
authors.lastname: van Gaal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000639:trends*; D015995:Prevalence; D017534:Radial Artery / Q000601:surgery*; D012042:Registries; D016896:Treatment Outcome
keywords: Femoral access; Percutaneous coronary intervention; Trans radial access