title: Comparison of transradial and transfemoral access in patients undergoing percutaneous coronary intervention for complex coronary lesions.
abstract: OBJECTIVE
  Comparison of transradial versus transfemoral access for complex percutaneous coronary intervention (PCI) with regard to both complications and long-term outcomes.
  
  
  BACKGROUND
  Radial access has been shown to confer superior results in patients undergoing PCI, especially in patients with acute coronary syndromes. However, radial access has limitations of sheath and device size, which may increase procedure time and result in inferior outcomes.
  
  
  METHODS
  Patients undergoing PCI for complex lesions, defined as type C according the ACC/AHA classification system, were included in this study. Propensity matching was performed to adjust for differences in baseline characteristics. Transradial patients were then compared to transfemoral patients in regard to procedural, in-hospital, and 6-month outcomes.
  
  
  RESULTS
  Among 2142 patients with 2591 lesions treated, 1876 had femoral access and 267 had radial access. Radial access patients were more likely to be male (75% vs. 66%, P = 0.003) and less likely to present with acute myocardial infarction (27% vs. 42%, P < 0.001). Procedural characteristics demonstrated lower use of heparin in the femoral group (17% vs. 73%, P < 0.001) with similarly low use of glycoprotein inhibitors (5.6% vs. 3.4%, P = 0.14). Patients in the femoral group had higher rates of transfusions (3.7% vs. 0%, P = 0.004) and vascular complications (1.7% vs. 0%, P = 0.03). Following propensity matching, there was no difference in mid-term outcomes between radial and femoral groups.
  
  
  CONCLUSIONS
  In patients with complex coronary lesions undergoing PCI, the radial approach demonstrates similar mid-term outcomes as the femoral approach with a potentially lower rate of complications. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Bernardo
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lager
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gallino
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Gai
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D004219:District of Columbia / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D017534:Radial Artery; D012189:Retrospective Studies; D013997:Time Factors
keywords: access; percutaneous coronary intervention; transfemoral; transradial