Transradial access should be ‘default strategy’ for PCI, new study confirms
Transradial access (TRA) has now replace transfemoral access (TFA) as the go-to approach for many interventional cardiologists performing percutaneous coronary intervention (PCI) procedures. How has this trend impacted patient outcomes? A team of researchers from the Icahn School of Medicine at Mount Sinai in New York City aimed to find out, publishing their analysis in The American Journal of Cardiology.[1]
“Despite the benefits of TRA-PCI, its uptake in the United States has lagged behind Europe and Asia,” wrote first author Gennaro Giustino, MD, with the Zena and Michael A. Wiener Cardiovascular Institute at Mount Sinai, and colleagues. “The potential reasons for this gap include the learning curve associated with this technique, unwillingness to adapt a new approach on the part of interventionalists, concerns over longer fluoroscopy times or higher contrast use. In addition, it has been shown that the increase in the use of TRA is paralleled by an increase in TFA-related complications. Therefore, in the present study, we sought to investigate the trends in the use and outcomes of TRA versus TFA-PCI in a large-volume, single-center, real-world experience over the last decade.
Giustino et al. focused on data from nearly 25,000 PCI procedures performed on real-world patients from 2012 to 2019. TRA was used for 19.9% of PCIs during that time, jumping from just 5.6% of PCIs in 2012 to 44.6% in 2019.
Patients who underwent TRA-PCI presented with fewer comorbidities and were associated with less complex heart disease. They were also more likely to be white and had a slightly younger mean age (64.2 years old) than patients who who underwent TFA-PCI (66.2 years old).
Diving deeper into the data, the team found that there were “no significant differences” in in-hospital death, myocardial infarction (MI) rate or stroke rate between the two PCI techniques. TRA, however, was linked to lower rates of in-hospital bleeding, access site hematoma and pseudoaneurysm. No rise in the likelihood of TFA-related complications was observed.
Also, after one full year, there were still no notable differences in mortality, MI rate or stroke rate.
“We did not observe significant differences in terms of death, MI, or stroke between the two approaches,” the authors concluded. “Considering its benefits, when feasible, TRA should be considered the default strategy for patients undergoing PCI across the spectrum of clinical risk and anatomic complexity.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.