Trends in vascular access for patients undergoing percutaneous coronary intervention in Australia: a report from the Melbourne Interventional Group Cohort.

Abstract

Background: This study sought to examine the rate of adoption of the transradial approach (TRA) amongst acute coronary syndrome (ACS) and non-ACS patients undergoing percutaneous coronary intervention (PCI), and to evaluate whether it is associated with superior clinical outcomes.

Methods: Temporal trends in using TRA between 2005 and 2017 were assessed in 26,896 patients who underwent PCI with ACS (n = 18,025) and without ACS (n = 8,871) from the Melbourne Interventional Group registry. Clinical and procedural variables, and clinical outcomes were compared between the TRA and femoral access (FA). The primary outcomes were in-hospital bleeding and 30-day major adverse cardiac and cerebrovascular events (MACCE: death, myocardial infarction, target vessel revascularisation, and stroke).

Results: Use of the TRA significantly increased from 3.3% (ACS) and 1.4% (non-ACS) in 2005 to 67.0% and 65.0%, respectively, by 2017 (p-for trend <0.01). The TRA was more likely to be used in ACS patients for urgent or rescue PCI, and in those who had received thrombolysis (p < 0.01). There were significantly lower in-hospital bleeding rates using TRA compared to FA in both ACS (1.0% vs 2.4%, p < 0.01)) and non-ACS (0.3% vs 1.1%, p < 0.01) cohorts. Multivariable analyses showed that vascular access (FA vs TRA) was not an independent predictor of 30-day MACCE in ACS (OR 1.01, 95% CI 0.85–1.21) and non-ACS (OR 0.95, 95% CI 0.69–1.32).

Conclusions: During a 13-year period there was a marked increase in transradial PCI in Victoria for both ACS and non-ACS patients. Transradial PCI was associated with significantly lower bleeding rates but equivalent MACCE rates.