Comparison of Frequency of Bleeding and Major Adverse Cardiac Events After Transradial Versus Transfemoral Intervention in the Recent Antiplatelet Era

초록

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 TM (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 TM 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 TM 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 TM independently predicted improved MACE (hazard ratio 0.64, 95% CI 0.43 to 0.91, p = 0.024). In conclusion, TM is associated with reduced bleeding rates and better clinical outcomes than TFI in all patients undergoing PCI. (C) 2016 Elsevier Inc. All rights reserved.

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