Transradial vs femoral percutaneous coronary intervention for left main disease in octogenarians

Little data is available on the immediate and late results of transradial percutaneous coronary intervention (PCI) compared to standard femoral approach in high-risk patients. Our objective was to compare our experience in > 80 years old patients undergoing left main PCI with transradial and femoral approach.

This was a retrospective analysis of octogenarians patients treated for left main PCI in our center. In-hospital and late results were assessed

From 2002 to 2008, one hundred and three octogenarians underwent PCI for left main disease. Ninety (87%) patients were treated by transradial approach and 13 (13%) by femoral approach. Patients were older in the radial group (85 +/- 3 years vs 82 + 3 years, p = 0.0067). All patients were pretreated with aspirin and clopidogrel. Patients received heparin-only in 90% of transradial cases and 85% of femoral cases (p = 0.63), bivalirudin in 0% vs 15% (p = 0.63) and platelets glycoprotein IIb/IIIa inhibitors in 33% vs 23% (p = 0.54), respectively. Patients received 3 +/- 2 stents in both groups with no difference in the rate of drug eluting stents (44% vs 69%, p = 0.14). Angiographic success was obtained in 98% vs 92% (p = 0.34) respectively with similar fluoroscopic time, procedure duration and contrast volume. Procedures were performed in 5-6Fr in 93% of transradial cases and 85% of femoral cases (p = 0.14). At 30 days, deaths (6% vs 15%, p = 0.21), myocardial infarction (12% vs 15%, p = 0.67) and revascularization (1% vs 0%, p = 1.00) were similar in transradial and femoral cases, respectively. Bleeding requiring transfusion occurred in 14% of radial cases compared to 23% in femoral cases (p = 0.42). Access site complications, mostly hematoma occurred less frequently after transradial than femoral approach (6% vs 31%, p = 0.014). At follow-up, cardiac death (17% vs 150%, p = 1.00), MI (23% vs 23%, p = 1.00) and revascularization (11% vs 0%, p = 0.35) remained similar in both groups.

The majority of octogenarians with left main disease can be treated by transradial approach with similar acute and long-term results as with femoral approach but with less risk of bleeding and access site complications.