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In-hospital outcome differences between transradial and transfemoral coronary approaches: Data from the Korean
Sung Gyun Ahn1, Jun-Won Lee1, Young Jin Youn1
1Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
Insights
Transradial coronary interventions (TRIs) show better in-hospital outcomes than transfemoral approaches, especially for high-risk patients and in high-volume centers. These findings support TRI as a preferred method in specific clinical scenarios.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access
Background:
- Transradial coronary interventions (TRIs) offer potential advantages over transfemoral coronary interventions (TFIs).
- The comparative benefit of TRIs versus TFIs may vary based on clinical context, procedure urgency, and operator experience.
- Identifying specific patient subgroups that benefit most from TRIs is crucial for optimizing outcomes.
Purpose of the Study:
- To investigate specific patient subgroups where transradial coronary interventions (TRIs) demonstrate enhanced benefits compared to transfemoral coronary interventions (TFIs).
- To analyze in-hospital outcomes and identify factors influencing the efficacy of TRIs.
Main Methods:
- A retrospective analysis of the 2014 Korean Percutaneous Coronary Intervention Registry.
- Propensity score matching was used to compare in-hospital outcomes between 22,993 patients undergoing TRI and 15,581 patients undergoing TFI.
- Composite endpoints including all-cause death, nonfatal myocardial infarctions (MIs), and transfusions were analyzed in the overall cohort and specific subgroups.
Main Results:
- TRIs were associated with significantly lower composite endpoints compared to TFIs (2.1% vs. 5.5%).
- The TRI group showed reduced rates of death (OR 0.44) and nonfatal MI (OR 0.66), and required fewer transfusions (OR 0.72).
- Benefits of TRI were consistent across most subgroups, with greater advantages observed in the elderly (≥75 years), ST-elevation MI patients, emergent PCI cases, and high PCI volume centers. Reduced benefits were noted in patients with chronic kidney disease and those treated in low-volume centers.
Conclusions:
- Transradial coronary interventions (TRIs) yield superior composite in-hospital outcomes compared to transfemoral coronary interventions (TFIs).
- The advantages of TRIs are particularly pronounced in high-risk clinical settings and high percutaneous coronary intervention (PCI) volume hospitals.
- These findings highlight the importance of procedural approach selection based on patient risk factors and institutional capacity.
Objectives:
We aimed to investigate specific subgroups in which the benefit of transradial coronary interventions (TRIs) would be enhanced.
Background:
The advantage of TRIs over transfemoral coronary interventions (TFIs) might differ according to a given clinical condition, urgency of the procedure, and operator volume pattern.
Methods:
Using a cohort from the 2014 Korean Percutaneous Coronary Intervention Registry, in-hospital outcomes of the TRI group (n = 22,993) were matched to those of the TFI group (n = 15,581). After propensity score matching, the composite endpoints between the groups and subgroups for all-cause death, nonfatal myocardial infarctions (MIs), or transfusions were analyzed.
Results:
The composite endpoints occurred less frequently in the TRI group than the TFI group [2.1% vs. 5.5%, OR 0.63, 95% CI 0.55-0.72]. The TRI group had a lower rate of death (OR 0.44, 95% CI 0.33-0.60) and nonfatal MI (OR 0.66, 95% CI 0.54-0.81) than the TFI group. The TRI group required fewer transfusions than the TFI group (OR 0.72, 95% CI 0.59-0.88). TRI benefits were consistent across subgroups except patients with chronic kidney disease and those treated in low tertile PCI volume centers. The favorable outcome of TRI was greater in the elderly (≥75 years), patients with ST-elevation MI, those who underwent emergent PCI, and those treated in high tertile PCI volume hospitals (P for the interaction <0.001 for all).
Conclusions:
Compared to TFI, TRI had favorable composite in-hospital outcomes. TRI benefits were pronounced in high-risk clinical settings and in high PCI volume centers.
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