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Long-term clinical outcomes in transradial versus transfemoral access for left main percutaneous coronary
Lijian Gao1, Zhan Gao1, Ying Song1
1Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Insights
Transradial access (TRA) and transfemoral access (TFA) show similar 10-year clinical outcomes for left main percutaneous coronary intervention (PCI). This study found no significant differences in major adverse cardiac or cerebrovascular events between the two approaches.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Limited long-term data exists on transradial access (TRA) for left main (LM) percutaneous coronary intervention (PCI).
- Transfemoral access (TFA) is a traditional approach for LM PCI.
Purpose of the Study:
- To compare the 10-year clinical outcomes of TRA versus TFA in patients undergoing unprotected LM PCI.
- To evaluate the long-term safety and efficacy of TRA for LM PCI.
Main Methods:
- Retrospective study of 913 patients undergoing unprotected LM PCI (2004-2008).
- Exclusion criteria: age <18 years, acute myocardial infarction.
- Primary endpoint: major adverse cardiac or cerebrovascular events (MACCE) at 10-year follow-up (all-cause death, MI, stroke, revascularization).
Main Results:
- TRA used in 417 patients, TFA in 496 patients.
- Similar 30-day outcomes between groups.
- 10-year MACCE rates were comparable: 46.7% for TRA vs. 51.2% for TFA (p = .3).
- Cumulative rates of all-cause death and cardiac death were also similar between TRA and TFA groups.
Conclusions:
- Transradial access and transfemoral access demonstrate comparable 10-year clinical outcomes for left main percutaneous coronary intervention.
- Neither TRA nor TFA showed significant differences in long-term major adverse cardiac or cerebrovascular events.
Objective:
The present study compared 10-year clinical outcomes between transradial access (TRA) and transfemoral access (TFA) for left main (LM) percutaneous coronary intervention (PCI).
Background:
There are limited data regarding the long-term safety and efficacy of TRA for LM PCI.
Methods:
This retrospective study evaluated consecutive patients who underwent unprotected LM PCI between January 2004 and December 2008 at Fu Wai Hospital. The exclusion criteria were age of less than 18 years and presentation with acute myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), which was defined as a composite of all-cause death, myocardial infarction, stroke, and any revascularization at the 10-year follow-up.
Results:
Among 913 eligible patients, TRA was used for 417 patients (45.7%) and TFA was used for 496 patients (54.3%). The 30-day clinical outcomes were similar between the two groups. Results from the 10-year follow-up revealed that MACCE occurred in 180 patients (46.7%) from the TRA group and in 239 patients (51.2%) from the TFA group (log-rank p = .3). The TRA and TFA groups also had low and comparable cumulative rates of all-cause death (14.6% vs. 17.3%, log-rank p = .56) and cardiac death (7.9% vs. 9.1%, log-rank p = .7).
Conclusion:
The present study revealed no significant differences in long-term clinical outcomes when TRA or TFA were used for LM PCI.
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