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Vascular access and mortality outcomes: insights from the Percutaneous Coronary Interventions registry from the
Ioannis Karalis1, Marijke Jc Timmermans2, Andrea Tuccillo3
1Leiden University Medical Center, Leiden, the Netherlands.
Insights
The transradial approach (TRA) for percutaneous coronary intervention (PCI) is linked to significantly lower mortality rates compared to the transfemoral approach (TFA). These findings support wider adoption of TRA in clinical practice.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- The transradial approach (TRA) is known for fewer bleeding complications than the transfemoral approach (TFA).
- The impact of vascular access site on mortality after percutaneous coronary intervention (PCI) in real-world settings requires further investigation.
Purpose of the Study:
- To evaluate the association between vascular access site (TRA vs. TFA) and mortality outcomes in patients undergoing PCI.
- To compare short-term (30-day) and long-term (1-year) mortality rates based on the access site used for PCI.
Main Methods:
- Retrospective cohort study utilizing prospectively collected data from the Netherlands Heart Registration (2017-2021).
- Included 130,813 PCI procedures.
- Adjusted for baseline variables using multivariable logistic regression and propensity score matching.
Main Results:
- The transfemoral approach (TFA) was significantly associated with higher 30-day mortality (OR 2.00) and 1-year mortality (OR 1.50) compared to TRA.
- Mortality benefits of TRA were more pronounced in patients with acute coronary syndrome and those aged 80 years or older.
- Benefits of TRA were consistent across varying procedural volumes and center adoption rates.
Conclusions:
- The transradial approach (TRA) is associated with significantly lower short-term and long-term mortality following PCI.
- These findings support the broader adoption of TRA in routine clinical practice for PCI procedures.
Objectives:
While the transradial approach (TRA) is associated with fewer bleeding complications than the transfemoral approach (TFA), its effect on mortality outcomes in real-world clinical practice remains unclear. This study examines the relationship between vascular access site and mortality in patients undergoing percutaneous coronary intervention (PCI).
Methods:
This retrospective cohort study used prospectively collected data from the Netherlands Heart Registration, including 130,813 PCI procedures between 2017 and 2021. The primary outcome was 30-day mortality and the secondary outcome was 1-year mortality. Outcomes were adjusted for baseline variables using multivariable logistic regression and propensity score matching.
Results:
TFA was associated with significantly higher mortality at 30 days (odds ratio, 2.00; 95% CI, 1.78-2.25) and 1 year (odds ratio, 1.50; 95% CI, 1.39-1.61). Mortality benefits with TRA were pronounced in acute coronary syndrome and in patients 80 years or older, and were consistent across procedural volumes and center-level TRA adoption rates.
Conclusions:
TRA is associated with lower short- and long-term mortality in PCI, supporting its broader adoption in routine clinical practice.
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