PMID- 25616814
OWN - NLM
STAT- MEDLINE
DCOM- 20150928
LR  - 20220317
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 8
IP  - 1 Pt A
DP  - 2015 Jan
TI  - Access site practice and procedural outcomes in relation to clinical presentation 
      in 439,947 patients undergoing percutaneous coronary intervention in the United 
      kingdom.
PG  - 20-9
LID - S1936-8798(14)01523-4 [pii]
LID - 10.1016/j.jcin.2014.06.026 [doi]
AB  - OBJECTIVES: This study sought to determine the relationships among access site 
      practice, clinical presentation, and procedural outcomes in a large patient 
      population. BACKGROUND: Transradial access (TRA) has been associated with 
      improved patient outcomes in selected populations in randomized trials. It is 
      unclear whether these outcomes are achievable in clinical practice. METHODS: 
      Using the BCIS (British Cardiovascular Intervention Society) database, we 
      investigated outcomes for percutaneous coronary intervention procedures 
      undertaken between 2007 and 2012 according to access site practice. Patients were 
      categorized as stable, non-ST-segment elevation acute coronary syndrome (NSTEACS) 
      and ST-elevation acute coronary syndrome (STEACS). The impact of access site on 
      30-day mortality, major adverse cardiac events, bleeding, and arterial access 
      site complications was studied. RESULTS: Data from 210,260 TRA and 229,687 
      transfemoral access procedures were analyzed. Following multivariate analysis, 
      TRA was independently associated with a reduction in bleeding in all presenting 
      syndromes (stable odds ratio [OR]: 0.24, p < 0.001; NSTEACS OR: 0.35, p < 0.001; 
      STEACS OR: 0.47, p < 0.001) as well as access site complications (stable OR: 
      0.21, p < 0.001; NSTEACS OR: 0.19; STEACS OR: 0.16, p < 0.001). TRA was 
      associated with reduced major adverse cardiac events only in patients with 
      unstable syndromes (stable OR: 1.08, p = 0.25; NSTEACS OR: 0.72, p < 0.001; 
      STEACS OR: 0.70, p < 0.001). TRA was associated with improved outcomes compared 
      with a transfemoral access (TFA) with a vascular closure device in a propensity 
      matched cohort. CONCLUSIONS: In this large study, TRA is associated with reduced 
      percutaneous coronary intervention-related complications in all patient groups 
      and may reduce major adverse cardiac events and mortality in ACS patients. TRA is 
      superior to transfemoral access with closure devices. Use of TRA may lead to 
      important patient benefits in routine practice. TRA should be considered the 
      preferred access site for percutaneous coronary intervention.
CI  - Copyright (c) 2015 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Ratib, Karim
AU  - Ratib K
AD  - Department of Cardiology, University Hospital of North Staffordshire, 
      Stoke-on-Trent, United Kingdom.
FAU - Mamas, Mamas A
AU  - Mamas MA
AD  - Manchester Heart Centre, United Kingdom; University of Manchester, Manchester, 
      United Kingdom.
FAU - Anderson, Simon G
AU  - Anderson SG
AD  - University of Manchester, Manchester, United Kingdom.
FAU - Bhatia, Gurbir
AU  - Bhatia G
AD  - Heart of England National Health Service Trust, west Midlands, United Kingdom.
FAU - Routledge, Helen
AU  - Routledge H
AD  - Worcestershire Royal Hospital, Worcestershire, United Kingdom.
FAU - De Belder, Mark
AU  - De Belder M
AD  - James Cook University Hospital, Middlesbrough, United Kingdom.
FAU - Ludman, Peter F
AU  - Ludman PF
AD  - University Hospital Birmingham, Birmingham, United Kingdom.
FAU - Fraser, Douglas
AU  - Fraser D
AD  - Manchester Heart Centre, United Kingdom.
FAU - Nolan, James
AU  - Nolan J
AD  - Department of Cardiology, University Hospital of North Staffordshire, 
      Stoke-on-Trent, United Kingdom. Electronic address: nolanjim@hotmail.com.
CN  - British Cardiovascular Intervention Society and the National Institute for 
      Cardiovascular Outcomes Research
LA  - eng
GR  - MC_PC_13042/MRC_/Medical Research Council/United Kingdom
GR  - MR/K006665/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
MH  - Acute Coronary Syndrome/diagnosis/mortality/*therapy
MH  - Chi-Square Distribution
MH  - Databases, Factual
MH  - *Femoral Artery
MH  - Hemorrhage/etiology/mortality/therapy
MH  - Hemostatic Techniques/instrumentation
MH  - Humans
MH  - Logistic Models
MH  - Multivariate Analysis
MH  - Myocardial Infarction/diagnosis/mortality/*therapy
MH  - Odds Ratio
MH  - Percutaneous Coronary Intervention/adverse effects/*methods/mortality
MH  - Practice Patterns, Physicians'
MH  - *Process Assessment, Health Care
MH  - Propensity Score
MH  - *Radial Artery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United Kingdom
MH  - Vascular Closure Devices
OTO - NOTNLM
OT  - access site
OT  - acute coronary syndromes
OT  - femoral
OT  - outcomes
OT  - percutaneous coronary intervention
OT  - radial
EDAT- 2015/01/27 06:00
MHDA- 2015/09/29 06:00
CRDT- 2015/01/25 06:00
PHST- 2014/06/04 00:00 [received]
PHST- 2014/06/19 00:00 [accepted]
PHST- 2015/01/25 06:00 [entrez]
PHST- 2015/01/27 06:00 [pubmed]
PHST- 2015/09/29 06:00 [medline]
AID - S1936-8798(14)01523-4 [pii]
AID - 10.1016/j.jcin.2014.06.026 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2015 Jan;8(1 Pt A):20-9. doi: 10.1016/j.jcin.2014.06.026.