PMID- 25922417
OWN - NLM
STAT- MEDLINE
DCOM- 20160225
LR  - 20181202
IS  - 1941-7632 (Electronic)
IS  - 1941-7640 (Linking)
VI  - 8
IP  - 5
DP  - 2015 May
TI  - Underutilization of Radial Access in Patients Undergoing Percutaneous Coronary 
      Intervention for ST-Segment-Elevation Myocardial Infarction: Insights From the 
      Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
LID - e002036 [pii]
LID - 10.1161/CIRCINTERVENTIONS.114.002036 [doi]
AB  - BACKGROUND: The purpose of this study was to evaluate the frequency and temporal 
      trends in use of transradial access (TRA) for percutaneous coronary intervention 
      (PCI) in ST-segment-elevation myocardial infarction (STEMI). The use of TRA has 
      been associated with less bleeding and improved clinical outcomes in patients 
      undergoing PCI for STEMI. METHODS AND RESULTS: The frequency of TRA compared with 
      transfemoral access for patients undergoing PCI for STEMI or other indications 
      (non-ST-segment-elevation myocardial infarction, unstable angina, and non-acute 
      coronary syndrome) in The Blue Cross Blue Shield of Michigan Cardiovascular 
      Consortium database between 2010 and 2013 was evaluated. Propensity matching was 
      used to assess the relationship of TRA with in-hospital clinical end points of 
      major bleeding, transfusion, and death. The TRA cohort of patients was stratified 
      into deciles based on their predicted bleeding risk and compared with PCI 
      indication. Of 122,728 PCI procedures, 17,912 (14.6%) were via TRA. Among 
      patients with STEMI cases, 8.3% of the PCI cases were performed via TRA. The use 
      of TRA increased over the study period although the growth was slower for STEMI 
      than for other indications, P<0.001. The use of TRA for PCI in STEMI was 
      associated with a lower rate of bleeding (11.7% versus 20.0%; P<0.001) and 
      vascular complications (0.7% versus 2.6%; P=0.001), but no mortality difference 
      (1.25% versus 2.33%; P=0.175). There was a strong negative association between 
      the predicted risk of bleeding and the use of TRA (P<0.001). CONCLUSIONS: The use 
      of radial access for PCI in STEMI is increasing but at a slower pace than for 
      patients with other indications. TRA was associated with a reduction in bleeding 
      and transfusion, but there is a strong negative correlation between the predicted 
      risk of bleeding and actual use of TRA in STEMI.
CI  - (c) 2015 American Heart Association, Inc.
FAU - Howe, Michael J
AU  - Howe MJ
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.).
FAU - Seth, Milan
AU  - Seth M
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.).
FAU - Riba, Arthur
AU  - Riba A
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.).
FAU - Hanzel, George
AU  - Hanzel G
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.).
FAU - Zainea, Mark
AU  - Zainea M
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.).
FAU - Gurm, Hitinder S
AU  - Gurm HS
AD  - From the Division of Cardiovascular Medicine, Department of Medicine, Frankel 
      Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); 
      Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare 
      System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of 
      Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular 
      Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. 
      Clemens, MI (M.Z.). hgurm@med.umich.edu.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circ Cardiovasc Interv
JT  - Circulation. Cardiovascular interventions
JID - 101499602
SB  - IM
MH  - Aged
MH  - Blue Cross Blue Shield Insurance Plans
MH  - Catheterization, Peripheral/*trends
MH  - Databases, Factual
MH  - Female
MH  - Health Services Misuse
MH  - Humans
MH  - Male
MH  - Michigan
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - Percutaneous Coronary Intervention/methods/*statistics & numerical data
MH  - Prospective Studies
MH  - *Radial Artery
MH  - Registries
OTO - NOTNLM
OT  - ST-segment-elevation myocardial infarction
OT  - percutaneous coronary intervention
OT  - radial artery catheter
EDAT- 2015/04/30 06:00
MHDA- 2016/02/26 06:00
CRDT- 2015/04/30 06:00
PHST- 2015/04/30 06:00 [entrez]
PHST- 2015/04/30 06:00 [pubmed]
PHST- 2016/02/26 06:00 [medline]
AID - CIRCINTERVENTIONS.114.002036 [pii]
AID - 10.1161/CIRCINTERVENTIONS.114.002036 [doi]
PST - ppublish
SO  - Circ Cardiovasc Interv. 2015 May;8(5):e002036. doi: 
      10.1161/CIRCINTERVENTIONS.114.002036.