PMID- 29169494
OWN - NLM
STAT- MEDLINE
DCOM- 20180725
LR  - 20190329
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 10
IP  - 22
DP  - 2017 Nov 27
TI  - Impact of Access Site Practice on Clinical Outcomes in Patients Undergoing 
      Percutaneous Coronary Intervention Following Thrombolysis for ST-Segment 
      Elevation Myocardial Infarction in the United Kingdom: An Insight From the 
      British Cardiovascular Intervention Society Dataset.
PG  - 2258-2265
LID - S1936-8798(17)31706-5 [pii]
LID - 10.1016/j.jcin.2017.07.049 [doi]
AB  - OBJECTIVES: This study sought to examine the relationship between access site 
      practice and clinical outcomes in patients requiring percutaneous coronary 
      intervention (PCI) following thrombolysis for ST-segment elevation myocardial 
      infarction (STEMI). BACKGROUND: Transradial access (TRA) is associated with 
      better outcomes in patients requiring PCI for STEMI. A significant proportion of 
      STEMI patients may receive thrombolysis before undergoing PCI in many countries 
      across the world. There are limited data around access site practice and its 
      associated outcomes in this cohort of patients. METHODS: The author used the 
      British Cardiovascular Intervention Society dataset to investigate the outcomes 
      of patients undergoing PCI following thrombolysis between 2007 and 2014. Patients 
      were divided into TRA and transfemoral access groups depending on the access site 
      used. Multiple logistic regression and propensity score matching were used to 
      study the association of access site with in-hospital and long-term mortality, 
      major bleeding, and access site-related complications. RESULTS: A total of 10,209 
      patients received thrombolysis and PCI during the study time. TRA was used in 48% 
      (n = 4,959) of patients; 3.3% (n = 336) patients died in hospital, 1.6% (n = 165) 
      of patients experienced major bleeding, 4.2% (n = 437) experienced major adverse 
      cardiac events (MACE), and 4.6% (n = 468) experienced 30-day mortality. After 
      multivariate adjustment, TRA was associated with significantly reduced odds of 
      in-hospital mortality (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.42 
      to 0.83; p = 0.002), major bleeding (OR: 0.45; 95% CI: 0.31 to 0.66; p < 0.001), 
      MACE (OR: 0.72; 95% CI: 0.55 to 0.94; p = 0.01), and 30-day mortality (OR: 0.72; 
      95% CI: 0.55 to 0.94; p = 0.01). CONCLUSIONS: TRA is associated with decreased 
      odds of bleeding complications, mortality, and MACE in patients undergoing PCI 
      following thrombolysis and should be preferred access site choice in this cohort 
      of patients.
CI  - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Rashid, Muhammad
AU  - Rashid M
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; 
      Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of 
      North Midlands, Stoke-on-Trent, United Kingdom. Electronic address: 
      doctorrashid7@gmail.com.
FAU - Rushton, Claire A
AU  - Rushton CA
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
FAU - Kwok, Chun Shing
AU  - Kwok CS
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; 
      Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of 
      North Midlands, Stoke-on-Trent, United Kingdom.
FAU - Kinnaird, Tim
AU  - Kinnaird T
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; 
      Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
FAU - Kontopantelis, Evangelos
AU  - Kontopantelis E
AD  - Farr Institute, University of Manchester, Manchester, United Kingdom.
FAU - Olier, Ivan
AU  - Olier I
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; School 
      of Computing, Mathematics and Digital Technology, Manchester Metropolitan 
      University, Manchester, United Kingdom.
FAU - Ludman, Peter
AU  - Ludman P
AD  - Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
FAU - De Belder, Mark A
AU  - De Belder MA
AD  - Department of Cardiology, James Cook University Hospital, Middlesbrough, United 
      Kingdom.
FAU - Nolan, James
AU  - Nolan J
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; 
      Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of 
      North Midlands, Stoke-on-Trent, United Kingdom.
FAU - Mamas, Mamas A
AU  - Mamas MA
AD  - Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of 
      Primary Care and Health Sciences, Keele University, Keele, United Kingdom; 
      Academic Department of Cardiology, Royal Stoke Hospital, University Hospitals of 
      North Midlands, Stoke-on-Trent, United Kingdom.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
SB  - IM
CIN - JACC Cardiovasc Interv. 2017 Nov 27;10(22):2266-2268. PMID: 29169495
MH  - Aged
MH  - Catheterization, Peripheral/adverse effects/*methods/mortality
MH  - Clinical Decision-Making
MH  - Female
MH  - *Femoral Artery/diagnostic imaging
MH  - Hemorrhage/etiology
MH  - Hospital Mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Patient Selection
MH  - Percutaneous Coronary Intervention/adverse effects/*methods/mortality
MH  - *Practice Patterns, Physicians'
MH  - Propensity Score
MH  - *Radial Artery/diagnostic imaging
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnostic imaging/mortality/*surgery
MH  - Thrombolytic Therapy/adverse effects/*methods/mortality
MH  - Time Factors
MH  - Treatment Outcome
MH  - United Kingdom
OTO - NOTNLM
OT  - PCI
OT  - TFA
OT  - TRA
OT  - percutaneous coronary intervention
OT  - rescue PCI
OT  - thrombolysis
OT  - transfemoral access
OT  - transradial access
EDAT- 2017/11/25 06:00
MHDA- 2018/07/26 06:00
CRDT- 2017/11/25 06:00
PHST- 2017/03/09 00:00 [received]
PHST- 2017/07/05 00:00 [revised]
PHST- 2017/07/24 00:00 [accepted]
PHST- 2017/11/25 06:00 [entrez]
PHST- 2017/11/25 06:00 [pubmed]
PHST- 2018/07/26 06:00 [medline]
AID - S1936-8798(17)31706-5 [pii]
AID - 10.1016/j.jcin.2017.07.049 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2017 Nov 27;10(22):2258-2265. doi: 
      10.1016/j.jcin.2017.07.049.