Korean Circ J.  2018 Aug;48(8):719-727. 10.4070/kcj.2018.0040.

A Comparison of Transradial and Transfemoral Percutaneous Coronary Intervention in Chinese Women Based on a Propensity Score Analysis

Affiliations
  • 1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. yangyjfw@126.com

Abstract

BACKGROUND AND OBJECTIVES
Over the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China.
METHODS
The study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched.
RESULTS
Baseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54-0.76; p < 0.001) and access site complications (OR, 0.67; 95% CI, 0.61-0.74; p < 0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) both during hospitalization and at 1-year follow-up (p > 0.05).
CONCLUSIONS
In this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.

Keyword

Coronary artery disease; Percutaneous coronary intervention; Women; Radial artery; Femoral artery

MeSH Terms

Asian Continental Ancestry Group*
Beijing
Bias (Epidemiology)
China
Coronary Artery Disease
Death
Female
Femoral Artery
Follow-Up Studies
Hemorrhage
Hospitalization
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention*
Propensity Score*
Radial Artery

Figure

  • Figure 1 Comparison of bleeding and access site complication between TRI and TFI groups in propensity score-matched patients. BARC = Bleeding Academic Research Consortium; TFI = transfemoral intervention; TRI = transradial intervention.

  • Figure 2 Kaplan-Meier curves for occurrence of MACE (A), cardiac death (B), MI (C), and TVR (D) between TRI and TFI groups of 1-year follow-up in propensity score-matched patients. MACE = major adverse cardiac event; MI = myocardial infarction; TFI = transfemoral intervention; TRI = transradial intervention; TVR = target vessel revascularization.


Cited by  1 articles

The Transradial Approach for Coronary Intervention: More Comfort, Better Outcome
Cheol Whan Lee, Sang-Cheol Cho
Korean Circ J. 2018;48(8):728-730.    doi: 10.4070/kcj.2018.0118.


Reference

1. Kiemeneij F, Jan Laarman G. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn. 1993; 30:173–178.
Article
2. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009; 157:132–140.
Article
3. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377:1409–1420.
Article
4. Bertrand OF, Bélisle P, Joyal D, et al. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J. 2012; 163:632–648.
Article
5. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015; 385:2465–2476.
Article
6. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012; 60:2481–2489.
7. Cooper CJ, El-Shiekh RA, Cohen DJ, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J. 1999; 138:430–436.
Article
8. Yang YJ, Kandzari DE, Gao Z, et al. Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes. JACC Cardiovasc Interv. 2010; 3:1035–1042.
Article
9. Lee HW, Cha KS, Ahn J, et al. Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction. Int J Cardiol. 2016; 202:419–424.
Article
10. Jin C, Xu Y, Qiao SB, et al. Transradial versus transfemoral approach for percutaneous coronary intervention in elderly patients in China: a retrospective analysis. Chin Med Sci J. 2017; 32:161–170.
11. Hibbert B, Simard T, Wilson KR, et al. Transradial versus transfemoral artery approach for coronary angiography and percutaneous coronary intervention in the extremely obese. JACC Cardiovasc Interv. 2012; 5:819–826.
Article
12. Hochman JS, Tamis JE, Thompson TD, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999; 341:226–232.
Article
13. Lansky AJ, Hochman JS, Ward PA, et al. Percutaneous coronary intervention and adjunctive pharmacotherapy in women: a statement for healthcare professionals from the American Heart Association. Circulation. 2005; 111:940–953.
Article
14. Mazure CM, Jones DP. Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. BMC Womens Health. 2015; 15:94.
Article
15. Bucholz EM, Krumholz HM. Women in clinical research: what we need for progress. Circ Cardiovasc Qual Outcomes. 2015; 8:S1–3.
Article
16. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials a consensus report from the bleeding academic research consortium. Circulation. 2011; 123:2736–2747.
17. Wang L, Yang Y, Zhou Y, Xu B, Zhao L. Prevalence of transradial coronary angiography and intervention in China: report from the Transradial coronary intervention Registration Investigation in China (TRI-China). Int J Cardiol. 2010; 145:246–247.
Article
18. Pandie S, Mehta SR, Cantor WJ, et al. Radial versus femoral access for coronary angiography/intervention in women with acute coronary syndromes: insights from the rival trial (radial vs femoral access for coronary intervention). JACC Cardiovasc Interv. 2015; 8:505–512.
19. Jin C, Xu Y, Qiao S, et al. Comparison of transradial and transfemoral approaches in women undergoing percutaneous coronary intervention in China: a retrospective observational study. Angiology. 2017; 68:799–806.
Article
20. Kedev S, Sukmawan R, Kalpak O, et al. Transradial versus transfemoral access for female patients who underwent primary PCI in STEMI: two years follow-up data from acute STEMI interventional registry. Int J Cardiol. 2016; 217:S16–20.
Article
21. Rao SV, Hess CN, Barham B, et al. A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. JACC Cardiovasc Interv. 2014; 7:857–867.
22. Doyle BJ, Rihal CS, Gastineau DA, Holmes DR. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol. 2009; 53:2019–2027.
23. Dauerman HL, Rao SV, Resnic FS, Applegate RJ. Bleeding avoidance strategies: consensus and controversy. J Am Coll Cardiol. 2011; 58:1–10.
24. Feldman DN, Swaminathan RV, Kaltenbach LA, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention an updated report from the National Cardiovascular Data Registry (2007–2012). Circulation. 2013; 127:2295–2306.
25. Jin C, Li W, Qiao SB, et al. Costs and benefits associated with transradial versus transfemoral percutaneous coronary intervention in China. J Am Heart Assoc. 2016; 5:e002684.
Article
26. Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997; 29:1269–1275.
Article
27. Ball WT, Sharieff W, Jolly SS, et al. Characterization of operator learning curve for transradial coronary interventions. Circ Cardiovasc Interv. 2011; 4:336–341.
Article
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr