J Korean Med Sci.  2024 Mar;39(10):e111. 10.3346/jkms.2024.39.e111.

Transradial Versus Transfemoral Access for Bifurcation Percutaneous Coronary Intervention Using SecondGeneration Drug-Eluting Stent

• Lee JH
• Youn YJ
• Jeon HS
• Lee JW
• Ahn SG
• Yoon J
• Gwon HC
• Song YB
• Choi KH
• Kim HS
• Chun WJ
• Hur SH
• Nam CW
• Cho YK
• Han SH
• Rha SW
• Chae IH
• Jeong JO
• Heo JH
• Lim DS
• Park JS
• Hong MK
• Doh JH
• Cha KS
• Kim DI
• Lee SY
• Chang K
• Hwang BH
• Choi SY
• Jeong MH
• Lee HJ

• KMID: 2554195
• DOI: http://doi.org/10.3346/jkms.2024.39.e111

Abstract

Background
The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs).
Methods
Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group).
Results
Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639).
Conclusion
The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.

Keyword

Transradial Approach; Bifurcation; Percutaneous Coronary Intervention; Drug-Eluting Stent

Figure

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  Fig. 1 Patient-oriented composite outcome based on vascular access in the total (A) and propensity score-matched populations (B).HR = hazard ratio, CI = confidence interval, TFA = transfemoral access, TRA = transradial access.

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  Fig. 2 Subgroup analysis of device-oriented composite outcome.CI = confidence interval, ACS = acute coronary syndrome, SA = stable angina, LM = left main, TRA = transradial access, TFA = transfemoral access.

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