Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes

• Published in: EuroIntervention Vol. 7; no. 1; pp. 91 - 97
• Main Authors: HAMON, Martial, MEHTA, Shamir, STEG, Gabriel, FAXON, David, KERKAR, Prafulla, RUPPRECHT, Hans-Jürgen, TANGUAY, Jean-François, AFZAL, Rizwan, YUSUF, Salim
• Format: Journal Article
• Language: English
• Published: Toulouse Société Europa Edition 01.05.2011
• Subjects: Acute Coronary Syndrome - therapy; Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Female; Femoral Artery; Heart; Humans; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Postoperative Hemorrhage - etiology; Radial Artery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Femur; Prognosis; bleeding; complications; Toxicity; Coronary artery; Cardiovascular disease; Myocardial disease; Coronary heart disease; Hemorrhage; radial; femoral; outcomes; Secondary effect; Complication; Acute coronary syndrome
• ISSN: 1774-024X; 1969-6213
• DOI: 10.4244/eijv7i1a16

The aim of the present study was to examine the impact of the transradial approach (TRA), in comparison to the transfemoral approach (TFA), on PCI-related bleeding and patient outcomes in acute coronary syndrome patients who underwent PCI in the OASIS-5 trial. The primary outcome (death, myocardial infarction, refractory ischaemia) at nine days was similar in both groups (7.1% in 872 TRA and 7.7% in 7,013 TFA). Major bleeding was significantly lower in patients who underwent PCI with TRA by comparison to TFA (1.6% vs 3.5%, p<0.003, respectively). No difference between patients treated by fondaparinux or enoxaparin was noted for ischaemic events at nine days according to the access site. The rate of major bleeding at nine days was markedly reduced with fondaparinux when compared to enoxaparin for both access sites (from 4.8% to 2.3%, HR 0.48 [0.37-0.62], p< 0.0001 for TFA and from 2.4 to 0.9%, HR 0.36 [0.11- 1.16], p<0.08 for TRA). TRA is associated with substantial decrease of PCI-related bleeding in current contemporary pharmacological environment in comparison to TFA. Even in the context of low access site complication rate provided by TRA, fondaparinux was effective in reducing major bleeding.