Radial Percutaneous Coronary Intervention and Survival
What is the pattern and impact of increasing adoption of radial percutaneous coronary intervention (PCI) in the United Kingdom (UK)?
The investigators used the the BCIS (British Cardiovascular Intervention Society) database to assess outcomes for growth of radial PCI in different regions in England and Wales in 448,853 patients who underwent PCI from 2005-2012. Multiple logistic regression was used to quantify the effect of radial use on 30-day mortality and quantify lives “saved” and “lost” by differences in transradial access (TRA) adoption.
The use of the radial approach increased from 14.0% to 58.6% overall, but there was a large variation in different parts of the country. Radial access was independently associated with a decreased risk of 30-day mortality (odds ratio, 0.70; 95% confidence interval [CI], 0.66-0.74). The number of estimated lives “saved” was 450 (95% CI, 275-650), and the authors estimated that an additional 264 (95% CI, 153-399) lives would have been saved if radial adoption were uniform nationally.
Radial access is the predominant approach to PCI in the UK, although there was significant variation in its adoption nationally.
Radial access is increasingly being used in the United States, and this study from the UK is no surprise. The dramatic survival benefit of radial use observed in this study is probably a reflection of confounding because the patients undergoing femoral access at high radial adoption are sicker than those undergoing radial PCI. There is no doubt, however, that radial PCI is associated with a reduction in bleeding events, and that is a good enough argument to recommend a radial first approach.
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