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Outcomes of Left and Right Radial Access for PCI
Study Questions:
What are the relationships between left radial access (LRA) or right radial access (RRA) and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI)?
Methods:
The investigators analyzed the relationship between use of LRA or RRA and clinical outcomes of in-hospital or 30-day mortality, major adverse cardiovascular events (MACE), in-hospital stroke, and major bleeding complications in patients undergoing PCI between 2007 and 2014. Multivariable logistic regression (MLR) modeling was used for risk estimation of all outcomes across both groups, adjusting for age, sex, and all the other variables included in the multiple imputations.
Results:
Out of 342,806 cases identified, 328,495 (96%) were RRA and 14,311 (4%) were LRA. Use of LRA increased from 3.2% to 4.6% from 2007 to 2014. In patients undergoing a repeat PCI procedure, the use of RRA dropped to 72% at the second procedure and was even lower in females (65%) and patients ages >75 years (70%). Use of LRA (compared to RRA) was not associated with significant differences in in-hospital mortality (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.90-1.57; p = 0.20), 30-day mortality (OR, 1.17; 95% CI, 0.93-1.74; p = 0.16), MACE (OR, 1.06; 95% CI, 0.86-1.32; p = 0.56), or major bleeding (OR, 1.22; 95% CI, 0.87-1.77; p = 0.24). In propensity-match analysis, LRA was associated with a significant decrease in in-hospital stroke (OR, 0.52; 95% CI, 0.37-0.82; p = 0.005).
Conclusions:
The authors concluded that use of LRA is limited compared to RRA, but conveys no increased risk of adverse outcomes, although it may be associated with a reduction in PCI-related stroke complications.
Perspective:
This study reports that use of LRA has modestly increased over time in UK practice and is used more often in females, the elderly, Asian ethnicity, patients with a previous history of coronary artery bypass grafting, and short stature patients. Overall, complications with LRA access were similar to those seen with RRA access, with no difference in in-hospital or 30-day mortality, in-hospital MACE, or major bleeding complications, although there was a significantly decreased odds of in-hospital stroke following PCI using the LRA approach in the propensity-matched cohort. It appears that LRA offers a safe alternative access site, and it may be preferable to switch from right radial to left radial rather than femoral, considering that one third of the patients undergoing RRA PCI at the first procedure will have their access changed to femoral route at the subsequent PCI.
Keywords: Coronary Artery Bypass, Geriatrics, Hemorrhage, Hospital Mortality, Percutaneous Coronary Intervention, Primary Prevention, Radial Artery, Stroke, Treatment Outcome, Vascular Diseases
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