Influence of Bleeding Risk on Outcomes of Radial and Femoral Access for Percutaneous Coronary Intervention: An Analysis From the GLOBAL LEADERS Trial |
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| Authors: | Chao Gao Piotr Buszman Pawe? Buszman Ply Chichareon Rodrigo Modolo Scot Garg Kuniaki Takahashi Hideyuki Kawashima Rutao Wang Chun Chin Chang Norihiro Kogame Mariusz Tomaniak Masafumi Ono Hironori Hara Ton Slagboom Adel Aminian Christoph Kurt Naber Didier Carrie Aleksander Zurakowski |
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| Institution: | 1. Department of Cardiology. Xijing Hospital, Xi’an, China;2. Department of Cardiology, Radboud University, Nijmegen, The Netherlands;3. Centre for Cardiovascular Research and Development, American Heart of Poland, Kostkowice, Poland;4. Andrzej Frycz Modrzewski Krakow University, Krakow, Poland;5. Centre for Cardiovascular Research and Development, American Heart of Poland, Ustron, Poland;6. Division of Cardiology, Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand;7. Cardiology Division. Department of Internal Medicine, University of Campinas, Campinas, Brazil;8. Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK;9. Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands;10. Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands;11. Division of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium;12. Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Essen, Germany;13. Cardiology B Department, CHU Toulouse, Hôpital Rangueil, Toulouse, France;14. Kerckhoff Heart Center, Bad Nauheim, Germany;15. Hôpital Bichat, l’Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot, Paris, France;p. Royal Brompton Hospital, Imperial College, London, United Kingdom;q. Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands;r. National Heart and Lung Institute, Imperial College London, London, United Kingdom;s. American Heart of Poland, Chrzanow, Poland;t. Department of Cardiology, National University of Ireland, Galway, Ireland |
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| Abstract: | BackgroundRadial artery access has been shown to reduce mortality and bleeding events, especially in patients with acute coronary syndromes. Despite this, interventional cardiologists experienced in femoral artery access still prefer that route for percutaneous coronary intervention. Little is known regarding the merits of each vascular access in patients stratified by their risk of bleeding.MethodsPatients from the Global Leaders trial were dichotomized into low or high risk of bleeding by the median of the PRECISE-DAPT score. Clinical outcomes were compared at 30 days.ResultsIn the overall population, there were no statistical differences between radial and femoral access in the rate of the primary end point, a composite of all-cause mortality, or new Q-wave myocardial infarction (MI) (hazard ratio HR] 0.70, 95% confidence interval CI] 0.42-1.15). Radial access was associated with a significantly lower rate of the secondary safety end point, Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding (HR 0.55, 95% CI 0.36-0.84). Compared by bleeding risk strata, in the high bleeding score population, the primary (HR 0.47, 95% CI 0.26-0.85; P = 0.012; Pinteraction = 0.019) and secondary safety (HR 0.57, 95% CI 0.35-0.95; P = 0.030; Pinteraction = 0.631) end points favoured radial access. In the low bleeding score population, however, the differences in the primary and secondary safety end points between radial and femoral artery access were no longer statistically significant.ConclusionsOur findings suggest that the outcomes of mortality or new Q-wave MI and BARC 3 or 5 bleeding favour radial access in patients with a high, but not those with a low, risk of bleeding. Because this was not a primary analysis, it should be considered hypothesis generating. |
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