Rev. Bras. Cardiol. Invasiva.2017;25(1-4):31-5.
Comparing radial and femoral access for percutaneous coronary intervention in chronic total occlusions
DOI: 10.31160/JOTCI2017;25(1-4)A0008
ABSTRACT
Background:
Coronary chronic total occlusion (CTO) is present in approximately 15% of coronary angiographies, and the success rates of percutaneous coronary interventions (PCI) range from 55 to 80%. The radial access has been increasingly used, even in more complex scenarios, such as CTO. The objective was to compare the profile and results of CTO patients undergoing PCI by radial or femoral access, and evaluate the independent predictors of in-hospital mortality.
Methods:
Data from the CENIC registry on patients submitted to CTO PCI from June 2006 to March 2016 were included and compared according to the access used. Death, reinfarction, and emergency revascularization during hospital stay were defined as major adverse cardiovascular events (MACE). A logistic regression model was adjusted for the evaluation of predictors of in-hospital mortality.
Results:
A total of 3,768 patients (radial access: 905) and 3,799 procedures were included. Mean age was 60.4 ± 11.0 years, and 68.4% were males. Angiographic success was similar between the radial and femoral groups (96.9% vs. 96.6%, p = 0.061), as well as MACE rates (0.6% vs. 0.7%, p = 0.71) and their individual components. The radial access had no association with death (OR = 0.57; 95% CI: 0.13-2.50, p = 0.46). Age, female sex, extent of coronary disease, and use of glycoprotein IIb/IIIa inhibitors were independent predictors of in-hospital mortality.
Conclusions:
Success rates in the treatment of coronary CTO were exceptionally high and similar in both groups. The rates of in-hospital MACE were low and similar, and the access chosen had no association with in-hospital mortality.
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