Cardiovascular Journal of Africa: Vol 29 No 6 (November/December 2018)

42 / 74

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018 374 AFRICA
Transradial versus transfemoral intervention in non-ST-
segment elevation acute coronary syndrome patients
undergoing percutaneous coronary intervention: the
Korean transradial intervention registry of 1 285 patients
Min-Ho Lee, Duk Won Bang, Byung Won Park, Byung-Ryul Cho, Seung-Woon Rha, Myung Ho Jeong,
Junghan Yoon, Jon Suh, Kyoo-Rok Han, Min Su Hyon
Abstract
Introduction: Although the implementation of transradial
intervention (TRI) has increased over the last few years, there
are limited data on the impact of TRI on efficacy and safety
in patients with non-ST-segment elevation acute coronary
syndrome (NSTE-ACS). We sought to compare one-year
clinical outcomes and bleeding complications of TRI with
those of transfemoral intervention (TFI) in patients with
NSTE-ACS.
Methods: The Korean TRI registry was a cohort of 20 centres
from 2012 to 2015. The primary efficacy endpoint was major
adverse cardiovascular events (MACE), defined as a composite
of cardiac death (CD), non-fatal myocardial infarction (MI)
and repeat revascularisation (RR). Among the 1 319 patients
with NSTE-ACS, 1 285 were finally analysed after excluding 34
due to lack of follow-up data. The patients were divided into
TRI and TFI groups according to the final access site.
Results: At one-year follow up, the TRI group showed a
significantly lower rate of MACE, and a marginally signifi-
cantly lower rate of CD than the TFI group in the crude
population. However, in propensity-score matched analysis,
the rate of MACE did not differ between the TRI and TFI
groups. Regarding bleeding complications, the TRI group
was associated with significantly lower rates of major bleed-
ing in both the crude and matched populations. Independent
predictors of MACE were chronic kidney disease (CKD) and
multi-vessel disease (MVD).
Conclusions: In patients with NSTE-ACS, TRI was associated
with favourable one-year clinical outcomes and lower bleed-
ing complications compared to TFI. Independent predictors
of MACE were clinical and angiographic profiles (CKD,
MVD) rather than vascular access sites.
Keywords: radial artery, femoral artery, acute coronary syndrome,
myocardial infarction, percutaneous coronary intervention
Submitted 27/7/17, accepted 30/8/18
Published online 6/11/18
Cardiovasc J Afr 2018; 29: 374–380
DOI: 10.5830/CVJA-2018-047
Compared with the femoral artery, the radial artery is more
superficial, smaller in diameter, it lacks important adjacent
structures or potential spaces, and is easily compressed.1
Therefore, although femoral access has traditionally been used
for percutaneous coronary intervention (PCI), radial access has
gained increasing popularity with evolving technology and the
increasing experience of interventional cardiologists over the
past few years.2,3
Risks related to PCI comprise ischaemic complications,
including cardiac death (CD), myocardial infarction (MI), stent
thrombosis and stroke, as well as vascular complications such as
bleeding.1 Bleeding complications are associated with subsequent
morbidity and mortality rates, 30 to 70% of which are related to
the vascular access site.4,5
A recent meta-analysis of 76 studies involving a total of
761 919 patients concluded that transradial intervention (TRI)
was associated with a 78% reduction in rate of bleeding and 80%
reduction in transfusion rates, regardless of the clinical indication
for PCI, compared with transfemoral intervention (TFI).6 This is
consistent with results from the largest randomised trial done to
date.5 However, the clinical outcomes of TRI varied according to
the clinical settings of the studies, including the inclusion criteria.
Division of Cardiology, Department of Internal Medicine,
Soonchunhyang University Hospital, Seoul, Korea
Min-Ho Lee, MD,
Duk Won Bang, MD, PhD
Byung Won Park, MD
Min Su Hyon, MD, PhD,
Division of Cardiology, Department of Internal Medicine,
Kangwon National University Hospital, Chuncheon, Korea
Byung-Ryul Cho, MD, PhD
Division of Cardiology, Department of Internal Medicine,
Korea University Guro Hospital, Seoul, Korea
Seung-Woon Rha, MD, PhD
Division of Cardiology, Department of Internal Medicine,
Chonnam National University Hospital, Gwangju, Korea
Myung Ho Jeong, MD, PhD
Division of Cardiology, Department of Internal Medicine,
Yonsei University Wonju Severance Christian Hospital,
Wonju, Korea
Junghan Yoon, MD, PhD
Division of Cardiology, Department of Internal Medicine,
Soonchunhyang University Bucheon Hospital, Bucheon,
Korea
Jon Suh, MD, PhD
Division of Cardiology, Department of Internal Medicine,
Kangdong Sacred Heart Hospital, Seoul, Korea
Kyoo-Rok Han, MD, PhD,