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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
376
AFRICA
Bleeding occurred in 27 patients (2.2%) in the crude population
and was significantly less frequent in the TRI group than in the
TFI group (1.3 vs 5.1%,
p
<
0.001). This difference was mainly
driven by the lower frequency of major bleeding in the TRI
group (0.4 vs 3.4%,
p
<
0.001). However, there was no significant
difference in minor bleeding rates between the two groups (0.8 vs
1.7%,
p
=
0.199) (Table 3).
To minimise allocation bias and better describe the treatment
impact of TRI in NSTE-ACS patients, propensity-score
matching was done. After 3:1 propensity-score matching, 624 of
983 patients in the TRI group (63.5%) were successfully matched
to 241 patients in the TFI group. The baseline characteristics of
the two groups were well balanced after matching (Table 4).
The clinical outcomes of the matched population were
different from those of the crude population (Table 2, Fig. 2).
The rate of MACE was not different between the TRI and TFI
groups (4.0 vs 5.4%,
p
=
0.333). Also, there were no significant
differences in rates of CD, MI and RR between the two groups.
Bleeding complications of the matched population were
similar to those of the crude population. Bleeding occurred in
20 patients (2.4%) and was significantly less frequent in the TRI
Table 1. Baseline characteristics of the crude population
Variables
Overall
(n
=
1 285)
TRI group
(n
=
983)
TFI group
(n
=
302)
p
-value
Age (years)
65.6
±
11.2 65.4
±
11.2 66.5
±
11.3 0.128
Male,
n
(%)
857 (66.7) 667 (67.9) 190 (62.9)
0.125
Hypertension,
n
(%)
836 (65.2) 640 (65.2) 196 (65.1) > 0.999
Diabetes mellitus,
n
(%)
432 (33.8) 306 (31.2) 126 (42.0)
0.001
Dyslipidaemia,
n
(%)
246 (19.3) 204 (20.9)
42 (14.0)
0.007
Chronic kidney disease,
n
(%)
52 (4.1)
7 (0.7)
45 (15.0)
<
0.001
Current smoker,
n
(%)
350 (27.4) 276 (28.3)
74 (24.6)
0.210
History of IHD,
n
(%)
331 (25.8) 223 (22.7) 108 (35.8)
<
0.001
History of PAD,
n
(%)
29 (2.4)
10 (1.1)
19 (6.5)
<
0.001
Procedural characteristics
Initial diagnosis,
n
(%)
<
0.001
Unstable angina
904 (70.4) 723 (73.6) 181 (59.9)
NSTEMI
381 (29.6) 260 (26.4) 121 (40.1)
Disease extent,
n
(%)
0.023
1VD
536 (42.7) 420 (43.9) 116 (38.8)
2VD
416 (33.1) 323 (33.8)
93 (31.1)
3VD
304 (24.2) 214 (22.4)
90 (30.1)
Culprit lesion,
n
(%)
0.091
LAD
372 (42.2) 291 (50.6)
81 (42.2)
LCX
134 (17.5) 102 (17.7)
32 (16.7)
RCA
226 (29.5) 156 (27.1)
70 (36.5)
LM
35 (4.6)
26 (4.5)
9 (4.7)
TRI
=
transradial intervention; TFI
=
transfemoral intervention; IHD
=
ischaemic heart disease; PAD
=
peripheral artery disease; NSTEMI
=
non-
ST-segment elevation myocardial infarction; VD
=
vessel disease; LAD
=
left
anterior descending artery; LCX
=
left circumflex artery; RCA
=
right coronary
artery; LM
=
left main.
Table 2. Clinical outcomes at one year
Variables
TRI
group
TFI
group
HR (95% CI)
p
-value
Crude population
n
=
983
n
=
302
MACE,
n
(%)
41 (4.2) 21 (7.0)
0.588
(0.347–0.995)
0.045
Cardiac death,
n
(%)
9 (0.9)
7 (2.3)
0.387
(0.144–1.039)
0.050
MI,
n
(%)
5 (0.5)
0 (0.0)
30.974
(0.005–192135.446)
0.207
Repeat revascularisation,
n
(%)
32 (3.3) 14 (4.6)
0.691
(0.369–1.296)
0.247
Propensity-score matched
population
n
=
624
n
=
241
MACE,
n
(%)
25 (4.0) 13 (5.4)
0.719
(0.368–1.406)
0.333
Cardiac death,
n
(%)
6 (1.0)
2 (0.8)
1.122
(0.226–5.558)
0.888
MI,
n
(%)
4 (0.6)
0 (0.0)
34.376
(0.004–322560.453)
0.204
Repeat revascularisation,
n
(%)
19 (3.0) 11 (4.6)
0.647
(0.308–1.360)
0.247
TRI
=
transradial intervention; TFI
=
transfemoral intervention; MACE
=
major adverse cardiovascular events; MI
=
myocardial infarction.
Table 3. Bleeding complications at one year
Variables
p
-value
Crude population
n
=
983
n
=
302
Any bleeding,
n
(%)
12 (1.3) 15 (5.1)
<
0.001
Major bleeding (BARC type 2 or above),
n
(%) 4 (0.4) 10 (3.4)
<
0.001
BARC type 2
3 (0.3)
9 (3.0)
BARC type 3
1 (0.1)
1 (0.3)
BARC type 4
0 (0.0)
0 (0.0)
BARC type 5
0 (0.0)
0 (0.0)
Minor bleeding (BARC type 1),
n
(%)
8 (0.8)
5 (1.7)
0.199
Propensity-score matched population
n
=
624
n
=
241
Any bleeding,
n
(%)
6 (1.0) 14 (6.0)
<
0.001
Major bleeding (BARC type 2 or above),
n
(%) 2 (0.3)
9 (3.8)
<
0.001
BARC type 2
1 (0.2)
9 (3.8)
BARC type 3
1 (0.2)
0 (0.0)
BARC type 4
0 (0.0)
0 (0.0)
BARC type 5
0 (0.0)
0 (0.0)
Minor bleeding (BARC type 1),
n
(%)
4 (0.7)
5 (2.1)
0.126
TRI
=
transradial intervention; TFI
=
transfemoral intervention; BARC
=
Bleeding Academic Research Consortium.
Table 4. Baseline characteristics of the propensity-score matched
population
Variables
TRI group
(n
=
624)
TFI group
(n
=
241)
p
-value
Age (years)
65.6
±
11.7
66.2
±
11.6
0.507
Male,
n
(%)
411 (65.9)
155 (64.3)
0.690
Hypertension,
n
(%)
204 (32.7)
86 (35.7)
0.433
Diabetes mellitus,
n
(%)
150 (34.8)
137 (31.8)
0.422
Dyslipidaemia,
n
(%)
91 (14.6)
35 (14.5)
> 0.999
Chronic kidney disease,
n
(%)
4 (0.6)
4 (1.7)
0.229
Current smoker,
n
(%)
180 (28.8)
68 (28.2)
0.867
History of IHD,
n
(%)
176 (28.2)
76 (31.5)
0.359
History of PAD,
n
(%)
9 (1.4)
7 (2.9)
0.164
Procedural characteristics
Initial diagnosis,
n
(%)
0.130
Unstable angina
418 (67.0)
148 (61.4)
NSTEMI
206 (33.0)
93 (38.6)
Disease extent,
n
(%)
0.595
1VD
262 (42.0)
96 (39.8)
2VD
202 (32.4)
75 (31.1)
3VD
160 (25.6)
70 (29.0)
Culprit lesion,
n
(%)
0.153
LAD
188 (51.9)
64 (41.6)
LCX
58 (16.0)
27 (17.5)
RCA
96 (26.5)
54 (35.1)
LM
20 (5.5)
9 (5.8)
TRI
=
transradial intervention; TFI
=
transfemoral intervention; IHD
=
ischaemic heart disease; PAD
=
peripheral artery disease; NSTEMI
=
non-
ST-segment elevation myocardial infarction; VD
=
vessel disease; LAD
=
left
anterior descending artery; LCX
=
left circumflex artery; RCA
=
right coronary
artery; LM
=
left main.