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Elderly patients and women have worse outcomes after percutaneous coronary interventions (PCI), due in part to bleeding and access site complications. Post-PCI bleeding is associated with increased mortality and recurrent myocardial infarction (MI). Studies have shown that transradial PCI is associated with a lower risk of bleeding, major vascular complications and mortality compared to transfemoral PCI. We sought to test the hypothesis that for PCI in elderly women, a particularly high risk group, the transradial approach would be superior to the transfemoral approach.
This was a single center retrospective study. 487 women aged 65 or older who underwent PCI at our center between June 2009 and September 2011 were grouped according to PCI access site (radial or femoral). The primary outcome was a composite of death, MI, and major vascular complications up to 60 days. Major vascular complications were as defined by the ACC CathPCI registry as any of the following: large hematoma, hemoglobin drop > 3 g/dL, the need for vascular repair, or the need for blood transfusion. Secondary outcomes included individual components of the primary outcome.
The composite outcome of death, MI, or major vascular complications within 60 days was higher in the femoral group versus the radial group (29% vs. 14.4%, p = 0.0026). This difference was driven mainly by a higher incidence of major vascular complications (13% vs. 5.8%, p = 0.05) and MI within 60 days (12.5% vs. 5.8%, p = 0.05). There was no difference in in-hospital or 60-day mortality.
In elderly women undergoing PCI, the transradial approach appears to be superior to the transfemoral approach. This seems to be driven by a lower occurrence of major vascular complications and lower rates of MI. These findings have important clinical implications for treatment in women and require further validation in larger, randomized prospective studies.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: PCI: Outcomes, Adherence and Appropriateness
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1288-106
- 2013 American College of Cardiology Foundation