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The aim of this study was to evaluate the optimal combination of anticoagulant, antiplatelet and access site and short term safety and efficacy outcomes in a contemporary population undergoing percutaneous coronary intervention (PCI).
We evaluated 248100 patients receiving PCI at 258 sites utilizing the ACC NCDR® CathPCI Registry® between 2009 - 2014. Patient presentation, PCI access site, PCI medication, bleeding, transfusion, cerebrovascular accident, rates of coronary artery bypass grafting and death were collected and analyzed using logistic regression. Patients were divided into high risk status (HRS) (cardiogenic shock, needed an IABP or emergent salvage PCI) or low risk status (LRS). Composite cardiovascular events (CCE) included a composite of death, need for transfusion and bleeding events) were recorded.
A total of 248113 PCI procedures were performed, most used a transfemoral approach (TFA) (91%), heparin was used in the majority (51%), GPI was used in a small number (13%) and the P2Y12 agent of choice was clopidogrel (90%). The overall CCE was significantly lower with transradial approach (TRA) vs. TFA (RR 0.6, CI (0.5-0.8) in both the HRS and LRS groups. These reductions were driven by a reduction in overall mortality and overall bleeding was lower with the TRA vs. TFA (p< 0.001). In the HRS and LRS subsets, TRA with bivalirudin use was associated with significantly lower mortality, bleeding and CCE events rates irrespective of GPI or P2Y12 use. Additionally, recurrent myocardial infarction and CVA rates were the no different with the use of bivalirudin vs. heparin in the HRS or LRS irrespective of GPI use.
In contemporary PCI, TRA with the use of bivalirudin with P2Y12 and irrespective of GPI use was associated with the optimal balance of safety and efficacy in both HRS and LRS subsets.
CORONARY: PCI Outcomes