Author + information
- Shmuel Chen1,
- Bjorn Redfors2,
- Yangbo Liu2,
- Ori Ben-Yehuda3,
- Marie-Claude Morice4,
- Martin Leon5,
- David Kandzari6,
- Roxana Mehran7,
- Nicholas Lembo8,
- Adrian Banning9,
- A. Pieter Kappetein10,
- Joseph Sabik11,
- Patrick Serruys12 and
- Gregg Stone13
- 1CRF, New York, New York, United States
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 4CERC, Massy, France
- 5Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 6Piedmont Heart Institute, Atlanta, Georgia, United States
- 7Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 8Columbia University, New York, New York, United States
- 9John Radcliffe Hospital, Oxford, United Kingdom
- 10Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 11Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 12Imperial College, London, United Kingdom
- 13Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Use of transradial access (TRA) for PCI is increasing; however, there is a paucity of data regarding outcomes after PCI with TRA compared to transfemoral access (TFA) in pts with left main coronary artery coronary artery disease (LMCAD).
The EXCEL trial randomized 1905 pts with LM disease and low or intermediate SYNTAX scores to PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents vs. CABG. We compared outcomes of pts undergoing PCI with TRA vs. TFA using multivariable Cox proportional hazards regression and linear regression. The primary endpoint was a composite of death, MI, or stroke at 3 years.
PCI was performed exclusively with TRA in 248 (26.6%) pts and TFA in 683 (73.4%) pts. TRA was used in 20/272 (7.4%) and 228/659 (34.6%) PCI pts enrolled in and outside the US, respectively (p<0.0001). Pts in the TRA group were younger and less likely to have hypertension and chronic kidney disease. The mean syntax score was similar in both groups. The average number of vessels and lesions treated as well as the number of stents per pt were higher in the TFA group. Procedural contrast use was less with TRA compared to TFA (231.1 ± 110.3 vs. 272.3 ± 131.0 mL, adjusted mean difference -43.1 mL, p=0.0001), although procedural times (adjusted mean difference -5.5 min, p=0.11) and radiation dose (adjusted mean difference -0.05 Gy, p=0.45) were similar between groups. Pts undergoing TRA compared to TFA had similar rates of in-hospital TIMI major or minor bleeding (4.2% vs. 5.8%, adjusted HR 0.68, 95% CI [0.33 to 1.4] p=0.31). The 3-year rates of the primary endpoint were similar for PCI with TRA vs. TFA (16.6% vs 14.7%, adjusted HR 1.19, 95% CI 0.77-1.82, p=0.43). There were no significant differences between TRA and TFA in the component rates of the primary endpoint or ischemia-driven revascularization (10.8% vs 13.2%, adjusted HR 1.05 95% CI [0.64 to 1.73] p=0.83).
In the EXCEL trial, PCI of LMCAD with TRA and TFA were associated with similar 3-year clinical outcomes.
OTHER: Vascular Access