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Transradial Versus Transfemoral Arterial Access During Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Five Year Retrospective Analysis From a Large Tertiary Care Cardiac Centre of North India

Sudarshan Kumar Vijay, Associate professor, Department of Cardiology, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh 226010, India. , Sudarshan Kumar Vijay1 , Bhuwan Chandra Tiwari2 , Naveen Jamwal3 , Ashish Jha4 , Mukul Misra5 , Dharmendra Kumar Srivastava6

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Journal of Cardiovascular Medicine and Surgery 4(2):p 150-158, April-June 2018. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4218.14

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Abstract

Background: Transfemoral arterial approach (TFA) is still the most common approach used in many countries for percutaneous coronary intervention(PCI). Transradial arterial access (TRA) is increasingly gaining acceptance globally for PCI. Acccess site for PCI are important considerations especially for high risk and acute coronary syndrome (ACS) patients in whom the negative implications of major bleeding are even greater.

Aims and objective: Our study comparedthetransradial and transfemoral artery approach for PCI in ACS patients in a north Indian population.

Material & Methods: A five year retrospective data (April 2013­ March 2018) of total patients of ACS including ST elevation myocardial infraction (STEMI) and Non ST elevation ACS (NSTEACS), who underwent PCI was retrieved from a registered and computerized database. The patients were divided into two groups depending upon transradial and transfemoral artery approach and compared for the various demographic and clinical features, risk factors profile, vascular access, procedural details and in hospital outcomes.

Results: 1284 patients of ACS underwent percutaneous coronary interventions at our center during this five year period. 79.9% were male and 21.1% were female. 420 patients (32.7%) underwent PCI through the transfemoral route and 864 (67.3%) patients underwent PCI through the transradial route. The mean fluoroscopy time was significantly more prolonged in the TRA group (14.83±9.24 mins) than TFA group (13.2±7.42 mins, p<0.001). Access site related major complications, major bleeding and total duration of hospital stay were significantly (p<0.001) more in the TFA group as compared to TRA group. There was no significant difference in the rate inhospital mortality (0.47% vs 0.46%, p=0.30) between two groups. The rate of TIA/ischemic stroke was similar in TFA and TRA groups (0.23% vs 0.34% respectively, p=0.07).

Conclusions: The transradial approach for PCI in ACS patients is safe and effective approach. The rates of major access site complications are more in transfemoral approach with lesser patient comfort than in transradial approach.


 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4218.14

Keywords

Transfemoral Approach (TFA); Transradial Approach (TRA); Acute Coronary Syndrome (ACS); Percutaneous Coronary Intervention (PCI)

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