J Korean Med Sci.  2013 Mar;28(3):388-395. 10.3346/jkms.2013.28.3.388.

Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry

• Chung S
• Her SH
• Song PS
• Song YB
• Hahn JY
• Choi JH
• Lee SH
• Jang Y
• Yoon JH
• Tahk SJ
• Park SJ
• Choi SH
• Seung KB
• Gwon HC

• KMID: 1786936
• DOI: http://doi.org/10.3346/jkms.2013.28.3.388

Abstract

Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).

Keyword

Bifurcation; Percutaneous Coronary Intervention; Trans-Radial Approach

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/adverse effects/*methods
Coronary Angiography
Coronary Stenosis/mortality/radiography/*therapy
Coronary Vessels/radiography/surgery
*Drug-Eluting Stents
Female
Follow-Up Studies
Hemorrhage/etiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction/etiology
Myocardial Revascularization
Proportional Hazards Models
Registries

Figure

• 

  Fig. 1 Kaplan-Meier curves for major adverse cardiac events (MACE) according to the vascular approach. (A) Kaplan-Meier curves for MACE in the overall population treated by trans-radial approach (TR group) versus trans-femoral approach (TF group). (B) Kaplan-Meier curves for MACE in propensity-matched patients.

• 

  Fig. 2 Subgroup analyses for major adverse cardiac events in 10 subgroups of the two vascular approach groups. CI, confidence interval; HR, hazard ratio; TF, trans-femoral; TR, trans-radial.

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