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

Affiliations
  • 1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. sh1214.choi@samsung.com
  • 2Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Division of Cardiology, Wonju Christian Hospital, Wonju, Korea.
  • 5Division of Cardiology, Ajou Univeristy Hospital, Suwon, Korea.
  • 6Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.


Cited by  1 articles

Transradial Versus Transfemoral Access for Bifurcation Percutaneous Coronary Intervention Using Second-Generation Drug-Eluting Stent
Jung-Hee Lee, Young Jin Youn, Ho Sung Jeon, Jun-Won Lee, Sung Gyun Ahn, Junghan Yoon, Hyeon-Cheol Gwon, Young Bin Song, Ki Hong Choi, Hyo-Soo Kim, Woo Jung Chun, Seung-Ho Hur, Chang-Wook Nam, Yun-Kyeong Cho, Seung Hwan Han, Seung-Woon Rha, In-Ho Chae, Jin-Ok Jeong, Jung Ho Heo, Do-Sun Lim, Jong-Seon Park, Myeong-Ki Hong, Joon-Hyung Doh, Kwang Soo Cha, Doo-Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung-Hee Hwang, So-Yeon Choi, Myung Ho Jeong, Hyun-Jong Lee
J Korean Med Sci. 2024;39(10):e111.    doi: 10.3346/jkms.2024.39.e111.


Reference

1. Latib A, Colombo A. Bifurcation disease: what do we know, what should we do? JACC Cardiovasc Interv. 2008. 1:218–226.
2. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, Vassanelli C, Zardini P, Louvard Y, Hamon M. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004. 44:349–356.
3. Chase AJ, Fretz EB, Warburton WP, Klinke WP, Carere RG, Pi D, Berry B, Hilton JD. Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L Study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg). Heart. 2008. 94:1019–1025.
4. Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J. 2009. 157:132–140.
5. Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS, Peterson ED. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008. 1:379–386.
6. Hamon M, Rasmussen LH, Manoukian SV, Cequier A, Lincoff MA, Rupprecht HJ, Gersh BJ, Mann T, Bertrand ME, Mehran R, et al. Choice of arterial access site and outcomes in patients with acute coronary syndromes managed with an early invasive strategy: the ACUITY Trial. EuroIntervention. 2009. 5:115–120.
7. Song YB, Hahn JY, Choi SH, Choi JH, Lee SH, Jeong MH, Kim HS, Seong IW, Yang JY, Rha SW, et al. Sirolimus-versus paclitaxel-eluting stents for the treatment of coronary bifurcations results: from the COBIS (Coronary Bifurcation Stenting) Registry. J Am Coll Cardiol. 2010. 55:1743–1750.
8. Seung KB, Koh YS, Koo BK, Lim DS, Ahn CM, Park SJ, Jeong MH, Hong YJ, Chung WS. Korean Society of Inteventional Cardiology. Part 2. practical guidelines for coronary intervention. The manual of interventional cardiology. 2011. 2nd ed. Seoul: ML Communications Co. Ltd;23–66.
9. Medina A, Suárez de Lezo L, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006. 59:183.
10. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, et al. Universal definition of myocardial infarction. Circulation. 2007. 116:2634–2653.
11. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007. 115:2344–2351.
12. Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D, Feit F, Gore JM, Hillis LD, Lambrew CT, et al. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. Ann Intern Med. 1991. 115:256–265.
13. Achenbach S, Ropers D, Kallert L, Turan N, Krähner R, Wolf T, Garlichs C, Flachskampf F, Daniel WG, Ludwig J. Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age. Catheter Cardiovasc Interv. 2008. 72:629–635.
14. Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv. 2009. 2:1047–1054.
15. Yang YJ, Kandzari DE, Gao Z, Xu B, Chen JL, Qiao SB, Li JJ, Qin XW, Yao M, Wu YJ, et al. Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes. JACC Cardiovasc Interv. 2010. 3:1035–1042.
16. Kim JS, Hong MK, Ko YG, Choi D, Yoon JH, Choi SH, Hahn JY, Gwon HC, Jeong MH, Kim HS, et al. Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: data from a Korean multicenter bifurcation registry. Am Heart J. 2011. 161:180–187.
17. Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, Yun SC, Lee CW, Hong MK, Lee JH, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009. 2:167–177.
18. Sciahbasi A, Pristipino C, Ambrosio G, Sperduti I, Scabbia EV, Greco C, Ricci R, Ferraiolo G, Di Clemente D, Giombolini C, et al. Arterial access-site-related outcomes of patients undergoing invasive coronary procedures for acute coronary syndromes (from the ComPaRison of Early Invasive and Conservative Treatment in Patients With Non-ST-ElevatiOn Acute Coronary Syndromes [PRESTO-ACS] Vascular Substudy). Am J Cardiol. 2009. 103:796–800.
19. Doyle BJ, Rihal CS, Gastineau DA, Holmes DR Jr. Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol. 2009. 53:2019–2027.
20. Rao SV, Eikelboom JA, Granger CB, Harrington RA, Califf RM, Bassand JP. Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007. 28:1193–1204.
21. Gwon HC, Hahn JY, Koo BK, Song YB, Choi SH, Choi JH, Lee SH, Jeong MH, Kim HS, Seong IW, et al. Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS Registry. Heart. 2012. 98:225–231.
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