Comparison Between Radial and Femoral Approach for Percutaneous Coronary Intervention in Patients Aged 80 Years or Older

Outcomes of Transradial Versus Transfemoral Access of Percutaneous Coronary Intervention in STEMI: Systematic Review and Updated Meta-analysis

BACKGROUND

Transradial (TR) percutaneous coronary intervention (PCI) is a preferable PCI route. The complication difference between TR and TF approaches is controversial.

METHODS

PubMed, Embase, and the Cochrane databases were queried for PCI outcomes of TR TF in STEMI for major cardiac and cerebrovascular events (MACCE), major bleeding, and mortality. The odds ratio (OR) was calculated using the random-effect model.

RESULTS

We included 56 studies comprising of 68,733 patients (TR, n = 26,179; TF, n = 42,537). TR-PCI was associated with statistically significant lower odds of MACCE (OR = 0.66, 95% CI: 0.49-0.88, p-value = 0.005), major bleeding (OR = 0.47, 95% CI 0.32-0.68, p-value<0.001), mortality (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001) at in hospital follow-up. TR-PCI was associated with statistically significant lower MACCE (OR = 0.59, 95% CI 0.43-0.80, p-value<0.001), major bleeding (OR = 0.58, 95% CI 0.49-0.68, p-value<0.001), and mortality (OR = 0.61, 95% CI 0.44-0.86, p-value = 0.005) at 30-day follow-up. The same difference was seen at 1-year.

CONCLUSION

TR-PCI was associated with lower odds of MACCE, major bleeding, and mortality during short- and long-term follow-up.

Meta-analysis comparing radial versus femoral approach in patients 75 years and older undergoing percutaneous coronary procedures

Introduction

Elderly patients (≥75 years) undergoing coronary angioplasty are increasing. Meta-analyses have shown the benefits of radial access which might reduce hospital stay by decreasing access site complications with associated secondary benefits, however, the population over the age of 75 years were not a large part of the cohort and may behave differently due to increased atherosclerotic burden and age-related vascular changes. In addition, complications unique to this age group such as delirium and deconditioning might occur which could have a bearing on the outcome.

Methods

We searched Pubmed, SCOPUS, Medline, Dynamed, Cochrane. The search terms used were femoral and radial, femoral versus radial, radial or femoral access site, radial or femoral comparison. There were no restrictions.

Results

There was a significant decrease (85%)in the incidence of access site complications in the radial group. The time to achieve ambulation was lower by 14.25 h (8.86–19.56 h). However, the incidence of crossover (in effect failure to perform catheterization by radial access) from radial to femoral was significantly higher. Radial access was associated with longer procedural times (2.75 min) and increased contrast dose however, there was no statistical difference in the fluoroscopy time between the two.

Conclusions

Radial access has similar benefits in elderly patients as those under the age of 75 and may be beneficial in patients at risk of delirium or deconditioning. However, crossover rates, contrast dose and procedure time were higher. It is conceivable that as experience is gained, these rates will diminish.

Management and decision-making process leading to coronary angiography and revascularization in octogenarians with coronary artery disease: Insights from a large single-center registry

AIMS

Cardiovascular diseases remain the most common cause of death in older adults. Guidelines state that advanced age alone should not limit the use of invasive therapy. However, coronary angiograms and subsequent revascularization are often not carried out in octogenarians. The benefit/risk balance of an invasive strategy and the decision-making process are not clearly defined. The aim of the present study was to assess the decision-making process, and the in-hospital and long-term mortality based on the clinical presentation, the diagnostic approach (coronary angiogram or conservative) and the therapeutic management (revascularization or not).

METHODS

The present study was a single-center retrospective analysis.

RESULTS

A total of 522 patients aged ≥80 years, with a diagnosis of coronary disease were included from 2003 to 2009. The mean age was 82 ± 2.6 years. A total of 195 of 522 (37%) presented with a ST segment elevation myocardial infarction (STEMI). A coronary angiogram was carried out in 316 patients (60.5%) and 71% were treated by percutaneous coronary revascularization. A total of 39.5% were considered ineligible for a coronary angiogram due to cardiological reasons or comorbidities. Excluding cardiogenic shock, overall in-hospital mortality was 4.9%. Clinical presentation strongly influenced both in-hospital and 6-month mortality rates (cardiogenic shock 20% and 28.7%, stable angina 1% and 4.1%, respectively, P < 0.001). Long-term mortality was reduced in the coronary angiography arm compared with the conservative group (14.3% vs 20.9%, P = 0.04) whether or not revascularization was carried out.

CONCLUSION

In the present study, in octogenarians, long-term mortality was lower in the group of patients who underwent a coronary angiogram, regardless of revascularization. The selection process for coronary angiography and angioplasty was mostly influenced by the existence of age-associated comorbidities. Risk prediction models are required to reduce age-dependent biases.