Outcomes Following Percutaneous Coronary Intervention Before, During, and After Transition to a Default Transradial Approach at a Veterans Affairs Medical Center

Abstract

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.