Impact of Transradial Approach in Patients with High Risk Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention and Abciximab on In-Hospital Clinical Outcomes and Bleeding Complications

BACKGROUNDS: There are increasing numbers of studies suggesting that transradial coronary intervention (TRI) is associated with better clinical outcomes by reducing bleeding and vascular complications when compared with transfemoral coronary intervention (TFI). The benefit of TRI might be enlarged in patients at high risk of bleeding. The purpose of this study was to evaluate clinical outcomes comparing transradial and transfemoral approaches in the treatment of high risk acute coronary syndrome undergoing percutaneous coronary intervention (PCI) with the GP IIb/IIIa inhibitor from Clotinab application in high risk Acute Coronary Syndrome undergoing PCI Registry (CAP Registry) METHODS: The CAP registry is a retrospective, multicenter, observational study. We analyzed 1272 patients who underwent PCI from April 2009 to December 2012. Because the access site was not randomly assigned, we used propensity score matching to minimize bias. Total 596 patients (298 in each group) remained after propensity score matching. The primary end point was in-hospital major adverse cardiac event (MACE) including all-cause death, non-fatal myocardial infarction, repeat revascularization and stent thrombosis. The secondary endpoint was major bleeding and any bleeding events of bleeding including access site hematoma, intracranial hemorrhage and other bleeding complications. RESULTS: After propensity score matching, there were no differences in baseline characteristics between two groups except history of atherosclerosis (7.7% vs. 13.4%, p=0.024). The primary endpoint occurred in 7 (2.4%) of 298 patients in the radial access group compared with 17 (5.7%) of 298 patients in the femoral access group (p=0.037). Non-fatal myocardial infarction (0.7% vs. 3.4%, p=0.019) were also less frequent in transradial approach group. Any bleeding events occurred in 15 (5.0%) of 298 patients in the radial access group compared with 21 (7.0%) of 298 patients in the femoral access group (p=0.302). Major bleeding occurred in 2 (0.7%) of 298 patients in the radial access group compared with 7 (2.3%) of 298 patients in the femoral access group (p=0.093). In multivariate analysis, independent predictors of in-hospital MACE included chronic renal failure, low ejection fraction, major bleeding and transfemoral approach (odds ratio=2.795 ; 95% CI, 1.085 to 7.198; P=0.033). CONCLUSIONS: Transradial approach in patient with high risk acute coronary syndrome treated with abciximab is associated with better in-hospital clinical outcomes and lower bleeding tendency.

Author dc:creator

• 최, 용우

Contributors dc:contributor

• 탁, 승제
• 대학원 의학과
• 106365

• percutaneous coronary intervention
• abciximab
• acute coronary syndrome
• myocardial infarction
• 경피적 관상동맥 중재시술
• 급성 관동맥 증후군
• 심근경색

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016543
000000016543

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10904