Access Site and Outcomes for Unprotected Left Main Stem Percutaneous Coronary Intervention: An Analysis of the British Cardiovascular Intervention Society Database.
Kinnaird T., Anderson R., Gallagher S., Sirker A., Ludman P., de Belder M., Copt S., Oldroyd K., Curzen N., Banning A., Mamas M.
OBJECTIVES: Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, temporal trends, predictors, and outcomes of radial access (RA) versus femoral access (FA) for unprotected left main stem percutaneous coronary intervention (LMS-PCI) were studied. BACKGROUND: Data on arterial access site for LMS-PCI are poorly defined. METHODS: Data were analyzed from 19,482 LMS-PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes. RESULTS: The frequency of FA use fell from 77.7% in 2007 to 31.7% in 2014 (p < 0.001 for trend). In the most contemporary study years (2012 to 2014), the strongest associates of FA use for unprotected LMS-PCI were renal disease, PCI for restenosis, chronic total occlusion intervention, and female sex. Use of intravascular imaging and chronic anticoagulation were associated with a higher likelihood of RA use. Complexity of the PCI procedure in the RA cohort increased significantly during the study period. Length of stay was shorter (2.6 ± 9.2 vs. 3.6 ± 9.0; p < 0.001) and same day discharge greater (43.0% vs. 26.6%; p < 0.001) with RA use. After propensity matching, RA use was associated with significant reductions in in-hospital events including access site arterial complications, major bleeding, and major adverse cardiovascular events. Conversion to RA for LMS-PCI was associated with similar reductions in the whole patient cohort. RA use was not associated with lower 12-month mortality. CONCLUSIONS: In contemporary practice, the radial artery is the predominant access site for unprotected LMS-PCI, and its use is associated with shorter length of stay, less vascular complications, and less major bleeding than femoral access.