Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox

Detalhes bibliográficos
Autor(a) principal: Lacerda,Yasmin Falcon
Data de Publicação: 2018
Outros Autores: Sá,Nicole Cruz de, Suerdieck,Jessica Gonzalez, Fonseca,Letícia, Lopes,Fernanda, Sodré,Gabriella Sant'Ana, Viana,Mateus dos Santos, Rabelo,Marcia Maria Noya, Correia,Luis Claudio Lemos
Tipo de documento: Artigo
Idioma: eng
Título da fonte: International Journal of Cardiovascular Sciences (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000600562
Resumo: Abstract Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05. Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access - age (OR = 0.98; 95%CI = 0.96 - 0.99), creatinine (OR = 0.54; 95%CI = 0.3 - 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 - 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 - 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)
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spelling Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment ParadoxAngioplastyCatheterismCoronary Artery DiseasePercutaneous Coronary InterventionRadial ArteryFemoral ArteryStentsAbstract Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05. Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access - age (OR = 0.98; 95%CI = 0.96 - 0.99), creatinine (OR = 0.54; 95%CI = 0.3 - 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 - 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 - 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)Sociedade Brasileira de Cardiologia2018-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000600562International Journal of Cardiovascular Sciences v.31 n.6 2018reponame:International Journal of Cardiovascular Sciences (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.5935/2359-4802.20180066info:eu-repo/semantics/openAccessLacerda,Yasmin FalconSá,Nicole Cruz deSuerdieck,Jessica GonzalezFonseca,LetíciaLopes,FernandaSodré,Gabriella Sant'AnaViana,Mateus dos SantosRabelo,Marcia Maria NoyaCorreia,Luis Claudio Lemoseng2018-11-13T00:00:00Zoai:scielo:S2359-56472018000600562Revistahttp://publicacoes.cardiol.br/portal/ijcshttps://old.scielo.br/oai/scielo-oai.phptailanerodrigues@cardiol.br||revistaijcs@cardiol.br2359-56472359-4802opendoar:2018-11-13T00:00International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC)false
dc.title.none.fl_str_mv Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
title Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
spellingShingle Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
Lacerda,Yasmin Falcon
Angioplasty
Catheterism
Coronary Artery Disease
Percutaneous Coronary Intervention
Radial Artery
Femoral Artery
Stents
title_short Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
title_full Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
title_fullStr Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
title_full_unstemmed Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
title_sort Option for the Radial versus Femoral Access in Coronary Intervention in Acute Coronary Syndromes: A Risk-Treatment Paradox
author Lacerda,Yasmin Falcon
author_facet Lacerda,Yasmin Falcon
Sá,Nicole Cruz de
Suerdieck,Jessica Gonzalez
Fonseca,Letícia
Lopes,Fernanda
Sodré,Gabriella Sant'Ana
Viana,Mateus dos Santos
Rabelo,Marcia Maria Noya
Correia,Luis Claudio Lemos
author_role author
author2 Sá,Nicole Cruz de
Suerdieck,Jessica Gonzalez
Fonseca,Letícia
Lopes,Fernanda
Sodré,Gabriella Sant'Ana
Viana,Mateus dos Santos
Rabelo,Marcia Maria Noya
Correia,Luis Claudio Lemos
author2_role author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Lacerda,Yasmin Falcon
Sá,Nicole Cruz de
Suerdieck,Jessica Gonzalez
Fonseca,Letícia
Lopes,Fernanda
Sodré,Gabriella Sant'Ana
Viana,Mateus dos Santos
Rabelo,Marcia Maria Noya
Correia,Luis Claudio Lemos
dc.subject.por.fl_str_mv Angioplasty
Catheterism
Coronary Artery Disease
Percutaneous Coronary Intervention
Radial Artery
Femoral Artery
Stents
topic Angioplasty
Catheterism
Coronary Artery Disease
Percutaneous Coronary Intervention
Radial Artery
Femoral Artery
Stents
description Abstract Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student’s t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05. Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access - age (OR = 0.98; 95%CI = 0.96 - 0.99), creatinine (OR = 0.54; 95%CI = 0.3 - 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 - 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 - 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients’ bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)
publishDate 2018
dc.date.none.fl_str_mv 2018-12-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000600562
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000600562
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.5935/2359-4802.20180066
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Sociedade Brasileira de Cardiologia
publisher.none.fl_str_mv Sociedade Brasileira de Cardiologia
dc.source.none.fl_str_mv International Journal of Cardiovascular Sciences v.31 n.6 2018
reponame:International Journal of Cardiovascular Sciences (Online)
instname:Sociedade Brasileira de Cardiologia (SBC)
instacron:SBC
instname_str Sociedade Brasileira de Cardiologia (SBC)
instacron_str SBC
institution SBC
reponame_str International Journal of Cardiovascular Sciences (Online)
collection International Journal of Cardiovascular Sciences (Online)
repository.name.fl_str_mv International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC)
repository.mail.fl_str_mv tailanerodrigues@cardiol.br||revistaijcs@cardiol.br
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