Transradial approach for percutaneous coronary interventions in patients older than 80 years with acute coronary syndrome

Abstract

Aims: transradial approach (TRA) is associated with lower complications rate in vascular access site and improved clinical outcomes compared with transfemoral approach (TFA). However at present data examining transradial access in the very elderly is limited. Therefore this study aims to compare in-hospital 1-year outcomes between TRA and TFA in this group.
Materials and methods: we have done a prospective cohort analysis of long-term outcomes. Our group included patients had under gone percutaneous coronary interventions (PCI) from January 2014 to September 2016. There were 285 patients. We registered clinical and demographic characteristics of patients, procedural complications and all cases of major adverse cardiovascular events (MACE) during hospitalization and follow-up 1 year. These patients were on average 85 year-old, predominantly female (64%) and having the following risk factors: hypertension (81%), diabetes mellitus (32%), chronic renal failure (18%). More than half of the patients (71%) having with ST-Elevation Myocardial Infarction. We divided our group into two, according to the angiographic approach: transradial (n. 89) (TR) or transfemoral (n. 196) (TF).
Results: patients in both groups were not statistically different from baseline characteristics. MACE illness rates during hospitalization (5% vs 12%, p<0,05) and at 1-year obse. Complication instances of both hematoma (2% vs 9%, p<0,05) and major bleeding (1% vs 6%, p<0,05) were higher in the TFA group.
Conclusion: transradial approach significantly reduces vascular complications reducing in-hospital 1-year major adverse cardio-vascular events. Therefore transradial approach should be considered as the preferred vascular access method with the elderly.