Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
30-day outcomes of transradial versus transfemoral access in patients treated with percutaneous coronary intervention – results from the German Austrian ABSORB registry (GABI-R)
B. Wein1, M. Zaczkiewicz2, M. Graf2, O. Zimmermann2, J. Kastner3, J. Wöhrle4, T. Riemer5, C. W. Hamm6, S. Achenbach7, G. Richardt8, T. Gori9, H. Nef6, J. Mehilli10, J. Torzewski11, für die Studiengruppe: GABI-R
1Kardiologie Herz- Gefäßzentrum, Klinikum Kempten Oberallgäu gGmH, Kempten; 2Herz- und Gefäßzentrum Oberallgäu-Kempten, Klinikverbund Kempten- Oberallgäu gGmbH, Immenstadt; 3Innere Medizin II, Klinische Abteilung für Kardiologie, Allgemeines Krankenhaus der Stadt Wien - Medizinischer Universitätscampus, Wien, AT; 4Klinik für Kardiologie, Klinikum Friedrichshafen GmbH, Friedrichshafen; 5IHF GmbH, Ludwigshafen am Rhein; 6Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 7Med. Klinik 2 - Kardiologie, Angiologie, Universitätsklinikum Erlangen, Erlangen; 8Herz- Gefäßzentrum, Segeberger Kliniken GmbH, Bad Segeberg; 9Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 10Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Landshut; 11Kardiologie, Klinikum Kempten Oberallgäu gGmH, Kempten;

1         Background:

Radial (RA) instead of femoral access (FA) for coronary interventions has become a Class-IA guideline recommendation, but when the decision of the access site was to the discretion of the operator, differences in adverse event rates mitigate.

2         Methods:

We compared the RA and FA 30 day outcome in all patients recruited for the observational German Austrian ABSORB Registry (GABI-R) in regard to all-cause mortality, stroke, myocardial infarction (MI), and TIMI major bleedings (TMB). All patients were treated with a bioresorbable vascular scaffold, access site was to the discretion of the operator.

3         Results

In total 3137 patients were included by 92 centres and received percutaneous coronary interventions (PCI) for acute MI in 51.5% and non-acute settings in 48.5%. RA was performed in 47.8% and had a higher median radiation exposure (3896 vs. 3082 cGycm², p<0.001), but no difference in the amount of contrast used. There was no difference in regard to all-cause mortality (0.53% vs. 0.49%, p=0.86), the combination of death, MI and stroke (1.87% vs. 1.83%, p=0.94), but a trend towards more TMB (0.47% vs. 1.04%, p=0.07) with FA. These outcomes were found in the subgroups of patients with ST-, non-ST-elevation-MI and non-acute PCI as well.

4         Conclusion

In this contemporary GABI-R cohort in which access site was to the discretion of the operator, both access routes appear to be safe for the patient, but RA was associated with a higher radiation exposure. We conclude, that performing both access routes in a younger and thereby presumably lower risk population, is safe and no malpractice, allowing operators to safely train both access routes in such patients.

 
https://dgk.org/kongress_programme/jt2021/aP540.html