Radial Versus Femoral Access for Percutaneous Coronary Intervention in Patients With Chronic Coronary Disease

作者：Garry Hamilton, Diem Dinh, J. Yeoh, Angela Brennan, M. Yudi, Christopher M. Reid, Dion Stub, William Chan, Melanie Freeman, Andrew E. Ajani, Omar Farouque, David Clark · 发表于：The American Journal of Cardiology · 年份：2025 · DOI：10.1016/j.amjcard.2025.08.038 · 被引用次数：7 · 研究领域：Vascular Procedures and Complications、Coronary Interventions and Diagnostics、Central Venous Catheters and Hemodialysis

Guidelines recommend trans-radial access (TRA) for all percutaneous coronary intervention (PCI). However, no randomized trials have shown a lower mortality when compared to the femoral approach in chronic coronary disease and femoral access may be preferred in certain situations. Consecutive eligible patients in a multi-center registry between 2014 - 2020 were included. Clinical characteristics and outcomes were compared between those who underwent radial versus femoral access. The main outcomes were major bleeding and 5-year mortality. Of the 6,158 patients included, 3,784 (61.4%) had TRA and 2,374 (38.6%) femoral access. TRA predominated from 2016. The femoral group had higher rates of diabetes mellitus, renal dysfunction and prior stroke. Trans-femoral procedures were more complex with higher rates of ACC/AHA type B2/C lesions, chronic total occlusions, left main PCI, use of adjuvants including rotational atherectomy, and lower procedural success rates. Major bleeding was higher in the femoral group (radial 0.4% vs femoral 0.8%, p = 0.039), however femoral access did not predict major bleeding (OR 1.68, 95% CI 0.74 to 3.82). There was no difference in 5-year mortality (radial 20.3% vs femoral 21%, p = 0.65). In conclusion, TRA predominates in contemporary PCI for CCD. The femoral group had higher procedural complexity and risk with a higher incidence of peri‑procedural major bleeding. Nonetheless, femoral access did not predict major bleeding and there was no difference in...