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Original article
DOI: 10.1016/j.rec.2020.09.019
Available online 19 November 2020
Comparison of safety and effectiveness between the right and left radial artery approach in percutaneous coronary intervention
Comparación de seguridad y efectividad entre los accesos radiales derecho e izquierdo en la intervención coronaria percutánea
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Tomasz Tokareka, Artur Dziewierzb, Krzysztof Plensc, Tomasz Rakowskib, Rafał Januszekd, Michał Zabojszcze, Agnieszka Janion-Sadowskae, Dariusz Dudeka,b, Zbigniew Siudake,
Corresponding author
zbigniew.siudak@gmail.com

Corresponding author: Faculty of Medicine and Health Science, Jan Kochanowski University, IX Wieków Kielc 19A St, 25-317, Kielce, Poland.
a Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
b 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
c Krakow Cardiovascular Research Institute LTD, Krakow, Poland
d Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
e Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
Received 31 May 2020. Accepted 29 September 2020
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Tables (5)
Table 1. Baseline characteristics before and after propensity score matching
Table 2. Percutaneous coronary intervention details after propensity score matching in stable angina
Table 3. Percutaneous coronary intervention details after propensity score matching in acute coronary syndrome
Table 4. Percutaneous coronary intervention details after propensity score matching for all included patients
Table 5. Independent predictors of left radial artery use for percutaneous coronary intervention
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Abstract
Introduction and objectives

There is a paucity of data comparing the left radial approach (LRA) and right radial approach (RRA) for percutaneous coronary intervention (PCI) in all-comers populations and performed by operators with different experience levels. Thus, we sought to compare the safety and clinical outcomes of the RRA and LRA during PCI in “real-world” patients with either stable angina or acute coronary syndrome (ACS).

Methods

To overcome the possible impact of the nonrandomized design, a propensity score was calculated to compare the 2 radial approaches. The study group comprised 18 716 matched pairs with stable angina and 46 241 with ACS treated with PCI and stent implantation between 2014 and 2017 in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).

Results

The rates of death and periprocedural complications were similar for the RRA and LRA in stable angina patients. A higher radiation dose was observed with PCI via the LRA in both clinical presentations (stable angina: 1067.0±947.1 mGy vs 1007.4±983.5 mGy, P=.001; ACS: 1212.7±1005.5 mGy vs 1053.5±1029.7 mGy, P=.001). More contrast was used in LRA procedures but only in ACS patients (174.2±75.4mL vs 167.2±72.1mL, P=.001). Furthermore, periprocedural complications such as coronary artery dissection (0.16% vs 0.09%, P=.008), no-reflow phenomenon (0.65% vs 0.49%, P=.005), and puncture site bleeding (0.09% vs 0.05%, P=.04) were more frequently observed with the LRA in ACS patients. There was no difference in mortality between the 2 groups (P=.90).

Conclusions

Our finding of poorer outcomes with the LRA may be related to lower operator experience with this approach. While both the LRA and RRA are safe in the setting of stable angina, the LRA was associated with a higher rate of periprocedural complications during PCI in ACS patients.

Keywords:
Registry
Radial
Acute coronary syndrome
Stable angina
Abbreviations:
ACS
LRA
PCI
RRA
SA
Resumen
Introducción y objetivos

Existen pocos estudios que comparen los accesos por la radial izquierda (ARI) y por la radial derecha en intervenciones coronarias percutáneas (ICP) en población general y practicadas por cirujanos con diferentes grados de experiencia en intervencionismo. El objetivo de nuestro estudio es comparar la seguridad y el beneficio clínico con cada acceso en pacientes no seleccionados con síndrome coronario agudo (SCA) y angina estable (AE).

Métodos

Para evitar los posibles sesgos de un estudio no aleatorizado, se usó la puntuación de propensión para comparar ambos accesos radiales. Se recogieron datos de 18.716 pares con AE y 46.241 con SCA sometidos a ICP con implante de stent entre 2014 y 2017, en 151 centros terciarios con cardiología intervencionista en Polonia (registro nacional de Polonia [ORPKI]).

Resultados

No se encontraron diferencias en cuanto a mortalidad y complicaciones periprocedimiento en AE. El ARI se asoció con mayores dosis de radiación independientemente de la presentación clínica (AE, 1.067,0±947,10 frente a 1.007,4±983,5 mGy; p=0,001; SCA, 1.212,7±1.005,5 frente a 1.053,5±1.029,7 mGy; p=0,001). En los pacientes con SCA, el ARI se asoció con mayor cantidad de contraste (174,2±75,4 frente a 167,2±72,1ml; p=0,001). Además, en los pacientes con SCA y ARI, las complicaciones periprocedimiento como disección coronaria (el 0,16 frente al 0,09%; p=0,008), fenómeno de no reflow (el 0,65 frente al 0,49%; p=0,005) y hemorragia en el sitio de punción (el 0,09 frente al 0,05%; p=0,04) resultaron más frecuentes. No hubo diferencias en la mortalidad entre los 2 grupos (p=0,90).

Conclusiones

Los resultados que se presentan podrían estar en relación con una menor experiencia en el ARI. Ambos accesos son seguros en los pacientes con AE, pero el ARI se asoció con una mayor frecuencia de complicaciones periprocedimiento de ICP en el SCA.

Palabras clave:
Registro
Radial
Síndrome coronario agudo
Angina estable

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