In-hospital outcomes associated with radial versus femoral access and intervention in acute coronary syndromes: results from the ISACS-TC registry

Background: Recent randomized studies have suggested that radial access (TRA) for percutaneous coronary intervention (PCI) reduces local vascular complications and bleeding compared with femoral access in patients presenting with acute coronary syndrome (ACS). Purpose: We sought to determine if TRA is associated with better in-hospital outcomes in a large, real world population of patients with ACS. Methods: Data were derived from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; NCT01218776) registry, a prospective survey of patients presenting with ACS over a 5-year period (January 2010 to January 2015). Outcomes measures were in-hospital mortality and the combined endpoint of periprocedural major complications, which included myocardial infarction type 4, abrupt closure (type 4b), loss of side branches, distal embolization, and no-reflow phenomenon. Results: Of 6006 ACS patients undergoing PCI, 3656 (60.9%) underwent TRA, which was more likely to be employed among male sex and patients with lower risk characteristics: patients were younger with a lower burden of risk factors. Patients undergoing TRA had significantly lower periprocedural complications (3.4% versus 10.3%, p<0.001). After adjustment for demographic and clinical characteristics, the risk of periprocedural complications was reduced by 40% (OR: 0.60; 95% CI: 0.45–0.81). The rate of in-hospital death, was 3.1% in the TRA group compared with 4.0% in the femoral group (Unadjusted OR: 0.76, 95% CI: 0.57–1.00). This borderline difference was no longer observed after multivariate adjustment (OR: 1.06, 95% CI: 0.75–1.48). Conclusions: No significant differences in in-hospital mortality were seen between TRA and femoral approach. However, the lower rate of periprocedural complications may be a reason to use TRA