Nav: Home

Radial access used less than femoral approach for emergency angioplasty

December 21, 2015

WASHINGTON (Dec. 21, 2015) -Although using the radial artery as the access point for angioplasty has been linked to reduced bleeding compared to use of the femoral artery, only a small number of high-risk heart attack patients who undergo rescue angioplasty--emergency procedures following failed therapy with clot-busting drugs--are treated by radial access, according to a study published today in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The radial artery is located in the forearm, and the femoral artery is in the thigh. Although other studies have shown a decreased risk of bleeding with radial access, this study represents the first time bleeding outcomes were assessed for patients undergoing rescue angioplasty.

Using data from the American College of Cardiology's National Cardiovascular Data Registry CathPCI Registry, researchers examined records of 9,494 heart attack patients who underwent rescue angioplasty after failed therapy with clot-busting drugs. Also called thrombolytic therapy, these drugs are administered directly into the veins to break up blood clots quickly.

The procedures were conducted at 603 facilities between 2009 and 2013. Among the patients who received rescue angioplasty, 14 percent had their procedure performed via radial access, while 85 percent were treated with femoral access.

After adjusting for many factors, including gender, race, body mass index, high blood pressure, high cholesterol, family history of coronary heart disease, and a history of congestive heart failure, radial access was associated with significantly less bleeding. But no differences were found in mortality.

The study also found that patients chosen for radial access treatment were actually at a lower predicted risk for bleeding than those chosen for the femoral access approach, pointing to a "risk-treatment paradox." The reason for this may be due to a lack of operator comfort with the radial approach or lack of awareness of its benefits.

To determine if other factors were influencing these results, researchers used gastrointestinal bleeding, which shouldn't have differed between the groups, as a negative control. They found that patients in the radial access group had fewer gastrointestinal bleeding incidents, suggesting that unmeasured confounders, such as patient characteristics used in deciding access approach, may have influenced adjusted outcomes.

"In a large, 'real-world' registry, transradial access was used in a little more than 14 percent of patients undergoing rescue angioplasty between 2009 and 2013, with high procedural success," said Jay Giri, M.D., the study's senior author and an assistant professor in the cardiovascular medicine division at the University of Pennsylvania. Due to the lower incidence of gastrointestinal bleeding in the radial access group, Giri pointed out that the findings "also demonstrated the likely presence of treatment-selection bias regarding access site choice that cannot be easily adjusted in observational datasets. However, given the lack of research regarding bleeding avoidance in rescue angioplasty, the present study is likely to represent the best available data in this area for the foreseeable future."

"This study makes it clear that radial access is used much less than femoral. The reason seems to be that operators comfortable with femoral access are reluctant to change. The best results from radial approach are among those operators who do the majority of their cases this way. Adopting a less familiar approach safely is the challenge for many who have established good results with femoral approaches. As recently trained operators take on more of the workload this is likely to change," said Spencer B. King III, M.D., MACC, editor-in-chief of JACC: Cardiovascular Interventions.

In an accompanying editorial, Ehtisham Mahmud, M.D., FACC, director of the Sulpizio Cardiovascular Center at the University of California - San Diego Health System in La Jolla, California, and his colleague, Mitul Patel, M.D., FACC, assistant professor of medicine at the same facility, said that because those who underwent transfemoral rescue angioplasty "were in fact at high risk of bleeding, this study indicates another failure to adequately utilize this [transradial access] very effective bleeding avoidance strategy in the highest risk patients."

They also pointed out the "surprising observation" of the relatively low mortality for rescue angioplasty patients. They attributed this to improved practice or "perhaps the relatively short period between drug therapy and rescue angioplasty." Alternatively, they suggested that excluding critically ill patients from the study may have resulted in the low mortality rate.

Mahmud and Patel said it was "puzzling" that radial access for rescue angioplasty is underutilized, noting that "the underlying reasons cannot be ascertained from the current analysis. A better understanding of the limited adoption of radial access may lead to the implementation of strategies to increase its utilization in addition to other bleeding avoidance strategies for patients at the highest risk of bleeding after angioplasty," they said.
-end-
The American College of Cardiology is a 49,000-member medical society that is the professional home for the entire cardiovascular team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research, and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit http://www.acc.org.

American College of Cardiology

Related Angioplasty Articles:

Study finds significant variability in doctors' angioplasty death rates
Some doctors have higher or lower than expected death rates from coronary angioplasty procedures, also known as percutaneous coronary intervention (PCI); however, doctors should not be judged solely on the rate of patients who die from the procedure.
Beta-blockers following angioplasty show little benefit for some older patients
Following coronary angioplasty, beta-blockers did not significantly improve mortality rates or reduce the number of future cardiovascular incidents for older patients with stable angina but no history of heart attack or heart failure, according to a study published today in the JACC: Cardiovascular Interventions.
Sleep disorders may predict heart events after angioplasty
People who have had procedures to open blocked heart arteries after acute coronary syndrome (ACS) may have a higher risk of death, heart failure, heart attack and stroke if they have sleep disorders, such as sleep apnea, compared to those who don't.
Reasons for hospital-level variations in bleeding post-angioplasty are unclear
The use of bleeding avoidance strategies has only a modest effect on the variation in bleeding rates post-angioplasty among hospitals performing this procedure, leaving about 70 percent of the causes for this variation unexplained, according to a study published today in JACC: Cardiovascular Interventions.
US prediction models for kidney injury following angioplasty hold up in Japan
Models developed by the American College of Cardiology NCDR CathPCI Registry to predict the likelihood of angioplasty patients developing acute kidney injury and acute kidney injury requiring dialysis have proven to be effective among patients in Japan.
IV beta blockers before angioplasty are safe, but offer no clinical benefit
Giving intravenous beta blockers before performing a coronary angioplasty in patients who had experienced the deadliest form of heart attack -- ST-segment elevation myocardial infarction (STEMI) -- was safe but did not reduce heart attack severity or improve blood flow from the heart's main pumping chamber, according to research presented at the American College of Cardiology's 65th Annual Scientific Session.
Life-threatening bowel ischemia can often be treated by balloon angioplasty
Acute mesenteric ischemia (AMI) can be successfully treated with endovascular therapy such as balloon angioplasty, according to research from the University of Eastern Finland.
Radial access used less than femoral approach for emergency angioplasty
Although using the radial artery as the access point for angioplasty has been linked to reduced bleeding compared to use of the femoral artery, only a small number of high-risk heart attack patients who undergo rescue angioplasty -- emergency procedures following failed therapy with clot-busting drugs -- are treated by radial access, according to a study published today in the Journal of the American College of Cardiology: Cardiovascular Interventions.
Use of rarely appropriate angioplasty procedures declined sharply
The number of angioplasty procedures classified as rarely appropriate declined sharply between 2010 and 2014, as did the number of those performed on patients with non-acute conditions, according to a study published today in the Journal of the American Medical Association and simultaneously presented at a meeting of the American Heart Association in Orlando.
Antiplatelet therapy with blood thinners reduces mortality for angioplasty patients
Patients with acute coronary syndrome who have undergone angioplasty have a reduced risk of all-cause in-hospital mortality but an increased risk of bleeding when given glycoprotein 2b/3a inhibitors after the procedure, according to a study published today in JACC: Cardiovascular Interventions.
More Angioplasty News and Angioplasty Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab