Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA)
during percutaneous coronary interventions of the unprotected left main coronary artery
(ULM), due to technical and safety concerns. The aim of this study was to compare
the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting
stents. Consecutive patients who underwent percutaneous coronary intervention on ULM
with second-generation drug-eluting stents were retrospectively enrolled in the multicenter
Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry. Patients
were stratified according to the arterial access. The choice between TRA and TFA was
left to each operator's preferences. Bleedings during index hospitalization were the
primary end point. Secondary end points were major adverse cardiovascular events (a
composite of death, reinfarction, and target lesion revascularization), the single
components of major adverse cardiovascular events at follow-up and stent thrombosis.
Propensity score matching was executed to account for possible confounding. Overall,
1,247 patients were enrolled (23.2% [289] of female gender, mean age 70.2 ± 10.2 years).
Diagnosis at presentation was stable angina in 603 (48.7%) cases, non–ST-segment elevation
acute coronary syndrome in 465 (37.3%), ST-segment elevation myocardial infarction
in 117 (9.5%). Mean follow-up was 726 ± 654 days. After propensity score with matching,
354 patients were included. The primary end point was significantly reduced in patients
treated with TRA (2.0% vs 4.0%, p = 0.042), whereas no differences emerged pertaining
the secondary end points, including target lesion revascularization and reinfarction.
In conclusion, TRA may reduce in-hospital bleedings in patients undergoing percutaneous
treatment of the ULM, without increasing the rate of adverse cardiovascular events
at follow-up, and may therefore be safely used in the treatment of the ULM.
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Article Info
Publication History
Published online: April 13, 2017
Accepted:
March 30,
2017
Received in revised form:
March 30,
2017
Received:
February 2,
2017
Footnotes
See page 37 for disclosure information.
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