Seoul Radial Artery Access 2009 1

Howard A. Cohen, MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute LENOX HILL HOSPITAL TRANSRADIAL COURSE New York, NY October 23-24, 2009

Why Do Transradial Access? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Why Do Transradial Access? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRANSRADIAL PTCA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRANSRADIAL PTCA ,[object Object],[object Object],Radial N=300 Brachial N=300 Femoral N=300 p value Successful access 93.0% 95.7% 99.7% 0.001 PTCA Success 91.7% 90.7% 90.7% ns Access Compl 0% 2.3% 2.0% 0.035 Time 40±24 39±25 38±24 ns

TRANSRADIAL CATHETERIZTION ,[object Object],[object Object],RADIAL n=68 FEMORAL n=77 p value 1° Success 65 (96%) 74 (96%) ns D/MI/CABG 0 0 ns Access site Comp 0 3 (4%) p<0.01

TRANSRADIAL CATHETERIZTION ,[object Object],[object Object],RADIAL FEMORAL p Value Post op LOS 1.4 2.3 p<0.01 Hospital LOS 3.0 4.5 p<0.01 Total Charges 20,476 23,389 p<0.01

TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRANSRADIAL APPROACH in AMI Prospective Consecutive PTCA in Two Centers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EFFECT of TRANSRADIAL ACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EFFECT of TRANSRADIAL ACCESS on QUALITY OF LIFE AND COST A RANDOMIZED COMPARISON ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RANDOMIZED COMPARISON OF TRANSRADIAL AND TRANFEMORAL APPROACHES IN OCTAGENARIANS Louvard et al Am J Cardiol 92:17L, 2003 RADIAL P VALUE FEMORAL Crossover 11.7 NS 9.5 Angio Duration(min) 18.1  10.8 NS 16.4  10.8 Xray Duration(min) 6.1  4.8 0.001 4.4  3.4 PCI Success (%) 96.8 NS 94.7 PCI Duration(min) 27.6  18.2 NS 33.3  23.2 Xray Duration(min) 9.9  8.3 NS 10.7  10.2 Primary EP (%) 1.4 0.08 5.9(58.5% FCD) Hematoma >3cm(%) 2.2 0.004 11.4

TRANSRADIAL CATHETERIZATION ,[object Object],[object Object],<80 PATIENTS >80 PATEINTS Access Failure 14% 2% Access Time 10.2±12.9 m ±2.8±2.5 Procedure Time 25.7±12.9 m 17.4±4,7

[object Object],[object Object],[object Object],Agostononi et al. J Am Coll Cardiol 2004;44:349-56

TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56

TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 MACE

TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 ENTRY SITE COMPLICATIONS

TRANRADIAL VS TRANSFEMORAL ACCESS Agostononi et al. J Am Coll Cardiol 2004;44:349-56 RISK OF PROCEDURAL FAILURE

TRANRADIAL VS TRANSFEMORAL ACCESS ,[object Object],[object Object],[object Object],[object Object],Agostononi et al. J Am Coll Cardiol 2004;44:349-56

BLEEDING AND PCI OUTCOMES ,[object Object],[object Object],[object Object],Yatskaar L et al. Catheter Cardiovasc Interv 2007;69:961-6

BLEEDING AND OUTCOMES WITH PCI IN ACS J Am Coll Cardiol 2007;49:1362-8

BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MAJOR BLEEDING

BLEEDING AND OUTCOMES WITH PCI IN ACS Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 INDEPENDENT PREDICTORS OF MORTALITY

Radial Artery Access Improving Outcomes and Decreasing Costs Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368 MORTALITY AND MAJOR BLEEDING

Radial Artery Access Improving Outcomes and Decreasing Costs Types of Major Bleeding by Treatment Group Manoukian, S. V. et al. J Am Coll Cardiol 2007;49:1362-1368

BLEEDING AND OUTCOMES WITH PCI IN ACS Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632

Nikolsky, E. et al. J Am Coll Cardiol Intv 2009;2:624-632 Kaplan-Meier Estimates of Adverse Events at 1 Year BLEEDING AND OUTCOMES WITH PCI IN ACS

PCI COMPLICATIONS AND GUIDE CATHETER SIZE BIGGER IS NOT BETTER ,[object Object],[object Object],[object Object],[object Object],Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644

. Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 8F GUIDE USE

Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 IN HOSPITAL OUTCOMES 8F VS 6F GUIDES

Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 S STANDARDIZED MORTALITY RATE BASED ON GUIDE SIZE

Grossman, P. M. et al. J Am Coll Cardiol Intv 2009;2:636-644 TEMPORAL USE OF 6,7 AND 8F GUIDES

Radial Artery Access Improving Outcomes and Decreasing Costs “… hospital savings were due primarily to a reduction in major bleeding.”

Association of the Arterial Access Site at Angioplasty with Transfusion and Mortality: the MORTAL Study (Mortality Benefit of Reduced Transfusion After Percutaneous Coronary Intervention via the Arm or Leg) ,[object Object],[object Object],[object Object],Chase A J et al. Heart 2008;95:1019-1025

MORTAL STUDY Chase et al. Heart ;94:1019-1025,2008

MORTAL STUDY Chase et al. Heart ;94:1019-1025,2008 Predictors of 1-Year Mortality in the Mortal Study

MORTAL STUDY 914 Matched Patients p=0.96 Chase et al. Heart ;94:1019-1025,2008 Trans No Trans ARR NNT RR 95% CI 30 Day Mortality 7.7% 2% 5.7 18 3.9 1.89-8.0 1 Year Mortality 19.3% 5.7% 12.5 7.4 3.38 2.22-5.14

Rao, S. V. et al. J Am Coll Cardiol Intv 2008;1:379-386 Proportion of PCI Cases Performed Via TRA

TRENDS IN TRANSRADIAL PCI Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383

UNADJUSTED OUTCOMES Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383

UNADJUSTED RATES OF BLEEDING & VASCULAR COMPLICATIONS IN KEY SUB-GROUPS Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383

Effect of Age, Gender,and Indication on Association of r-PCI Success and Bleeding Complications Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383

Unadjusted and Adjusted Association Between PCI and Primary Outcomes (f PCI as Reference) Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383 Outcome Unadjusted Odds Ratio (95% CI) Adjusted Odds Ratio (95% CI) Procedural Success 1.09 (0.97-1.23) 0.92 (1.02-1.12) Any Bleeding Comp 0.38 (0.26-.0.54) 0.42 (0.31-0.56)

CONCLUSIONS ,[object Object],[object Object],[object Object],Rao et al. J. Am. Coll. Cardiol. Intv :2008; 1:379-383

PREVAIL STUDY ,[object Object],[object Object],[object Object],[object Object],Pristipino et al. Heart :2009;95:476-82

PREVAIL STUDY Pristipino et al. Heart :2009;95:476-82 Overall (1052) Femoral (543) Radial (509) P Value Male gender 71% 66% 75% <0.002 Prior radial 9% 4% 14% <0.0001 Prior PCI 20% 17% 24% <0.01 Chronic SAP 35% 28% 42% <0.0001 ACS 31% 35% 28% <0.01 Sheath size F 5.9 6.1 5.7 <0.0001 Heparin IU 4950 4270 5650 <0.0001 GP II IIIa RA 12% 8% 15% <0.002

Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82

Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Stable ACS

Major Improvement of PCI Outcomes with Radial Artery Access from the Prevail Study Pristipino et al. Heart :2009;95:476-82 Adjusted Multivariate Analysis

PREVAIL STUDY ,[object Object],[object Object],[object Object]

BLEEDING/TRANSFUSION AND ADVERSE OUTCOMES IN PCI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TRANS RADIAL CATHETERIZATION ,[object Object],[object Object],[object Object],[object Object],[object Object]

Why Do Transradial Access? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Radial Artery Access Improving Outcomes in PCI

TRANSRADIAL ACCESS ,[object Object],[object Object],[object Object],[object Object]

Seoul Radial Artery Access 2009 1

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