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Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach.

Publication ,  Journal Article
Manly, DA; Karrowni, W; Rymer, JA; Kaltenbach, LA; Swaminathan, RV; Messenger, JC; Abbott, JD; Seto, A; Panetta, C; Brilakis, E; Gilchrist, IC ...
Published in: JACC Cardiovasc Interv
April 26, 2021

OBJECTIVES: The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach. BACKGROUND: There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI. METHODS: Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access. RESULTS: The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG. CONCLUSIONS: The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

April 26, 2021

Volume

14

Issue

8

Start / End Page

907 / 916

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Humans
  • Femoral Artery
  • Coronary Artery Bypass
  • Catheterization, Peripheral
  • Cardiovascular System & Hematology
 

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Manly, D. A., Karrowni, W., Rymer, J. A., Kaltenbach, L. A., Swaminathan, R. V., Messenger, J. C., … Rao, S. V. (2021). Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach. JACC Cardiovasc Interv, 14(8), 907–916. https://doi.org/10.1016/j.jcin.2021.01.053
Manly, David A., Wassef Karrowni, Jennifer A. Rymer, Lisa A. Kaltenbach, Rajesh V. Swaminathan, John C. Messenger, J Dawn Abbott, et al. “Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach.JACC Cardiovasc Interv 14, no. 8 (April 26, 2021): 907–16. https://doi.org/10.1016/j.jcin.2021.01.053.
Manly DA, Karrowni W, Rymer JA, Kaltenbach LA, Swaminathan RV, Messenger JC, et al. Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach. JACC Cardiovasc Interv. 2021 Apr 26;14(8):907–16.
Manly, David A., et al. “Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach.JACC Cardiovasc Interv, vol. 14, no. 8, Apr. 2021, pp. 907–16. Pubmed, doi:10.1016/j.jcin.2021.01.053.
Manly DA, Karrowni W, Rymer JA, Kaltenbach LA, Swaminathan RV, Messenger JC, Abbott JD, Seto A, Panetta C, Brilakis E, Nikolakopoulos I, Gilchrist IC, Kaul P, Dakik H, Rao SV. Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach. JACC Cardiovasc Interv. 2021 Apr 26;14(8):907–916.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

April 26, 2021

Volume

14

Issue

8

Start / End Page

907 / 916

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Humans
  • Femoral Artery
  • Coronary Artery Bypass
  • Catheterization, Peripheral
  • Cardiovascular System & Hematology