1. Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents
- Author
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Sebastiano Gili, Hiroyoshi Kawamoto, Marco Pavani, Pierluigi Omedè, Claudio Moretti, Giuseppe Biondi Zoccai, Antonio Colombo, Maurizio D'Amico, Fabrizio D'Ascenzo, Roberto di Summa, Alaide Chieffo, Fabrizio Ugo, Fiorenzo Gaita, Ferdinando Varbella, Giacomo Boccuzzi, Francesco Tomassini, Antonio Montefusco, Federico Conrotto, Roberto Garbo, Javier Escaned, Enrico Cerrato, Gili, Sebastiano, D'Ascenzo, Fabrizio, Di Summa, Roberto, Conrotto, Federico, Cerrato, Enrico, Chieffo, Alaide, Boccuzzi, Giacomo, Montefusco, Antonio, Ugo, Fabrizio, Omedã©, Pierluigi, Kawamoto, Hiroyoshi, Tomassini, Francesco, Pavani, Marco, Varbella, Ferdinando, Garbo, Roberto, D'Amico, Maurizio, Biondi Zoccai, Giuseppe, Moretti, Claudio, Escaned, Javier, Colombo, Antonio, and Gaita, Fiorenzo
- Subjects
Registrie ,Male ,medicine.medical_specialty ,Acute coronary syndrome ,Percutaneous ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Follow-Up Studie ,Catheterization ,Peripheral ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Retrospective Studie ,Internal medicine ,medicine.artery ,Catheterization, Peripheral ,Drug-Eluting Stent ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Radial artery ,Coronary Vessel ,Aged ,Retrospective Studies ,Coronary Vessels ,Female ,Femoral Artery ,Follow-Up Studies ,Radial Artery ,Treatment Outcome ,Drug-Eluting Stents ,Cardiology and Cardiovascular Medicine ,business.industry ,Percutaneous coronary intervention ,Retrospective cohort study ,medicine.disease ,Surgery ,Propensity score matching ,Cardiology ,business ,Human - Abstract
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, nonâST-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.
- Published
- 2017
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