SAN FRANCISCO – Access site made no difference in major adverse events 1 year after percutaneous coronary intervention in patients randomized to transradial or transfemoral access, in a study of more than 1,700 Chinese patients.
The DRAGON trial (Determination of the Radial vs. Groin Coronary Angioplasty) also showed that the two types of access had virtually identical rates of bleeding complications a week after the intervention.
“This was an incredible study,” Dr. Roxana Mehran
Dr. Roxana Mehran
At 25 surgery sites across China, patients who presented with the need for ad hoc percutaneous coronary intervention (PCI) were randomly assigned in a 2:1 fashion to have transradial or transfemoral access. In all, 1,212 PCI patients had transradial catheterization, while 527 were given transfemoral PCI. After 1 year, patients in both groups were found to have nearly identical major adverse cardiac or cerebrovascular event–free (MACCE-free) rates: 95.8% for transradial access vs. 95.5% for transfemoral access (P for noninferiority, less than .001). Bleeding complication rates at 7 days were also similar: 99.9% of patients who’d received transradial PCI were free of any access site bleeding event, as were 99.0% of all transfemoral PCI patients (P for superiority, less than .001). Nearly half of patients in the transfemoral access group also received a hemostatic intervention, and 40% of all patients required anticoagulation therapy, Dr. Shigeru Saito reported at the meeting, sponsored by the Cardiovascular Research Foundation.
While transradial access’s noninferiority to rates of site complications in transfemoral access is already supported in the literature, Dr. Saito, director of cardiology and catheterization laboratories at Shonan Kamakura General Hospital, Kanagawa, Japan, said he and his colleagues wanted to establish transradial PCI’s long-term efficacy so that it could become the standard internationally, unless the patient’s situation dictates otherwise.
Transradial access is considered routine in much of Asia and Europe, but in the United States, fewer than 20% of interventionalists currently use it, said Dr. Daniel I. Simon.
Dr. Daniel Simon
“[Radial access] is certainly increasing, but ... what I would hate to see happen is for our fellows and trainees to lose the femoral techniques that you need for some cases,” said Dr. Simon, professor of medicine at Case Western Reserve University, Cleveland. “Certainly, femoral access will be required for some procedures, but you can make the case for ST-segment elevation MI that transradial access should really be the standard, because that’s where the data is the most robust.” Dr. Simon was not involved in the study.
Dr. Saito, Dr. Mehran, and Dr. Simon had no relevant disclosures.
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