Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents

Sebastiano Gili, Fabrizio D'Ascenzo, Roberto Di Summa, Federico Conrotto, Enrico Cerrato, Alaide Chieffo, Giacomo Boccuzzi, Antonio Montefusco, Fabrizio Ugo, Pierluigi Omedé, Hiroyoshi Kawamoto, Francesco Tomassini, Marco Pavani, Ferdinando Varbella, Roberto Garbo, Maurizio D'Amico, Giuseppe Biondi Zoccai, Claudio Moretti, Javier Escaned, Antonio ColomboFiorenzo Gaita

Research output: Contribution to journalArticle

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, 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.

Original languageEnglish
Pages (from-to)33-39
Number of pages7
JournalAmerican Journal of Cardiology
Volume120
Issue number1
DOIs
Publication statusPublished - Jul 1 2017

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Drug-Eluting Stents
Thigh
Propensity Score
Percutaneous Coronary Intervention
Stents
Therapeutics
Hemorrhage
Stable Angina
Acute Coronary Syndrome
Registries
Coronary Vessels
Hospitalization
Thrombosis
Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents. / Gili, Sebastiano; D'Ascenzo, Fabrizio; Di Summa, Roberto; Conrotto, Federico; Cerrato, Enrico; Chieffo, Alaide; Boccuzzi, Giacomo; Montefusco, Antonio; Ugo, Fabrizio; Omedé, Pierluigi; Kawamoto, Hiroyoshi; Tomassini, Francesco; Pavani, Marco; Varbella, Ferdinando; Garbo, Roberto; D'Amico, Maurizio; Biondi Zoccai, Giuseppe; Moretti, Claudio; Escaned, Javier; Colombo, Antonio; Gaita, Fiorenzo.

In: American Journal of Cardiology, Vol. 120, No. 1, 01.07.2017, p. 33-39.

Research output: Contribution to journalArticle

Gili, S, D'Ascenzo, F, Di Summa, R, Conrotto, F, Cerrato, E, Chieffo, A, Boccuzzi, G, Montefusco, A, Ugo, F, Omedé, P, Kawamoto, H, Tomassini, F, Pavani, M, Varbella, F, Garbo, R, D'Amico, M, Biondi Zoccai, G, Moretti, C, Escaned, J, Colombo, A & Gaita, F 2017, 'Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents', American Journal of Cardiology, vol. 120, no. 1, pp. 33-39. https://doi.org/10.1016/j.amjcard.2017.03.262
Gili, Sebastiano ; D'Ascenzo, Fabrizio ; Di Summa, Roberto ; Conrotto, Federico ; Cerrato, Enrico ; Chieffo, Alaide ; Boccuzzi, Giacomo ; Montefusco, Antonio ; Ugo, Fabrizio ; Omedé, Pierluigi ; Kawamoto, Hiroyoshi ; Tomassini, Francesco ; Pavani, Marco ; Varbella, Ferdinando ; Garbo, Roberto ; D'Amico, Maurizio ; Biondi Zoccai, Giuseppe ; Moretti, Claudio ; Escaned, Javier ; Colombo, Antonio ; Gaita, Fiorenzo. / Radial Versus Femoral Access for the Treatment of Left Main Lesion in the Era of Second-Generation Drug-Eluting Stents. In: American Journal of Cardiology. 2017 ; Vol. 120, No. 1. pp. 33-39.
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AU - Di Summa, Roberto

AU - Conrotto, Federico

AU - Cerrato, Enrico

AU - Chieffo, Alaide

AU - Boccuzzi, Giacomo

AU - Montefusco, Antonio

AU - Ugo, Fabrizio

AU - Omedé, Pierluigi

AU - Kawamoto, Hiroyoshi

AU - Tomassini, Francesco

AU - Pavani, Marco

AU - Varbella, Ferdinando

AU - Garbo, Roberto

AU - D'Amico, Maurizio

AU - Biondi Zoccai, Giuseppe

AU - Moretti, Claudio

AU - Escaned, Javier

AU - Colombo, Antonio

AU - Gaita, Fiorenzo

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