1. Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions.
- Author
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Abdelaal E, Brousseau-Provencher C, Montminy S, Plourde G, MacHaalany J, Bataille Y, Molin P, Déry JP, Barbeau G, Roy L, Larose É, De Larochellière R, Nguyen CM, Proulx G, Costerousse O, and Bertrand OF
- Subjects
- Aged, Aged, 80 and over, Coronary Artery Bypass adverse effects, Female, Femoral Artery, Hospitals, High-Volume, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Percutaneous Coronary Intervention adverse effects, Quebec, Retrospective Studies, Risk Assessment, Risk Factors, Sex Factors, Shock, Cardiogenic complications, Tertiary Care Centers, Treatment Failure, Percutaneous Coronary Intervention methods, Radial Artery
- Abstract
Objectives: To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI)., Background: TRA-PCI failure has been reported in 5% to 10% of cases., Methods: TRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed., Results: From January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%., Conclusions: In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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