TY - JOUR
T1 - The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications with Femoral Access
T2 - The Campeau Radial Paradox
AU - Azzalini, Lorenzo
AU - Tosin, Kunle
AU - Chabot-Blanchet, Malorie
AU - Avram, Robert
AU - Ly, Hung Q.
AU - Gaudet, Benoit
AU - Gallo, Richard
AU - Doucet, Serge
AU - Tanguay, Jean François
AU - Ibrahim, Réda
AU - Grégoire, Jean C.
AU - Crépeau, Jacques
AU - Bonan, Raoul
AU - De Guise, Pierre
AU - Nosair, Mohamed
AU - Dorval, Jean François
AU - Gosselin, Gilbert
AU - L'Allier, Philippe L.
AU - Guertin, Marie Claude
AU - Asgar, Anita W.
AU - Jolicœur, E. Marc
N1 - Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/12/21
Y1 - 2015/12/21
N2 - Objectives The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. Background The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted. Methods Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort. Results A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%. Conclusions In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
AB - Objectives The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. Background The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted. Methods Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort. Results A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%. Conclusions In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
KW - access site
KW - cardiac catheterization
KW - percutaneous coronary intervention
KW - vascular complications
UR - https://www.scopus.com/pages/publications/84955656310
U2 - 10.1016/j.jcin.2015.07.029
DO - 10.1016/j.jcin.2015.07.029
M3 - Article
C2 - 26604063
AN - SCOPUS:84955656310
SN - 1936-8798
VL - 8
SP - 1854
EP - 1864
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 14
ER -