• Warren J Cantor, Shamir R Mehta, Fei Yuan, Vladimír Džavík, Matthew Worthley, Kari Niemelä, Vicent Valentin, Anthony Fung, Asim N Cheema, Petr Widimsky, Madhu Natarajan, Barbara Jedrzejowski, and Sanjit S Jolly.
• Southlake Regional Health Centre, Newmarket, ON, Canada. Electronic address: cantorw@rogers.com.
• Am. Heart J. 2015 Nov 1; 170 (5): 880-6.

BackgroundRadial access for percutaneous coronary intervention is associated with lower rates of access site complications and bleeding. However, elderly patients have more complex vascular anatomy and radial access may be more challenging in this population. There remains uncertainty regarding the role of radial access in elderly patients undergoing cardiac catheterization.Methods And ResultsThe RIVAL trial randomized patients with acute coronary syndromes undergoing cardiac catheterization to radial versus femoral access. In this analysis, the rates of access site complications and access site cross-over were compared across different age groups. Among the 7,021 patients, 1035 (15%) were ≥75 years of age. Across all age categories, radial access was consistently associated with higher rates of access site cross over and lower rates of major access site complications, with no significant interaction between age and access site. Radial access was associated with lower rates of major vascular access site complications in patients ≥75 years of age (3.6% vs 6.6%; P = .03) and in patients <75 years of age (1.0% vs 3.2%; P < .001; P value for interaction = .2). The rates of access site crossover were higher with radial access among patients ≥75 (12.5% vs 2.6%; P < .001) and <75 (6.7% vs 1.9%; P < .001; P value for interaction = .9). There were no significant differences in the primary composite outcome (death, myocardial infarction, stroke or non coronary artery bypass graft major bleeding) or its individual components in either age group. In patients ≥75 years of age undergoing primary percutaneous coronary intervention, there was no significant difference in procedure time (120 vs 115 minutes; P = .3).ConclusionsConsistent with the overall RIVAL trial population, elderly patients undergoing cardiac catheterization have lower rates of major bleeding or access site complications and higher rates of access site crossover with radial access compared to femoral access.Copyright © 2015 Elsevier Inc. All rights reserved.

17 keywords...

hide…