Trends and Outcomes of Radial Approach in Left-Main Bifurcation Percutaneous Coronary Intervention in the Drug-Eluting Stent Era: A Two-Center Registry

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Objective. To analyze the immediate and long-term outcomes of transradial (TR) percutaneous coronary intervention (PCI) to unprotected left main stem (ULMS) bifurcation and to assess the main aspects affecting access-site choice in this specific PCI setting. Background. TR-PCI to the ULMS is feasible, but data specifically comparing TR and transfemoral (TF) approaches in ULMS-bifurcation PCI are limited. Methods. We set up a two-center (Rome, Italy and Oxford, United Kingdom) retrospective registry aimed at comparing the immediate and 1-year outcomes of consecutive patients who underwent ULMS-bifurcation PCI with drug-eluting stent implantation from 2005 to 2013 using the TF or TR approach. Clinical endpoints were: total mortality; major adverse cardiac and cerebrovascular event (MACCE) rate; and net adverse clinical event (NACE) rate. Results. A total of 467 patients undergoing ULMS-bifurcation PCI were enrolled (221 TF and 244 TR). TR approach was increasingly adopted over time for both simple and complex procedures. No significant differences were observed between the TR and TF groups in terms of 1-year mortality (10.7% vs 9.8%; P = .79) and MACCE (18.2% vs 15.2%; P = .44). TR patients, as compared with TF, had significantly fewer access-site complications (2.0% vs 6.3% in TF; P = .02), resulting in a significant reduction of NACE rate (6.9% vs 15.7;%; P = .01). Conclusion. In patients undergoing ULMS-bifurcation PCI, the selection of TR instead of TF approach is associated with similar early and long-term ischemic complications and with a significant reduction of access-site complications, resulting in lower NACE rate.

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