The Impact of Radial Access in the Reduction of Bleeding in Patients with Acute Coronary Syndrome: Comparison between Two Israeli Surveys - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Gabby Elbaz-Greener ^1,4 Eran Kalmanovich ^1,4 Roy Beigel ^2,4 Zaza Iakobishvili ^3,4 Meital Shlezinger ² Nir Shlomo Ilan Goldenberg ^2,4 Zvi Vered ^1,4 Alex Blatt ^1,4

¹Department of Cardiology, Assaf Harofeh Medical Center, Zerifin
²The Heart Center, Chaim Sheba Medical Center, Tel HaShomer
³The Heart Institute, Rabin Medical Center, Petach-Tikva
⁴Sackler School of Medicine, Tel Aviv University

Background: The translation of the benefit of transradial (TRI) over transfemoral intervention (TFI) approach in the prevention of major bleeding events (MBE) was demonstrated in randomized trials, however it has less well been assessed in the real life all comers` patients.

Methods: We compared the rates, characteristics, risk factors and clinical outcomes associated with MBE in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) 2010 and 2013.

Results: A total of 4089 patients were enrolled, of them 3586 underwent coronary angiography (87.7%). In this group 29 (0.81%) patients experienced a MBE during index hospitalization for ACS. The MBE incidence was higher in 2010, 1.15% versus 0.41% in 2013. No statistical differences were found between the two MBE surveys patient group regarding age, weight, risk factors, ST elevation MI type and medical management. The TFI was performed in 67.8% in 2010, while in 2013 only in 36.4%, while TRI, was performed in 32.1% in 2010 and increased to 64.2% in 2013. In 2010 the MBE related to the access site was 63.3% and decreased to 28.5% in 2013. The non-access site related bleeding was 36.7% in 2010 and 71.3% in 2013. The 30 day mortality rate was 13% (2010) and 10% (2013) (NS) and the365 days mortality rate was 17.4% (2010) and 30% (2013) (NS).

Conclusions: The current common practice in Israel has switched to TRI as the default procedure. This approach resulted in reduced site related MBE while the non-access MBE remained unchanged.