The 67th Annual Conference of the Israel Heart Society

Trans Radial versus Trans Femoral Approach Percutaneous Coronary Interventions for Coronary Bifurcation Lesions

Maya Wiessman 1,2 Leor Pearl 1,2 Hana Vaknin-Assa 1,2 Gabriel Greenberg 1,2 Abed Samara 1,2 Pablo Codner 1,2 Abid Assali 1,2 Ran Kornowski 1,2
1Cardiology Department, Rabin Medical Center, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Israel

Background: The trans radial approach (TRA) compared with trans femoral approach (TFA), has become preferred for percutaneous coronary intervention (PCI) in most clinical situations. However, adopting the TRA to more complex lesions, specifically coronary bifurcations, has been limited by technical challenges mostly, and data is lacking. We thus decided to assess the efficacy and safety of TRA versus TFA for coronary bifurcation lesions.

Methods: 921 consecutive patients treated with coronary bifurcation PCI during 2006-2018 were included in our prospective registry. 632 (68.6%) were treated using the TFA and 289 (31.4%) with TRA. All-cause mortality and MACE (cardiac death, myocardial infarction, target vessel revascularization and coronary artery bypass surgery) were compared at 12 months and 3 years.

Results: Mean age was similar for both groups (TRA 64±11.49 vs TFA 64±12.55, p=0.853). Male gender was dominant (81% for TRA vs 77% for TFA, p=0.188). Comorbidities such as diabetes mellitus (34% for TRA vs 33% for TFA, p=0.795), hypertension (72% for TRA vs 66% for TFA, p=0.081) and previous cerebrovascular accident (7% for TRA vs 8% for TFA, p=0.560) did not differ between groups.

Unadjusted all-cause mortality and MACE at 12 months were lower for TRA (1% vs 6% all-cause mortality, p=0.001; 11% vs 21% MACE, p<0.001). Similar results favouring TRA were observed at 3 years (5% vs 10% all-cause mortality, p=0.011; 19% vs 31% MACE, p<0.001).

Following adjustment for confounding factors, TRA was not associated with significantly lower risk of death at 3 years (HR 0.69; 95% CI 0.37-1.29, p=0.253). However, we observed a lower rate of MACE among those treated with TFA (HR 0.63; 95% CI 0.45-0.89, p=0.009).

Conclusions: In our prospective registry of patients treated with PCI for bifurcation lesions, MACE was significantly lower among those treated with TRA versus TFA, while no adjusted difference in all-cause mortality was found.









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