Choice of arterial access for percutaneous coronary intervention in patients with acute coronary syndrome without st-segment elevation

Aim — to evaluate early and long-term outcomes of endovascular treatment of acute coronary syndrome without ST-elevation in patients with multivascular coronary disease. Material and methods. 346 patients were randomized into two groups depending on the arterial access for PCI. Transfemoral approach was used in group I (155 patients), transradial access — in group II (191 patients). The study suggested an additional randomisation into 3 subgroups depending on terms of complete myocardial revascularization. Subgroup 1 consisted of 100 patients who underwent complete myocardial revascularization during primary PCI. Subgroup II included 124 patients who underwent complete myocardial revascularization within one hospitalization. Subgroup III included 122 patients who had complete revascularization within different terms after primary hospitalization. Results. Overall incidence of intra-and postoperative cardiovascular events (death, myocardial infarction, urgent re-operations) was not significantly different in both groups (7.1 and 8.4%, respectively (p=0.6423)). Severe bleeding (BARC 3 and 5) was significantly more frequent in case of transfemoral access compared with transradial approach. Resistant arterial spasm was more common after transradial interventions. Analysis of vascular complications incidence in subgroups did not determine significant differences. However, overall incidence of vascular complications after transradial and transfemoral intervenrions differed significantly in these subgroups and was 17, 27.4 and 35.2% respectively (p<0.001) that is directly associated with re-operations. Long-term outcomes within 11—18 months (mean period 12±0.14 months) were followed-up in 192 patients including 91 patients from group I and 101 patients from group II. Overall incidence of cardiovascular events (death, myocardial infarction, re-operations) was significantly lower in group I compared with group II (2.2 and 6%, respectively) (p=0.0312). Conclusion. Transradial approach may be advisable for PCI in patients with ACS without ST-segment elevation because it is associated with low rate of major and minor bleeding in early postoperative period and severe cardiovascular complications in long-term period. However, arterial spasm is more common. © 2016, Media Sphera Publishing Group. All rights reserved.