The prevalence and outcomes of transradial percutaneous coronary intervention for acute coronary syndrome. Analysis from the single-centre ISACS-TC Registry (International Survey of Acute Coronary Syndrome in Transitional Countries) (2010-12)

Abstract

The aims were to compare the prevalence and short-term outcomes of transradial (TRA) percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in dedicated radial centre. This was a single-centre observational study of 3484 consecutively enrolled patients with ACS in a 3-year period (2010–12). There were 1648 patients with ST-elevation myocardial infarction (STEMI) and 1836 with non-ST-elevation ACS (NSTEACS). All patients underwent diagnostic coronary angiography within 24 h (STEMI) or within 72 h (NSTEACS). Percutaneous coronary intervention was performed in 84.9% patients (96.6% with STEMI and 74.9% with NSTEACS). Optimal medical treatment (OMT) only was recommended to 2.2% with STEMI and to 11.1% with NSTEACS. Coronary artery bypass graft (CABG) surgery was performed for 1.7% of STEMI and 14.1% of patients with NSTEACS (P < 0.0001). Most of the PCI procedures were performed through the wrist access (radial 97% and ulnar artery access 1.3%). There was high overall procedural success 98.5% (STEMI 99% and NSTEACS 97%). At 30 days, cardiovascular mortality was 4.7% in STEMI patients and 1.4% in patients with NSTEACS who were treated by PCI (P < 0.0001). Major adverse cardiac events defined as a composite of death, myocardial infarction, stroke, and non-CABG major bleeding and major access site complications at 30 days were higher in STEMI vs. NSTEACS patients (7.7 vs. 4.4%; P < 0.0001). Transradial access for PCI in a large cohort of unselected patients with ACS, is safe and feasible when performed by experienced radial operators. Patients with NSTEACS are more frequently treated with OMT and have higher referral rate to CABG in comparison with STEMI patients. There is higher 30 day mortality in patients with STEMI.