An invasive approach including percutaneous coronary intervention (PCI) improves clinical outcomes in clients with ST-segment elevation myocardial infarction (STEMI) and in clients with non-ST-segment elevation acute coronary syndromes (NSTEACS) (Mehta et al., 2012). Periprocedural major bleeding is a strong autonomous predictor of early and late major adverse cardiovascular events and mortality (Bertrand, Larose, & Rodes-Labau, 2009; Verneugt, Steinhubl, & Hamon, 2011; as cited in Bernat et al., 2014). In an investigation of more than three million PCIs from the U. S. national registry, post-procedural bleeding events were linked with an increased chance of in-hospital mortality and an approximated 12.1% death rate related to bleeding complications
…show more content…
Clients were randomly assigned to radial or femoral access with a web-based system. Eligibility criteria included patients with ACS with or without STEMI, were about to undergo an invasive approach, and the interventional cardiologist was inclined to continue with either radial or femoral access and had proficiency for both, including at least 75 PCIs performed, and at least 50% of interventions in ACS via the radial approach during the prior year. Patients with cardiogenic shock, severe peripheral vascular disease, or prior coronary artery bypass graft (CABG) surgery were considered eligible. Exclusion criteria consisted of the use of low-molecular-weight heparin in the previous six hours, glycoprotein IIb/IIIa inhibitors in the previous three days, or any PCI’s performed in the previous 30 days. Two coprimary 30-day composite outcomes measured were major adverse cardiovascular events, described as the composite of all-cause mortality, stroke, or MI; an NACE, described as the composite of major bleeding not associated to CABG or major adverse cardiovascular events. Secondary outcomes consisted of each component of the composite outcomes, cardiovascular mortality, and stent thrombosis. Between October 11, 2011 and November 7, 2014, 8,404 patients were randomly assigned to obtain radial (4, 197 patients) or femoral access (4, 207 patients). Of these patients, 3,951 (94%) underwent radial approach, and 4,098 (97.4%) underwent femoral approach. According to the researchers, radial access was associated with a lower risk of all-cause mortality than femoral approach (1.6% vs. 2.2%), respectively. In addition, researchers obtained positive tests for trend
Clients were randomly assigned to radial or femoral access with a web-based system. Eligibility criteria included patients with ACS with or without STEMI, were about to undergo an invasive approach, and the interventional cardiologist was inclined to continue with either radial or femoral access and had proficiency for both, including at least 75 PCIs performed, and at least 50% of interventions in ACS via the radial approach during the prior year. Patients with cardiogenic shock, severe peripheral vascular disease, or prior coronary artery bypass graft (CABG) surgery were considered eligible. Exclusion criteria consisted of the use of low-molecular-weight heparin in the previous six hours, glycoprotein IIb/IIIa inhibitors in the previous three days, or any PCI’s performed in the previous 30 days. Two coprimary 30-day composite outcomes measured were major adverse cardiovascular events, described as the composite of all-cause mortality, stroke, or MI; an NACE, described as the composite of major bleeding not associated to CABG or major adverse cardiovascular events. Secondary outcomes consisted of each component of the composite outcomes, cardiovascular mortality, and stent thrombosis. Between October 11, 2011 and November 7, 2014, 8,404 patients were randomly assigned to obtain radial (4, 197 patients) or femoral access (4, 207 patients). Of these patients, 3,951 (94%) underwent radial approach, and 4,098 (97.4%) underwent femoral approach. According to the researchers, radial access was associated with a lower risk of all-cause mortality than femoral approach (1.6% vs. 2.2%), respectively. In addition, researchers obtained positive tests for trend