Cardiovascular Intervention and Therapeutics

, Volume 32, Issue 1, pp 18–23 | Cite as

Impact of transradial coronary intervention on bleeding complications in octogenarians

  • Khalid Tammam
  • Yuji Ikari
  • Fuminobu Yoshimachi
  • Fumie Saito
  • Walid Hassan
Original Article


Percutaneous coronary intervention (PCI) in the elderly is a major hospital burden since this group of patients exhibits high mortality rates and many comorbidities. The aim of this study was to analyze the impact of a transradial intervention (TRI) approach for PCI on bleeding complications in octogenarians. We retrospectively analyzed a consecutive cohort of 2530 patients who underwent PCI at a tertiary care center in Japan. Octogenarians constituted 12 % (291 cases) of the total PCI cases during the study period. Bleeding complications and all-cause mortality were observed at 30 days after PCI. Average age was 83 ± 3 years and female gender was 32 %. Stable coronary artery disease was 59 %. TRI was performed in 218 patients (75 %) and transfemoral intervention (TFI) in 73 (25 %). Bleeding Academic Research Consortium (BARC) major bleeding unrelated to bypass surgery were observed in 7.6 %, which were significantly lower in TRI than TFI (5.1 vs. 15.1 %, P = 0.005). The 30-day mortality rate was significantly low in patients without bleeding (4.9 vs. 31 %, p < 0.0001). In octogenarians, major bleeding complication was significant at 30 days after PCI. TRI had lower bleeding complication rate than TFI in this population. Octogenarians may be a subgroup of patients who derive benefits from TRI.


Elderly Percutaneous coronary intervention Bleeding complications Transradial intervention 



We thank Ms. Chie Kato for her clerical help.

Compliance with ethical standards

Authors have nothing to disclose.


  1. 1.
    Johnman C, Oldroyd KG, Mackay DF, Slack R, Pell AC, Flapan AD, et al. Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007. Circ Cardiovasc Interv. 2010;3:341–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Singh M, Rihal CS, Gersh BJ, Lennon RJ, Prasad A, Sorajja P, et al. Twenty-five-year trends in in-hospital and long-term outcome after percutaneous coronary intervention: a single-institution experience. Circulation. 2007;115:2835–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Singh M, Peterson ED, Roe MT, Ou FS, Spertus JA, Rumsfeld JS, et al. Trends in the association between age and in-hospital mortality after percutaneous coronary intervention: national Cardiovascular Data Registry experience. Circ Cardiovasc Interv. 2009;2:20–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Velders MA, James SK, Libungan B, Sarno G, Frobert O, Carlsson J, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001–2011: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J. 2014;167:666–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Mehran R, Pocock SJ, Stone GW, Clayton TC, Dangas GD, Feit F, et al. Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial. Eur Heart J. 2009;30:1457–66.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1815–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Valgimigli M, Gagnor A, Calabro P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385:2465–76.CrossRefPubMedGoogle Scholar
  8. 8.
    Hassan WM, Flaker GC, Feutz C, Petroski GF, Smith D. Improved anticoagulation with a weight-adjusted heparin nomogram in patients with acute coronary syndromes: a randomized trial. J Thromb Thrombolysis. 1995;2:245–9.PubMedGoogle Scholar
  9. 9.
    Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Tsuchida K, Ikegami R, Sato M, Shobugawa Y, Okubo T, Yano T, et al. Primary percutaneous coronary intervention and bleeding risk in the era of drug-eluting stent: a long-term cohort study. Cardiovasc Interv Ther. 2015;30:216–26.CrossRefPubMedGoogle Scholar
  11. 11.
    Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med. 2006;355:1006–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA. 2004;292:696–703.CrossRefPubMedGoogle Scholar
  14. 14.
    Guagliumi G, Stone GW, Cox DA, Stuckey T, Tcheng JE, Turco M, et al. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation. 2004;110:1598–604.CrossRefPubMedGoogle Scholar
  15. 15.
    Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, et al. Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Int J Cardiol. 2015;195:259–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Ielasi A, Brugaletta S, Silvestro A, Cequier A, Iniguez A, Serra A, et al. Everolimus-eluting stent versus bare-metal stent in elderly (≥75 years) versus non-elderly (<75 years) patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the examination trial. Int J Cardiol. 2015;179:73–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Mamas MA, Anderson SG, Carr M, Ratib K, Buchan I, Sirker A, et al. Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. J Am Coll Cardiol. 2014;64:1554–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.CrossRefPubMedGoogle Scholar
  19. 19.
    Masuda N, Matsukage T, Ogata N, Morino Y, Tanabe T, Ikari Y. Analysis of peripheral arterial bends that interfere with coronary catheterization. J Invasive Cardiol. 2010;22:197–203.PubMedGoogle Scholar
  20. 20.
    Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Labata C, Oliete C, et al. Results of primary percutaneous coronary intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol. 2014;113:452–6.CrossRefPubMedGoogle Scholar
  21. 21.
    He PY, Yang YJ, Qiao SB, Xu B, Yao M, Wu YJ, et al. A comparison of transradial and transfemoral approaches for percutaneous coronary intervention in elderly patients based on a propensity score analysis. Angiology. 2015;66:448–55.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2016

Authors and Affiliations

  • Khalid Tammam
    • 1
  • Yuji Ikari
    • 2
  • Fuminobu Yoshimachi
    • 2
  • Fumie Saito
    • 2
  • Walid Hassan
    • 1
  1. 1.Cardiac Center of Excellence, International Medical CenterJeddahSaudi Arabia
  2. 2.Department of CardiologyTokai University School of MedicineIseharaJapan

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