Post-interventional adverse event risk by vascular access site among patients with acute coronary syndrome in Japan: observational analysis with a national registry J-PCI database
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This study evaluated whether radial access intervention had a lower risk of post-treatment adverse events in acute coronary syndrome (ACS) even in Japan where the use of a strong antithrombotic regimen was not approved. We retrospectively analyzed a large nation-wide registry in Japan to compare the incidence of post-treatment adverse events according to the types of vessel access (trans-radial; TRI vs. trans-femoral; TFI) among ACS cases (n = 76,835; 43,288 TRI group and 33,547 TFI group). Primary outcome was a composite of in-hospital death, myocardial infarction associated with percutaneous coronary intervention, bleeding complication requiring transfusion, and stent thrombosis during in-hospital stay. Propensity score matching (PS) and instrumental variable (IV) analyses were used to account for treatment selection. The incidence of post-treatment adverse events was lower in the TRI group by 0.95% compared to the TFI group with PS (p < 0.001) and by 0.34% with IV (p = 0.127). A significantly lower risk for access site bleeding was observed by 0.34% with PS (p < 0.001) and by 0.53% with IV (p < 0.001). Radial access was related to a significantly lower risk for access site bleeding compared with femoral access, even without strong antithrombotic drugs for ACS in Japan, and may also relate to lower risk for a wider set of post-treatment adverse events.
KeywordsAcute coronary syndrome Trans-radial approach Access site bleeding Propensity score Instrumental variable
The authors thank all the members of the CVIT and CVIT secretariat.
J-PCI Investigators: Members of the CVIT Scientific Committee: Kazushige Kadota (Kurashiki Central Hospital), Nobuo Shiode (Hiroshima City Hospital), Nobuhiro Tanaka (Tokyo Medical University), Tetsuya Amano (Aichi Medical University), Shiro Uemura (Kawasaki Medical School), Takashi Akasaka (Wakayama Medical University), Yoshihiro Morino (Iwate Medical University), Kenshi Fujii (Sakurabashi Watanabe Hospital), and Hiroshi Hikichi (Saga University). Members of the Registry Subcommittee: Tetsuya Amano (Aichi Medical University), Kenshi Fujii (Sakurabashi Watanabe Hospital), Shun Kohsaka (Keio University), Hideki Ishii (Nagoya University), Kengo Tanabe (Mitsui Memorial Hospital), Yukio Ozaki (Fujita Health University), Satoru Sumitsuji (Osaka University), Osamu Iida (Kansai Rosai Hospital), Hidehiko Hara (Toho University Ohashi Medical Center), Hiroaki Takashima (Aichi Medical University), Shinichi Shirai (Kokura Memorial Hospital), Mamoru Nanasato (Nagoya Daini Red Cross Hospital), Taku Inohara (Keio University), Yasunori Ueda (Osaka National Hospital), Yohei Numasawa (Japanese Red Cross Ashikaga Hospital), and Shigetaka Noma (Saiseikai Utsunomiya Hospital).
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