AHA: Transradial Approach Promoted for Same-Day Coronary Stenting


DALLAS, Nov. 14 - For coronary-artery stenting the wrist may be a safer port of entry than the groin, a shift that could allow same-day discharge after angioplasty, according to research reported here.
Transradial percutaneous coronary intervention (PCI) combined with single bolus administration of ReoPro (abciximab) allowed patients to be safely discharged without an overnight hospital stay, a team of Canadian researchers reported at the American Heart Association meeting.
Olivier Bertrand, M.D., of Laval Hospital in Quebec City said that the outpatient PCI approach is also much less expensive than inpatient PCI because it reduces hospital costs and the single bolus of ReoPro is less expensive than a 12-hour ReoPro infusion.
The EArly Discharge after Transradial Stenting of CoronarY Arteries (EASY) study compared same-day discharge with bolus ReoPro to overnight ReoPro bolus plus infusion after transradial coronary stenting. There were 504 patients randomized to the same day discharge arm and 501 to overnight stay. In addition, 343 patients who could not be randomized because of arterial dissection, sub-occluded branch vessels, or insufficient TIMI flow were entered into a registry.
Eighty-eight percent of the patients randomized to same day procedures were discharged home on the same day, he said.
The primary endpoint was death, myocardial infarction, urgent revascularization, repeat hospitalization, bleeding, or access site complications at 30 days. In the same-day group 13.9% of patients met the primary endpoint versus 11.8% in the overnight stay arm, which was not significant, Dr. Bertrand said.
At six months the rate of death, MI or revascularization was 5.7% in the same day group and 5.4% in the overnight group, which was not significant. Both the overnight group and the bolus group had significantly lower 30-day and six month event rates than the registry group that had a 30-day major event rate of 12.2% and a six month event rate of 21.3%, which was highly significant (P0.0001).
"The real advantage is the smile on our patients' faces as they can get up immediately with just a bandage on their wrists," said Dr. Bertrand.
Timothy Gardner, M.D., the AHA program chairman and is medical director at the Center for Vascular Health, of Christiana Care, Health Services in Wilmington, Del., said the EASY results were interesting but noted that it was a single-center study. "I think we need to some evidence from a multi-center study before we can draw any conclusions."
Dr. Gardner said that while the transradial approach is popular in Canada, few U.S. centers have abandoned the femoral artery for the radial artery. "The radial artery is trickier mainly because of concerns about circulation problems in the hand," he said. "Diabetic patients, for instance, could be problematic." But he said that the Canadians appear to have "adequately assessed the circulation issues."
On the plus side, Dr. Gardner agreed that it is easier to control bleeding with a transradial approach since "you can easily immobilize the arm and get these people up and walking."
Dr. Gardner said he could not speculate on whether the EASY study would spur the use of transradial PCI in the U.S.Primary source: American Heart Association Scientific Sessions 2005Source reference: Bertrand, O et al "Same-day home discharge after transradial coronary stenting with a single Abciximab Bolus: 6 month results of the EASY randomized trial" PS.O1 Sunday Nov 13, 2005