Transradial versus transfemoral intervention for the treatment of left main coronary bifurcations: results from the COBIS (COronary BIfurcation Stenting) II Registry.

Abstract

OBJECTIVES: We compared clinical outcomes of transradial (TR) and transfemoral (TF) percutaneous coronary interventions (PCI) in patients with left main coronary artery (LMCA) bifurcation lesions.

BACKGROUND: The use of TR approach is growing as an alternative to the routine use of the TF approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of LMCA bifurcation lesions.

METHODS: Between January 2003 and December 2009, a total of 853 patients undergoing PCI using drug-eluting stent (DES) implantation for LMCA bifurcation lesions were enrolled from 18 centers in Korea. We classified patients into the TR group (n = 212) and TF group (n = 641) according to the vascular approach. The primary outcome was major adverse cardiac event (MACE) rate, including composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 483 propensity-score matched patients.

RESULTS: There were no significant differences between TR and TF approaches for procedural success in the main vessel (98.6% vs. 99.7%; P=.07) and side branches (90.6% vs. 94.4%; P=.05). Thrombolysis in Myocardial Infarction major or minor bleeding occurred less frequently in the TR group than in the TF group (2.4% vs. 9.4%; P=.01). Over a median follow-up of 35 months, MACE rate did not significantly differ between TR and TF groups (9.9% vs. 14.5%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.49-1.29; P=.36). These results were consistent after propensity-score matched analysis.

CONCLUSIONS: TR-PCI is a safe and effective vascular approach, even in patients with LMCA bifurcation lesions undergoing PCI with DES implantation.