A Pilot Study Comparing Transradial Approach Versus Transfemoral Approach in Diabetic Patients Undergoing Elective Percutaneous Coronary Intervention in Ain Shams University Hospitals

Abstract

SUMMARY P ercutaneous coronary intervention is an integral part of treatment of ischemic heart disease. With the increasing prevalence of coronary artery disease, coronary catheterization has become even more important. (1) Coupled with evidence-based pharmacological strategies, the use of coronary catheterization in appropriate patients reduces morbidity and mortality. Continuous evolution of antithrombotic therapy and device technology has resulted in the application of PCI to a wider population of patients. (2) Coronary catheterization is usually performed via the transfemoral approach. Although the transfemoral approach to cardiac catheterization has dominated the explosive growth of interventional cardiology in past decades, transradial access for coronary artery catheterization has several advantages in comparison with the transfemoral route, especially under conditions of aggressive anticoagulation and antiplatelet treatment in which bleeding complications at the femoral puncture site can result in increased morbidity and duration of hospitalization. (3, 4) As experience with the transradial approach grew, the lack of severe access-site complications when compared with the transfemoral approach was repeatedly demonstrated. A “learning curve” for developing proficiency in transradial procedures was noted and cost-effectiveness was demonstrated. (10, 11) Transradial procedures have been demonstrated to be an effective and safe alternative to transfemoral procedures. Safety of transradial coronary catheterization is mainly determined by the favorable anatomic relations of the radial artery. Superficial course of the radial artery gives the advantage of easy hemostasis by local compression. (11) Our study was conducted on 60 diabetic patients presenting to Ain Shams University Specialized Hospital for elective PCI. Patients were divided into two groups, Group A, where 30 patients underwent the transradial approach, and Group B, where 30 patients underwent the transfemoral approach. There was no significant difference between both groups regarding demographic data, risk factors, past history, family history and examination. Also target vessels and number of stents deployed were similar in the two groups. Regarding procedure timings, there was no significant difference found as regards time to successful puncture, time to successful cannulation of the right coronary artery, and total procedure time. Fluoroscopy time was significantly longer in group A with a mean of 10.51 ± 5.69 minutes versus a mean of 7.94 ± 3.36 minutes in group B (p = 0.03). Left main coronary artery cannulation took significantly longer time in patients of group A, with a mean of 2.83 ± 1.46 minutes versus a mean of 1.23 ± 0.63 minutes for group B (p < 0.001). There was no significant difference between both groups regarding vascular and access site complications. This contrast with other studies was contributed to the small number of patients in our study and to the large experience of our operators in the transfemoral approach in comparison to the transradial approach. Highly significant difference between both groups was found regarding time to discharge. In group A, time to discharge ranged from 6 to 24 hours with a mean of 6.60 ± 3.29 hours, which was significantly shorter than in group B, which ranged from 18 to 24 hours with a mean of 23.80 ± 1.1 hours, (p = 0.0001). Regarding the patient satisfaction, no significant difference was found between the two groups but there was a trend towards more patient satisfaction in group A. In a scale from 1 to 5, where 5 was “Very satisfied”, while 1 was “Not satisfied”, group A showed a mean of 4.57 ± 0.73, while group B showed a mean of 4.17 ± 0.91, (p = 0.066). There was no significant difference between both groups regarding the procedural cost which ranged from 8500 LE to 9000 LE, with a mean of 8750 LE, excluding the stents prices. There was highly significant difference between both groups regarding the accommodation fees. Group A was much less expensive with a mean of 87.5±12.5 LE only versus 350±50 LE for group B, with a p value of p < 0.001.