In a retrospective study published in Circulation using data from the CathPCI registry on more than 2.8 million procedures between January 2007 and September 2012, researchers found that radial access PCI increased 13-fold, from a negligible 1.2% at the beginning of the study to 16.1% at the end. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49–0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31–0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. Despite this, radial access is used less often in certain high-risk groups, including elderly patients 75 years of age or greater, women, and patients with acute coronary syndromes (ACS). The authors note, these high-risk groups may derive the greatest benefit from radial access in terms of absolute risk reduction in bleeding and vascular complications.
SCAI has entered into a partnership relationship with the Health Disparities Research Consortium (HDRC). HDRC is a new non-profit organization started in order to improve clinical research and clinical trial strategies so they can more appropriately address minority and female patient populations, not just in interventional cardiology but across medicine. Health disparities are a multi-faceted issue, but part of the solution for achieving improved outcomes is to change the research approach – enroll more diverse patients into trials, improve analysis of trial data and translate trial results directly into practice. HDRC Medical Director, Dr. Roxana Mehran, saw the potential to broaden the work of SCAI WIN to a larger platform, and approached SCAI to partner on the new initiative.
The WIN TAVI Registry enrolled its first patient! The patient (pictured left) is an 87 year-old active woman with aortic stenosis, prior medically treated NSTEMI, atrial fibrillation, and PM implantation due to an AV block. She was admitted to the hospital because of acute pulmonary edema and an echocardiogram showed a worsening of her aortic stenosis – the peak and mean aortic gradient were 60mmHg and 41mmHg respectively – and a LVEF of 20%. The logistic EuroSCORE and the EuroSCORE II were 18,92% and 10% respectively. The STS Score was 34.85%. The heart team at San Raffele Hospital in Milan, Italy discussed the case and because of the high operative risk, TAVI was agreed upon as the best treatement option. The patient was enrolled in WIN TAVI Registry and underwent transfemoral TAVI on March 8, 2013 with a CoreValve 26mm. There was no peri-procedural complication and the patient was discharged without event. We look forward to reporting updates from the WIN TAVI Registry as it continues to enroll.