The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox
The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. The recent widespread adoptio...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2015-12, Vol.8 (14), p.1854-1864 |
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| creator | Azzalini, Lorenzo Tosin, Kunle Chabot-Blanchet, Malorie Avram, Robert Ly, Hung Q Gaudet, Benoit Gallo, Richard Doucet, Serge Tanguay, Jean-François Ibrahim, Réda Grégoire, Jean C Crépeau, Jacques Bonan, Raoul de Guise, Pierre Nosair, Mohamed Dorval, Jean-François Gosselin, Gilbert L'Allier, Philippe L Guertin, Marie-Claude Asgar, Anita W Jolicœur, E Marc |
| description | The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.
The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators. |
| doi_str_mv | 10.1016/j.jcin.2015.07.029 |
| format | Article |
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The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.</description><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2015.07.029</identifier><identifier>PMID: 26604063</identifier><language>eng</language><publisher>United States</publisher><subject>Cardiac Catheterization - adverse effects ; Cardiac Catheterization - methods ; Coronary Artery Disease - surgery ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Odds Ratio ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - methods ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Quebec - epidemiology ; Radial Artery ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Vascular Access Devices - adverse effects</subject><ispartof>JACC. Cardiovascular interventions, 2015-12, Vol.8 (14), p.1854-1864</ispartof><rights>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26604063$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azzalini, Lorenzo</creatorcontrib><creatorcontrib>Tosin, Kunle</creatorcontrib><creatorcontrib>Chabot-Blanchet, Malorie</creatorcontrib><creatorcontrib>Avram, Robert</creatorcontrib><creatorcontrib>Ly, Hung Q</creatorcontrib><creatorcontrib>Gaudet, Benoit</creatorcontrib><creatorcontrib>Gallo, Richard</creatorcontrib><creatorcontrib>Doucet, Serge</creatorcontrib><creatorcontrib>Tanguay, Jean-François</creatorcontrib><creatorcontrib>Ibrahim, Réda</creatorcontrib><creatorcontrib>Grégoire, Jean C</creatorcontrib><creatorcontrib>Crépeau, Jacques</creatorcontrib><creatorcontrib>Bonan, Raoul</creatorcontrib><creatorcontrib>de Guise, Pierre</creatorcontrib><creatorcontrib>Nosair, Mohamed</creatorcontrib><creatorcontrib>Dorval, Jean-François</creatorcontrib><creatorcontrib>Gosselin, Gilbert</creatorcontrib><creatorcontrib>L'Allier, Philippe L</creatorcontrib><creatorcontrib>Guertin, Marie-Claude</creatorcontrib><creatorcontrib>Asgar, Anita W</creatorcontrib><creatorcontrib>Jolicœur, E Marc</creatorcontrib><title>The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.
The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.</description><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - methods</subject><subject>Coronary Artery Disease - surgery</subject><subject>Female</subject><subject>Femoral Artery</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Quebec - epidemiology</subject><subject>Radial Artery</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Access Devices - adverse effects</subject><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kEFr3DAQhUWhJGnSP9BDmWMv645kW_b2tjVJGwikNEt7XGRpxGqxLVeSoelP7K-Klu72Mg8e8715DGPvOBYcufx4KA7aTYVAXhfYFCjWr9gVbxu5aiTWl-xNjAdEietGXLBLISVWKMsr9ne7J_hME1mXInR-shQCGeif4bsyTg2w0ZpiBOsDdCpkS2dNe0oU3B-VnJ9gEwgerY2UjpyCbyoo4387nfH7SQdSkcBNkKmcmgi8hR8q6mVQ4Zz_5LLf-XEeMnZMjfDTpT3c0ejD_xqf4Ni3U-NMajk3PJ27Ya-tGiK9Pek1297dbruvq4fHL_fd5mE1C87TShLWDbW65dxaQlSGhLF1z7XCktaV4dhXfWn7tjdGcCorYSXmST1v26q8Zh_-xc7B_1oopt3ooqZhUBP5Je54U5fIsVmLvPr-tLr0I5ndHNyowvPu_P7yBV2UiRc</recordid><startdate>20151221</startdate><enddate>20151221</enddate><creator>Azzalini, Lorenzo</creator><creator>Tosin, Kunle</creator><creator>Chabot-Blanchet, Malorie</creator><creator>Avram, Robert</creator><creator>Ly, Hung Q</creator><creator>Gaudet, Benoit</creator><creator>Gallo, Richard</creator><creator>Doucet, Serge</creator><creator>Tanguay, Jean-François</creator><creator>Ibrahim, Réda</creator><creator>Grégoire, Jean C</creator><creator>Crépeau, Jacques</creator><creator>Bonan, Raoul</creator><creator>de Guise, Pierre</creator><creator>Nosair, Mohamed</creator><creator>Dorval, Jean-François</creator><creator>Gosselin, Gilbert</creator><creator>L'Allier, Philippe L</creator><creator>Guertin, Marie-Claude</creator><creator>Asgar, Anita W</creator><creator>Jolicœur, E Marc</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20151221</creationdate><title>The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox</title><author>Azzalini, Lorenzo ; Tosin, Kunle ; Chabot-Blanchet, Malorie ; Avram, Robert ; Ly, Hung Q ; Gaudet, Benoit ; Gallo, Richard ; Doucet, Serge ; Tanguay, Jean-François ; Ibrahim, Réda ; Grégoire, Jean C ; Crépeau, Jacques ; Bonan, Raoul ; de Guise, Pierre ; Nosair, Mohamed ; Dorval, Jean-François ; Gosselin, Gilbert ; L'Allier, Philippe L ; Guertin, Marie-Claude ; Asgar, Anita W ; Jolicœur, E Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-6e057e8c811ffe00ade2df5b1ca03e94d10b4b3fb8bdd21e342f60342eb18843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - methods</topic><topic>Coronary Artery Disease - surgery</topic><topic>Female</topic><topic>Femoral Artery</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - methods</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Quebec - epidemiology</topic><topic>Radial Artery</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Access Devices - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azzalini, Lorenzo</creatorcontrib><creatorcontrib>Tosin, Kunle</creatorcontrib><creatorcontrib>Chabot-Blanchet, Malorie</creatorcontrib><creatorcontrib>Avram, Robert</creatorcontrib><creatorcontrib>Ly, Hung Q</creatorcontrib><creatorcontrib>Gaudet, Benoit</creatorcontrib><creatorcontrib>Gallo, Richard</creatorcontrib><creatorcontrib>Doucet, Serge</creatorcontrib><creatorcontrib>Tanguay, Jean-François</creatorcontrib><creatorcontrib>Ibrahim, Réda</creatorcontrib><creatorcontrib>Grégoire, Jean C</creatorcontrib><creatorcontrib>Crépeau, Jacques</creatorcontrib><creatorcontrib>Bonan, Raoul</creatorcontrib><creatorcontrib>de Guise, Pierre</creatorcontrib><creatorcontrib>Nosair, Mohamed</creatorcontrib><creatorcontrib>Dorval, Jean-François</creatorcontrib><creatorcontrib>Gosselin, Gilbert</creatorcontrib><creatorcontrib>L'Allier, Philippe L</creatorcontrib><creatorcontrib>Guertin, Marie-Claude</creatorcontrib><creatorcontrib>Asgar, Anita W</creatorcontrib><creatorcontrib>Jolicœur, E Marc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azzalini, Lorenzo</au><au>Tosin, Kunle</au><au>Chabot-Blanchet, Malorie</au><au>Avram, Robert</au><au>Ly, Hung Q</au><au>Gaudet, Benoit</au><au>Gallo, Richard</au><au>Doucet, Serge</au><au>Tanguay, Jean-François</au><au>Ibrahim, Réda</au><au>Grégoire, Jean C</au><au>Crépeau, Jacques</au><au>Bonan, Raoul</au><au>de Guise, Pierre</au><au>Nosair, Mohamed</au><au>Dorval, Jean-François</au><au>Gosselin, Gilbert</au><au>L'Allier, Philippe L</au><au>Guertin, Marie-Claude</au><au>Asgar, Anita W</au><au>Jolicœur, E Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2015-12-21</date><risdate>2015</risdate><volume>8</volume><issue>14</issue><spage>1854</spage><epage>1864</epage><pages>1854-1864</pages><eissn>1876-7605</eissn><abstract>The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.
The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.</abstract><cop>United States</cop><pmid>26604063</pmid><doi>10.1016/j.jcin.2015.07.029</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiac Catheterization - adverse effects Cardiac Catheterization - methods Coronary Artery Disease - surgery Female Femoral Artery Follow-Up Studies Humans Incidence Male Middle Aged Odds Ratio Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - methods Postoperative Complications - epidemiology Postoperative Complications - etiology Quebec - epidemiology Radial Artery Retrospective Studies Risk Factors Time Factors Treatment Outcome Vascular Access Devices - adverse effects |
| title | The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox |
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