Original title: Baseline bleeding risk and arterial access site practice in relation to procedural outcomes after percutaneous coronary intervention. Presenter: Mamas A. Mamas et al. J Am Coll Cardiol. 2014;64:1554-1564.

The transradial approach has been associated with reduced access site related bleeding complications as well as a reduced mortality in the context of PCI. It seems reasonable to assume that baseline bleeding risk could also influence the benefit associated to the transradial approach, but it has not yet been established.

This trial studied the relationship between baseline bleeding risk, the transradial approach and post PCI events of all patients included in the British Cardiovascular Intervention Society database.

Baseline bleeding risk was calculated with the modified Mehran score in 348689 patients undergoing PCI between the years2006 and 2011. Patients were divided according to score in 4 categories of risk (low <10, moderate 10-14, high 15-19 and very high ≥20). The impact of baseline risk was analyzed on mortality at 30 days, according to access site.

Radial access was associated to a reduction of 35% mortality at 30 days (OR 0.65, IC 95% 0.59 to 0.72; p < 0.0001) and this reduction was associated to baseline bleeding risk (for those with

Conclusion

The transradial approach was independently associated to a reduction of mortality at 30 days and the magnitude of this effect was associated to bleeding risk. PCI patients with higher risk of bleeding are the ones that most benefit from the transradial approach.

Editorial Comment

In this study of the daily practice it was observed that 43% of patients with the lowest bleeding risk received the radial approach and, unexpectedly, only 40% of patients with the highest bleeding risk saw the same benefit. Even though there is enough evidence to adopt the transradial approach in all patients, we should give special attention to those with higher risk of bleeding, risk that should be calculated prior to intervention and should be known by the operator for him to make an informed decision on the most appropriate access site.

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