004 DCVI 2016 Radial Banerjee

Radial for all……..
Subhash Banerjee, MD, FACC, FSCAI
Professor of Medicine, UT Southwestern Med. Ctr.
Chief of Cardiology, VA North Texas Health Care System
Dallas, TX
Dallas CVI
Dallas Cardiovascular Innovation 2016
Disclosures
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Honoraria: Medtronic, CSI
Research grants: Boston Scientific, InfraRedx, Merck
Intellectual property: Mdcareglobal, HygeiaTel
Dallas CVI
Dallas Cardiovascular Innovation 2016
What are we debating?
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Using the radial artery in
the wrist vs. the femoral
in the groin
Radial artery is
superficial, compressible,
smaller, spasm
Learning curve
DVARC
Objective
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Get your facts first, and you may
distort them as you please
Mark Twain
Dallas CVI
Dallas Cardiovascular Innovation 2016
And the facts are…..
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Bleeding following percutaneous coronary interventions
(PCI) ~ 3%
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Post-PCI bleeding is associated with an increased risk for future
bleeding complications, MACE, & all-cause mortality (!patient
QOL)
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460,000 patients, CathPCI Registry; Rao SV et al. JACC Interv. 2012
Measures we have adopted to reduce bleeding
complications:
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Radial access, appropriate dosing of APT, newer agents,
education & public awareness campaigns
DVARC
MACE: major adverse cardiovascular events; QOL: quality of life
And the facts are…..
Study
Year
N
RIVAL1
2011
7,021
NSTEMI, STEMI
RIFFLE
STEACS2
MATRIX3
ACS+Bival/Heparin
Mega-analysis4
(76 studies)
Mega-analysis5
(32studies)
1Lancet
Bleeding
MACE
30-day: 3.7% vs 4.0%
(sig. benefit in STEMI)
2012
1,001
30d: 7.8% vs
12.2%*
2014
7,213
30d: 1.0% vs
1.4%*
PCI vasc. comp: 1.8%
vs. 4.4%*
30d: 7.2% vs.
11.4%*
30-day death: 5.2% vs
9.2%*
30d: 8.8% vs.
10.3%*
No. needed to
prevent=53
2012
761,919
44% risk reduction in mortality with radial
>70% risk reduction in access site complications & major
bleeding
80% reduction in the need for transfusions
2015
44,854
Radial reduced the risk of major bleeding by 55%
compared with femoral
2011; 2JACC 2012; 3Lancet. 2015; 4Am Heart J. 2012; 5South Med J. 2016
DVARC
Comments
Event rates displayed as radial vs. femoral; *statistical significance
Get your facts first, and you may distort them as you please….
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Facts:
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Bleeding in really bad for our patients
Radial cath consistently lowers bleeding complications,
cost & improves patient satisfaction
Distortions:
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Dallas CVI
Emmanouil S. Brilakis, MD, PhD
Dallas Cardiovascular Innovation 2016
Manos Brilakis….parts unknown
‘It’s time to try
a bite of
radial cath’
Dallas CVI
Dallas Cardiovascular Innovation 2016
Thank you