Angioplastia coronária nas indicações off-label: Comparação das vias radial vs. femoral

Abstract

Background: There is increasing interest in the use of the radial approach in diagnostic and therapeutic procedures due to several advantages such as patient comfort in the immediate post-procedure with early return to daily routine activities, decreased hospitalization time and consequent reduction of hospital costs and low puncture site complication rates when compared with the femoral approach, reducing the rate of major bleeding, which is in turn related to increased risk of death and ischemic events. Method: Retrospective analysis of 1,807 consecutive patients undergoing off-label percutaneous transluminal coronary angioplasty (PTCA) from September 2006 to December 2009. The outcome of patients undergoing PTCA using the radial and femoral approaches during hospitalization and late follow-up were compared. Results: The radial approach prevailed in younger, male patients with lower angiographic complexity, which was due to the learning curve. Major adverse cardiac events (MACE), death and target-vessel revascularization rates were lower when the radial approach was used, both during hospitalization and in the late follow-up due to a more favorable clinical-angiographic profile. The femoral approach was an independent predictor of hospital MACE. The adjusted survival curve, however, showed that the access route did not have a significant impact on long-term clinical events. Conclusion: The transradial approach is safe when used in selected patients with off-label indication, providing good clinical results in the early and late follow-up.