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| The Impact of Transradial Approach for In-Hospital Major Bleeding in Non-ST elevation Acute Coronary Syndrome Patients at Moderate to Very High CRUSADE Bleeding Scores
: From TransRadial Coronary Intervention(TRI)-Registry
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| 전남대학교병원¹ ,부산대학교병원² ,순천향대학 서울병원³ ,상계백병원⁴ ,동아대학교병원5 ,강동성심병원6,원주기독병원 7 ,인하대학교병원8 |
| 박근호¹ , 정명호¹ ,안영근¹ ,차광수² ,현민수³ ,김병옥⁴ ,김무현5 ,한규록6 ,윤정한7 ,박금수8 |
Backgrounds: It is well known that bleeding is associated with adverse clinical outcomes in Non-ST elevation acute coronary syndrome (NSTE-ACS) patients. The aim of our study was to evaluate the association between vascular access and in-hospital major bleeding (MB) in NSTE-ACS patients at moderate to very high CRUSADE bleeding scores.
Methods and Results: We analyzed 1,180 NSTE-ACS patients at CRUSADE bleeding scores ≥31 from Trans-radial coronary intervention (TRI) registry. Among them, 450 patients received coronary intervention via transradial approach (TRI group) and 730 patients via transfemoral approach (TFI group). In-hospital MB was defined as intracranial hemorrhage, documented retroperitoneal bleed, hematocrit drop ≥12% (baseline to nadir), any red blood cell transfusion when baseline hematocrit was ≥28%, or any red blood cell transfusion when baseline hematocrit was <28% with witnessed bleed by the CRUSADE. The CRUSADE bleeding score was higher (42.20±8.56 vs. 43.43±9.72, p=0.024) and diagnosis of NSTEMI and use of heparin were more common in TFI group (29.8% vs. 36.0%, p=0.027; 51.1% vs. 70.3%, p<0.001), however, current smokers, the history of dyslipidemia and use of low molecular weight heparin were more common in TRI group (16.9% vs. 11.2%, p=0.006; 30.9% vs. 22.2%, p=0.001; 23.3% vs. 14.9%, p<0.001). Use of glycoprotein IIb/IIIa inhibitors and the other anti-platelete agents were no differences between two groups. In hospital clinical outcomes, there were no differences in the incidence of all-cause death, Q wave myocardial infarction and cerebrovascular accidents between two groups. However, TRI group had lower incidences of in-hospital MB and blood transfusion than TFI group (4.0% vs. 12.7%, p<0.001; 3.1% vs. 11.1%, p<0.001). The independent predictors of in-hospital MB were the CRUSADE risk score [Odds ratio (OR)=1.082, 95% confidence interval (CI)=1.048-1.118], use of heparin (OR=4.317, 95% CI=1.434-12.993), history of dyslipidemia (OR=0.246, 95% CI=0.098-0.619) and TRI (OR=0.164, 95% CI=0.046-0.578).
Conclusions: Our study suggests that TRI can reduce in-hospital major bleeding on NSTE-ACS patients, especially at moderate to very high CRUSADE bleeding scores.
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