The Journal of invasive cardiology, 7 1 2025 Vascular access and mortality outcomes: insights from the Percutaneous Coronary Interventions registry from the Netherlands Heart Registration. Karalis I, Timmermans MJ, Tuccillo A, Jukema JW, Derks L, Verbeek EC, Amoroso G, PCI Registration Committee of the Netherlands Heart Registration (NHR)
Objectives
While the transradial approach (TRA) is associated with fewer bleeding complications than the transfemoral approach (TFA), its effect on mortality outcomes in real-world clinical practice remains unclear. This study examines the relationship between vascular access site and mortality in patients undergoing percutaneous coronary intervention (PCI).
Methods
This retrospective cohort study used prospectively collected data from the Netherlands Heart Registration, including 130,813 PCI procedures between 2017 and 2021. The primary outcome was 30-day mortality and the secondary outcome was 1-year mortality. Outcomes were adjusted for baseline variables using multivariable logistic regression and propensity score matching.
Results
TFA was associated with significantly higher mortality at 30 days (odds ratio, 2.00; 95% CI, 1.78-2.25) and 1 year (odds ratio, 1.50; 95% CI, 1.39-1.61). Mortality benefits with TRA were pronounced in acute coronary syndrome and in patients 80 years or older, and were consistent across procedural volumes and center-level TRA adoption rates.
Conclusions
TRA is associated with lower short- and long-term mortality in PCI, supporting its broader adoption in routine clinical practice.
