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. 2021 Jul;14(7):e009328.
doi: 10.1161/CIRCINTERVENTIONS.120.009328. Epub 2021 Jul 13.

Transradial Access for High-Risk Percutaneous Coronary Intervention: Implications of the Risk-Treatment Paradox

Amit P Amin  1   2 , Sunil V Rao  3 , Arnold H Seto  4 , Manoj Thangam  1   2 , Richard G Bach  1   2 , Samir Pancholy  5 , Ian C Gilchrist  6 , Prashant Kaul  7 , Binita Shah  8 , Mauricio G Cohen  9 , Ty J Gluckman  10 , Anna Bortnick  11 , James T DeVries  12 , Hemant Kulkarni  13 , Frederick A Masoudi  14
Affiliations

Transradial Access for High-Risk Percutaneous Coronary Intervention: Implications of the Risk-Treatment Paradox

Amit P Amin et al. Circ Cardiovasc Interv. 2021 Jul.

Abstract

[Figure: see text].

Keywords: acute kidney injury; hemorrhage; hospitals; incidence; percutaneous coronary intervention.

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Figures

Figure 1.
Figure 1.. Risk-treatment paradox in transradial percutaneous coronary intervention (TRI).
TRI use by estimated preprocedural risks of (A) bleeding, (B) acute kidney injury (AKI), and (C) mortality. The bars are color coded to indicate the risk categories (low-risk [blue], moderate risk [orange], and high-risk [red] groups). Open and filled bars indicate the use of TRI before and since 2015, respectively.
Figure 2.
Figure 2.. Differential association of transradial percutaneous coronary intervention (PCI; TRI) with adverse outcomes on the backdrop of baseline risk.
Results are shown for (A) bleeding, (B) acute kidney injury (AKI), and (C) death. The bar charts show the event rate in the TRI (green bars) and transfemoral PCI (TFI; gray bars) groups. Bar charts show the event rates separately in the low-risk (blue), moderate risk (orange), and high-risk (red) groups. The absolute risk reduction (ARR) is shown in the forest plot (diamonds show the point estimate and error bars represent the 95% CI). The ARR and error bars are color matched with the baseline risk groups. In each forest plot are also shown the estimated number needed to treat (NNT) to prevent one occurrence of the outcome. Pint, significance of interaction between TRI and risk strata obtained by comparing likelihood ratio χ2 values for logistic models with and without the interaction term for the indicated outcome.
Figure 3.
Figure 3.. Modeling analyses of the impact of transradial percutaneous coronary intervention (PCI; TRI) practice change on outcomes in high-risk patients.
Model projections are for anticipated changes in outcomes of (A) bleeding, (B) acute kidney injury (AKI), and (C) death by varying proportion of TRI and high-risk patients. To generate the plots, observed event rates were used to model the projected change in the average incidence of an outcome. Two predictors were used–p(high-risk [HR]), the proportion of patients belonging to the HR group (varied over a range of 0.1–0.5) and the proportion of TRIs (varied over the entire range of 0 through 1, shown on x axis).
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