LAUSR

The trans-radial approach (TRA) has been increasingly adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. To assess the temporal trends of TRA PCI in a single tertiary center over a decade. From a database of 21,763 consecutive PCI's, we analyzed 15,429 patients in 2 periods – 2008 to 2012 (period 1) and 2013 to 2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes and adjusted long-term effects. The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA vs. TFA (1.8% vs. 5.1%, overall, p<0.001), as were rates of additional bleeding events in the following 12 months (1.3% vs. 2.4%, p<0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization or coronary artery bypass surgery [at 4 years, HR-0.86 (95% CI 0.77–0.96 p=0.007) during period 1 and HR-0.62 (95% CI 0.55–0.7 p<0.0001) during period 2, figure 1]. Interaction analysis showed a stronger effect at the latter period (HR-0.69, 95% CI 0.59–0.81, p<0.001). Figure 1 Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients- a course which is associated with consistent short and long-term clinical benefits.