A RANDOMIZED COMPARISON OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY BY THE RADIAL, BRACHIAL AND FEMORAL APPROACHES - THE ACCESS STUDY

Objectives. This study sought to compare procedural and clinical outco mes of percutaneous transluminal coronary angioplasty (PTCA) performed with 6F guiding catheters introduced through the radial, brachial or femoral arteries. Background. Transradial PTCA has been demonstrated t o be an effective and safe alternative to transfemoral PTCA; however, no randomized data are currently available. Methods. A randomized comp arison between transradial, transbrachial and transfemoral PTCA with 6 F guiding catheters was performed in 900 patients. Primary end points were entry site and angioplasty related. Secondary end points were qua ntitative coronary analysis after PTCA, procedural and fluoroscopy tim es, consumption of angioplasty equipment and length of hospital stay. Results. Successful coronary cannulation was achieved in 279 (93.0%), 287 (95.7%) and 299 (99.7%) patients randomized to undergo PTCA by the radial, brachial and femoral approaches, respectively. PTCA success w as achieved in 91.7%, 90.7% and 90.7% (p = NS) of patients, with 88.0% , 87.7% and 90.0% event free at 1-month follow-up, respectively (p = N S). Major entry site complications were encountered in seven patients (2.3%) in the transbrachial group, six (2.0%) in the transfemoral grou p and none in the transradial group (p = 0.035). Transradial PTCA led to asymptomatic loss of radial pulsations in nine patients (3%). Proce dural and fluoroscopy times were similar, as were consumption of guidi ng and balloon catheters and length of hospital stay ([mean +/- SD] 1. 5 +/- 2.5, 1.8 +/- 3.8 and 1.8 +/- 4.2 days, respectively). Conclusion s. With experience, procedural and clinical outcomes of PTCA were simi lar for the three subgroups, but access failure is more common during transradial PTCA. Major access site complications were more frequently encountered after transbrachial and transfemoral PTCA. (C) 1997 by th e American College of Cardiology.