TY - JOUR AU - Chew D. AU - French J. AU - Brieger D. AU - Gamble G. AU - Briffa T. AU - Hyun K. AU - Hammett C. AU - Ellis C. AU - Brooks M. AU - Devlin G. AU - Elliott J. AU - Rankin J. AU - D'Souza M. AU - Redfern J AB -

BACKGROUND: There is wide variation in the use of radial over femoral access for patients with ACS. This study evaluates the factors associated with the selection of radial versus femoral angiography in Australia and New Zealand and the effect of access site on clinical events in acute coronary syndrome (ACS) patients. METHODS: An analysis of the SNAPSHOT ACS audit was conducted during May 2012 across 286 hospitals in Australia and New Zealand. Data collected included baseline patient characteristics, hospital site details, treatment received, clinical events in-hospital and mortality at 18 months. Univariate and multivariable analyses were performed. RESULTS: Of the 1621 patients undergoing coronary angiography, access was through the femoral artery in 1043 (63%), and the radial in 578 (36%) patients. Radial access dominated in New Zealand (241 out of 327, 73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with interstate variation (6% to 54%, p=<0.001). Independent predictors of access site included country of admission (Odds of radial, Aus v NZ OR 0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI 0.09-0.31, p=<0.0001), high GRACE score (90th decile) (OR 0.44, 95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After adjustment, there was no difference in clinical events in-hospital or mortality at 18 months CONCLUSION: Coronary angiography in New Zealand rather than Australia is the strongest predictor of radial access in ACS patients. There was no difference in outcomes according to access site in this population based cohort study.

AD - Concord Medical School, The University of Sydney, Sydney, NSW, Australia.
Department of Cardiology, Auckland City Hospital, Auckland, NZ.
Department of Medicine, University of Auckland, Auckland, NZ.
Cardiology, Waikato Hospital, Waikato, NZ.
Cardiology, Christchurch Hospital, Christchurch, NZ.
Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld., Australia.
Cardiology, Department of Cardiovascular Medicine, Flinders University, Adelaide, SA, Australia.
Coronary Care Unit, Liverpool Hospital, Sydney, NSW, Australia.
Cardiovascular Research Group, School of Population Health, University of Western Australia, Perth, WA, Australia.
Cardiovascular Division, The George Institute of Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
The George Institute for Global Health, Sydney, NSW, Australia.
Concordance Registry, Concord Hospital, Sydney, NSW, Australia.
Coronary Care and Coronary Intervention, Department of Cardiology, Concord Hospital, Sydney, NSW, Australia. Electronic address: dbrieger@uni.sydney.edu.au. AN - 27697388 BT - Heart, Lung & Circulation CN - [IF]: 1.438 DP - NLM ET - 2016/10/05 LA - Eng LB - AUS
CDV
FY16 N1 - Brooks, Mitchell
Ellis, Chris
Gamble, Greg
Devlin, Gerry
Elliott, John
Hammett, Chris
Chew, Derek
French, John
Briffa, Tom
Redfern, Julie
Rankin, Jamie
Hyun, Karice
D'Souza, Mario
Brieger, David
Australia
Heart Lung Circ. 2016 Aug 22. pii: S1443-9506(16)31532-3. doi: 10.1016/j.hlc.2016.06.1215. N2 -

BACKGROUND: There is wide variation in the use of radial over femoral access for patients with ACS. This study evaluates the factors associated with the selection of radial versus femoral angiography in Australia and New Zealand and the effect of access site on clinical events in acute coronary syndrome (ACS) patients. METHODS: An analysis of the SNAPSHOT ACS audit was conducted during May 2012 across 286 hospitals in Australia and New Zealand. Data collected included baseline patient characteristics, hospital site details, treatment received, clinical events in-hospital and mortality at 18 months. Univariate and multivariable analyses were performed. RESULTS: Of the 1621 patients undergoing coronary angiography, access was through the femoral artery in 1043 (63%), and the radial in 578 (36%) patients. Radial access dominated in New Zealand (241 out of 327, 73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with interstate variation (6% to 54%, p=<0.001). Independent predictors of access site included country of admission (Odds of radial, Aus v NZ OR 0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI 0.09-0.31, p=<0.0001), high GRACE score (90th decile) (OR 0.44, 95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After adjustment, there was no difference in clinical events in-hospital or mortality at 18 months CONCLUSION: Coronary angiography in New Zealand rather than Australia is the strongest predictor of radial access in ACS patients. There was no difference in outcomes according to access site in this population based cohort study.

PY - 2016 SN - 1444-2892 (Electronic)
1443-9506 (Linking) T2 - Heart, Lung & Circulation TI - A Comparison of Radial and Femoral Coronary Angiography in Patients From SNAPSHOT ACS, a Prospective Acute Coronary Syndrome Audit in Australia and New Zealand Y2 - FY17 ER -