1. Radial Approach:
An International Journey !
Olivier F. Bertrand, MD, PhD
Associate-Professor of Medicine, Laval University
Adjunct-Professor, Department of Mechanical Engineering, McGill University
Quebec Heart-Lung Institute
DUKE TRANSRADIAL ADVANCED COURSE,
20 OCTOBER 2011
Friday, October 21, 2011
2. Disclosures
Research grants: Cordis, Eli-Lilly, Bristol-
Myers-Squibb,GE Healthcare, Sanofi-
Aventis, Eurocor
Consultant: Cordis, Astra-Zeneca,
Opsens
Research-Scholar from Quebec
Foundation for Health Research
Friday, October 21, 2011
10. N = 1107
75 countries
01-08-2010
BERTRAND OF ET AL. JACC INTV 2010;3:1022-31
Friday, October 21, 2011
11. CAPUTO R ET AL. CCI 2011 (IN PRESS)
Friday, October 21, 2011
12. Quebec Heart-Lung Institute
91-93% RADIAL FOR
ANGIO AND PCI
1ST PTCA ALL PCI OPERATORS ALL OPERATORS ALL OPERATORS
7 FR 6 FR 6 FR 5-6 FR
FEMORAL KIT 19G NEEDLE ADHOC PCI SAME-DAY DISCHARGE
GB
ADAPTED FROM TIZON-MARCOS H. ET AL. (2009)
Friday, October 21, 2011
13. QHLI- RADIAL VS FEMORAL APPROACHES PER OPERATOR
Radial (%) Femoral (%)
100
16 14 12 10 9 8 8 7 7 6 5 2
98
94 95
92 92 93 93
90 91
88
86
84
75
50
VARIATION IN RADIAL USE IN STEMI
25 AMONG 12 OPERATORS
0
JR SR BN CN EL GP RL LR GB JPD OG OB
Friday, October 21, 2011
17. Meta-Analysis
Ischemic outcomes: All-cause death and the
combined incidence of Death-MI
Bleeding included both standardized and study-
specific definitions. Most definitions involved fatal or
intracranial bleeding, bleeding associated with Hb
drop ≥ 3 g/dl or ≥ 5 g/dl, or access-related bleeding
requiring transfusion or surgery
Transfusion rates
Early (≤ 30 days)
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18. Studies Selection
TOTAL OF 761,919
PATIENTS
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19. Impact on Bleeding
RANDOMIZED
OR 0.21 (95% CR I: 0.15-0.28) OR 0.27 (95% CR I: 0.08-0.47)
OBSERVATIONAL
Friday, October 21, 2011
20. Impact on Transfusion
RANDOMIZED
OR 0.19 (95% CR I: 0.09-0.30)
OBSERVATIONAL
OR 0.25 (95% CR I: 0.01-1.07)
Friday, October 21, 2011
21. Impact on Death (Early)
RANDOMIZED
OR 0.52 (95% CR I: 0.40-0.63)
OBSERVATIONAL
OR 0.80 (95% CR I: 0.49-1.23)
Friday, October 21, 2011
32. EASY-Bivalirudin To Reduce Bleeding (B2B)
Patients at high risk of non-access site bleeding ie ≥
2 risk-factors: Age > 70, female, CKD, recent GI or
organ bleeding, anemia, diabetes, prior GPI/Tnk.
≃ 2500 Transradial PCI
HEPARIN BIVALIRUDIN
1ST END-POINT: DEATH, MI, URGENT REVASCULARIZATION,
BARC BLEEDING 2,3,5 AT 30 DAYS FU
Friday, October 21, 2011
39. Conclusion: Think Different!
Transradial practice is already used worldwide
Use will likely continue to increase significantly
over next few years
Physicians = Education, EBM (Publications !!)
Health systems = Cost reduction
Patients = Qol, better outcomes
Still ways for improvement (RAO...)
Friday, October 21, 2011
40. IT IS NOT ABOUT YOU!!
IT IS ABOUT THE PATIENT AND
BETTER OUTCOMES...
“Great invention and I’d love to invest, but I can’t
spend time to learn how to use it and I never
have trouble getting places when I have to
anyway. I’ll just stick with what I’m doing…”
ADAPTED FROM I GILCHRIST
Friday, October 21, 2011
46. Objectives
To conduct a systematic review and
meta-analysis of all observational
studies and randomized trials
comparing TRA to FA for PCI
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47. PI: S. RAO, M. KRUCOFF
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48. JOLLY S ET AL. LANCET 2011, 377:1409-20
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49. JOLLY S ET AL. LANCET 2011, 377:1409-20
Friday, October 21, 2011
50. JOLLY S ET AL. LANCET 2011, 377:1409-20
Friday, October 21, 2011
51. JOLLY S ET AL. LANCET 2011, 377:1409-20
Friday, October 21, 2011
52. JOLLY S ET AL. LANCET 2011, 377:1409-20
Friday, October 21, 2011
53. JOLLY S ET AL. LANCET 2011, 377:1409-20
Friday, October 21, 2011