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The Impact of Vascular Access for In-Hospital Major Bleeding in Patients with Acute Coronary Syndrome at Moderate- to Very High-Bleeding Risk

Authors
Park, Keun-HoJeong, Myung HoAhn, YoungkeunJung, Sang SikKim, Moo HyunYang, Hyoung-MoYoon, JunghanRha, Seung WoonPark, Keum SooHan, Kyoo RokCho, Byung RyulCha, Kwang SooKim, Byung OkHyon, Min SooShin, Won-YongChoe, HyunminBae, Jang-WhanKim, Hee Yeol
Issue Date
9월-2013
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Acute Coronary Syndrome; Radial Artery; Hemorrhage
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.28, no.9, pp.1307 - 1315
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
28
Number
9
Start Page
1307
End Page
1315
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/102319
DOI
10.3346/jkms.2013.28.9.1307
ISSN
1011-8934
Abstract
The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate-to very high-bleeding risk.
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