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The Influence of Radial vs. Femoral Access on Acute Blood Loss in Patients Undergoing Percutaneous Coronary Intervention Amit Nanda 1, Eric Novak MS 2, Eesha Kelkar, Mary Caruso RN 2, Adam C. Salisbury MD MS 1, Jasvindar Singh MD 2 and Amit P. Amin MD MS 2 1 UMKC School of Medicine, Kansas City, MO 2 Washington University School of Medicine, St. Louis, MO BACKGROUND We retrospectively identified 3,557 patients from a single hospital, undergoing PCI via radial and femoral approaches. Time period: Dec 1st 2011- Jan 31st 2014. Hemoglobin values before and after the PCI were recorded and the difference in hemoglobin was calculated as pre post hemoglobin. RESULTS II LIMITATIONS OBJECTIVE Our objective was to determine if Radial PCI is associated with lower acute blood loss than Femoral PCI. CONCLUSIONS Observational study. Single center study, limited generalizability to other hospitals. Residual confounding and selection bias cannot be excluded. Acute blood loss and anemia are common after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Acute blood loss after AMI and PCI is associated with higher morbidity and mortality. Although radial PCI reduces bleeding and vascular complications, whether it is independently associated with less blood loss is unknown. Radial PCI is independently associated with a smaller volume of acute blood loss than femoral PCI. Radial PCI appears to be less invasive than femoral PCI and could represent the access of choice in those who are anemic at baseline. Further research is required to ascertain if lower blood loss with radial PCI translates into, and is the mechanism responsible for improved outcomes after Radial PCI. DISCLOSURES Dr. Amin is a consultant to Astra Zeneca, Terumo Corporation and the Medicines Company. STUDY DESIGN RESULTS I The difference in hemoglobin drop by radial vs. femoral procedure was compared via the univariate Students t-test. A multivariable generalized estimating equation (GEE) model using robust standard errors to account for clustering within hemoglobin pre- and post-PCI values was developed. This model examined the drop in hemoglobin attributable to Radial vs. Femoral PCI, after adjusting for socio- demographic characteristics, risk factors and comorbidities. Most importantly, this model also adjusted for established confounders of overt bleeding and transfusion as well as the ceiling effect due to extremely high hemoglobin values > 16 g/dL at baseline. Radial PCI was performed in 148 (5%) of procedures. The mean hemoglobin drop after PCI was 1.18 g/dl for the entire cohort. The mean hemoglobin drop in those undergoing radial PCI was 0.95 g/dL as compared to 1.19 g/dL for femoral PCI, a difference of 0.24 g/dL, P-value < 0.01. When adjusted for all the comorbidities and patient and procedural characteristics, the mean hemoglobin drop was still lower by 0.20 g/dL in the radial group as compared to femoral group (95% CI -0.37 to -0.03 g/dL, P-value 0.019) STATISTICAL METHODS Fig 2: Independent predictors of hemoglobin drop after PCI