The most common type of heart disease occurs when blood vessels that supply the heart become too narrow to deliver adequate blood. When such disease cannot be controlled with medications, doctors may suggest a procedure to open the blocked blood vessel. This
procedure is called a percutaneous coronary intervention – or
Similar to the repair of a clogged pipe, the PCI opens the blocked blood vessel to allow better blood flow to the heart. Developed by cardiologists in Georgia, PCIs are now common, with more than 600,000 done in the U.S. yearly.
PCIs have traditionally been performed through a small incision in the groin, and the most frequent complications are bleeding and damage to surrounding blood vessels.
Recently, cardiologists have been able to perform the procedure using a new approach: a small incision near the wrist rather than the groin.
A new study published in the heart journal Circulation shows that the wrist approach is growing in use and has a lower rate of complications.
Dr. Dmitriy Feldman, assistant professor of medicine at Cornell University, and colleagues analyzed nearly 3 million PCIs performed between 2007 and 2012 in a large national database maintained by the American College of Cardiology.
They compared procedures that were performed with a wrist incision vs. those performed with a groin incision. They found that in 2007 fewer than 2 percent of the PCIs used the wrist approach. By 2012, one in every six used the procedure.
During this time, PCIs performed using the wrist had better outcomes for patients, cutting the rates of bleeding and blood-vessel complications in half while maintaining the same rate of success. These findings held true even after adjusting for differences in age and degree of illness among patients.
Unfortunately, all patients may not be candidates for the wrist approach because of the size of blood vessels in their wrist and the type of PCI being performed.
Also, because the wrist approach is a newer technique, not all cardiologists are trained to perform it.
Going forward, more PCIs will likely be performed through the wrist and patients can look forward to a reduced likelihood of complications.