***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Limited information is available about clinical outcomes following routine percutaneous coronary intervention ( PCI ) in the current era . This study aim ed to identify predictors of adverse clinical or angiographic complications following  PCI in patients from many different countries . METHODS RIVIERA is a multinational , prospect i ve , observational study in patients undergoing elective or primary PCI . Consecutive patients ( n=7962 ) were enrolled in 144 hospitals from 23 countries in four different continents . Primary outcome was death or myocardial infa rct ion ( MI ) .  The mean age of the patients was 59 years and 77 % were men ; 92 % of patients underwent elective and 8 % primary PCI .  RESULTS The rate of in-hospital outcomes was low : death 0.3 % , MI 1 % , any bleeding 3.4 % . Angiographic complications occurred in 8.7 % of patients , mainly coronary dissection ( 3.7 % ) and no reflow ( 2 % ) . After multivariable analysis , the strongest independent predictors of death or MI were clinical presentation with non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infa rct ion and administration of a glycoprotein ( GP ) IIb/IIIa inhibitor . Radial access , thienopyridine pretreatment and anticoagulation with enoxaparin were associated with a lower risk of death or MI . Female gender , PCI of coronary artery bypass graft , administration of a GP IIb/IIIa inhibitor and combined use of enoxaparin and unfractionated heparin were significantly associated with more bleeding . Radial access was the only variable associated with less bleeding . CONCLUSIONS Routine PCI appears to be a relatively safe revascularization procedure . Many of the variables identified as predictors of adverse cardiac outcomes confirm results obtained in recent r and omized PCI trials and are modifiable , suggesting that further improvements can be made Transradial coronary intervention ( TRI ) can be performed in elective patients with low incidence of access site complications . However , the feasibility of primary stent implantation by TRI is still not clear in patients with acute myocardial infa rct ion ( AMI ) . We prospect ively r and omized 149 patients out of 213 patients with AMI within 12 hr from onset into two groups : 77 patients treated by TRI ( TRI group ) and 72 patients by transfemoral coronary intervention ( TFI ; TFI group ) . We compared the incidences of major adverse cardiac events ( MACE ; repeat MI , target lesion revascularization , and cardiac death ) during the initial hospitalization and 9‐month follow‐up periods in both groups . There were one patient who crossed over to the opposite arm , and two patients with severe bleeding complications in the TFI group . Background characteristics of patients were similar between the two groups . The success rate of reperfusion and the incidence of in‐hospital MACE were similar in both groups ( 96.1 % and 5.2 % vs. 97.1 % and 8.3 % in TRI and TFI groups , respectively ) . In selected patients with AMI  , primary stent implantation  by TRI is feasible as compared to TFI . Cathet Cardiovasc Intervent 2003;59:26–33 . © 2003 Wiley‐Liss , This prospect i ve multicenter study was conducted to compare the incidence of significant vascular complications delaying hospital discharge after coronary angiography and percutaneous coronary intervention ( PCI )  between the radial approach ( n = 192 ) and the femoral approach ( n = 185 ) in octogenarians , a rapidly growing population with numerous risk factors for complications . By intention-to-treat analysis , the incidence of vascular complications was found to be significantly less in the radial group ( 1.6 % vs 6.5 % , p = 0.03 ) , without any decrease in the efficacy of PCI  and only a slight increase in procedure duration for coronary angiography . All vascular complications , except for 1 , occurred in patients treated with the transfemoral approach BACKGROUND Transradial percutaneous coronary intervention ( PCI ) results in fewer vascular complications , earlier ambulation , and improved patient comfort . Limited data exist for radial access in acute myocardial infa rct ion , where reperfusion must occur quickly . METHODS In a multicenter pilot trial , 50 patients with myocardial infa rct ion requiring either primary or rescue PCI  were r and omized to radial or femoral access . All operators had previously performed at least 100 transradial cases . Procedure times were prospect ively recorded . RESULTS Thrombolysis was used in 66 % of the cases and glycoprotein IIb/IIIa inhibitors in 94 % . Crossover from radial to femoral access was required in one case . Percutaneous coronary intervention was performed in 47 patients , with stenting in 45 . One procedural failure occurred with radial access because of inability to cross the occlusion . The time from local anesthesia to first balloon inflation was 32 ( 25th percentile 26 , 75th percentile 38 ) minutes for radial access and 26 ( 22 , 33 ) minutes for femoral access ( P = .04 ) . There were no significant differences in contrast use or fluoroscopy time . No patient experienced major bleeding or required transfusion . Doppler studies demonstrated 2 asymptomatic radial occlusions and 2 pseudoaneurysms ( 1 from each group ) . One patient in the femoral group died 2 days after PCI . At 30 days , there were no strokes or reinfa rct ions and no patient required bypass surgery or repeat PCI . CONCLUSIONS Primary and rescue PCI can be performed with high success rates using either radial or femoral access . Although radial access was associated with a longer time to first balloon inflation , the difference was small and likely not clinical ly significant . In patients without shock , major bleeding and vascular complications are infrequent with either access site despite the high use of thrombolysis and glycoprotein IIb/IIIa inhibitors Radial access and closure devices are associated with improved quality of life ( QOL )  after cardiac catheterization . Whether this is related to the access site or time to ambulation is unknown . Seventy‐five patients undergoing cardiac catheterization were r and omized to femoral 6 Fr with AngioSeal closure ( F+C ) , femoral 4 Fr without closure , and radial ( R ) access . All patients were ambulated at 1 hr . QOL was measured utilizing visual analogue scales and Short Form‐36 at baseline , 1 day , and 1 week . Time to ambulation and discharge were equivalent , as was postprocedure QOL . However , angiographic quality was lower in the 4 Fr group ( P < 0.0001 ) and catheterization costs were higher in the F+C group ( P < 0.0001 ) . Ambulation 1 hr after catheterization can be accomplished utilizing radial , femoral 6 Fr with closure device , or femoral 4 Fr access with equivalent outcomes and QOL . However , this is achieved at a higher cost with a closure device , or lesser angiographic quality with 4 Fr catheters . Catheter Cardiovasc Interv 2004;62:143–149 . © 2004 Wiley‐Liss , OBJECTIVES This study sought to compare procedural and clinical outcomes of percutaneous transluminal coronary angioplasty ( PTCA )  performed with 6F guiding catheters introduced through the radial , brachial or femoral arteries . BACKGROUND Transradial PTCA has been demonstrated to be an effective and safe alternative to transfemoral PTCA ; however , no r and omized data are currently available . METHODS A r and omized comparison between transradial , transbrachial and transfemoral PTCA with 6F guiding catheters was performed in 900 patients . Primary end points were entry site and angioplasty related . Secondary end points were quantitative coronary analysis after PTCA , procedural and fluoroscopy times , consumption of angioplasty equipment and length of hospital stay . RESULTS Successful coronary cannulation was achieved in 279 ( 93.0 % ) , 287 ( 95.7 % ) and 299 ( 99.7 % ) patients r and omized to undergo PTCA by the radial , brachial and femoral approaches , respectively . PTCA success was achieved in 91.7 % , 90.7 % and 90.7 % ( p = NS ) of patients , with 88.0 % , 87.7 % and 90.0 % event free at 1-month follow-up , respectively ( p = NS ) . Major entry site complications were encountered in seven patients ( 2.3 % ) in the transbrachial group , six ( 2.0 % ) in the transfemoral group and none in the transradial group ( p = 0.035 ) . Transradial PTCA led to asymptomatic loss of radial pulsations in nine patients ( 3 % ) . Procedural and fluoroscopy times were similar , as were consumption of guiding and balloon catheters and length of hospital stay ( [ mean + /- SD ] 1.5 + /- 2.5 , 1.8 + /- 3.8 and 1.8 + /- 4.2 days , respectively ) . CONCLUSIONS With experience , procedural and clinical outcomes of PTCA were similar for the three subgroups , but access failure is more common during transradial PTCA . Major access site complications were more frequently encountered after transbrachial and transfemoral PTCA In a previous study , the radial approach for coronary angiography was shown to be associated with a lower success rate and longer procedural and X‐ray times compared to the femoral approach . However , this approach is associated with a steep learning curve . A series of 210 consecutive nonselected patients were r and omized to  femoral versus right radial approach or femoral versus left radial approach  by two experienced operators . Clinical characteristics were similar in the three groups . Technical failure occurred in one patient in the right radial group with subsequent crossover to left radial artery . The number of coronary catheters used was lower in the right radial group ( 1.4 ± 0.7 vs. 2.1 ± 0.4 for the two other groups ) . The procedural duration was longer with left radial ( 14.2 ± 3.3 min ; P < 0.05 ) approach than with right radial ( 12.4 ± 5.8 min ) and femoral ( 11.2 ± 3.3 min ) without significant differences between femoral and right radial . X‐ray exposure was shorter in the femoral group ( 3.1 ± 1.7 min ) than in both radial groups ( right : 3.8 ± 2.2 min ; left : 4.2 ± 1.7 min ) . The angiographic quality was not different between the three groups for RCA , but was less good for LCA through right radial approach . Bed rest and hospital stay were shorter in the two radial groups . The comfort was judged better with the transradial approach . An ad hoc PTCA was performed in 45.7 % of femoral patients , 41.4 % of right radial , and 44.3 % of left radial with immediate sheath withdrawal ( closure device for femoral group ) . There were no severe complications in the three groups , but two patients from the femoral group were discharged later because of vascular complications . The total cost of coronary angiography was higher in the femoral group . In conclusion , after the learning period , transradial coronary angiography can be performed with a high success rate , low rate of complication , and good angiographic quality . It is associated with a slight increase in procedural ( LR ) and fluoroscopy times , but permits earlier ambulation and discharge , improves patient comfort , and reduces the cost . Cathet Cardiovasc Intervent 2001;52:181–187 . © 2001 Wiley‐Liss , Objective : To compare bleeding complications and results of percutaneous coronary intervention ( PCI ) between patients treated by radial and femoral approaches for acute myocardial infa rct ion ( AMI , ) and using abciximab and 5 French guiding-catheters . Patients : 114 consecutive patients with AMI were prospect ively r and omised . Exclusion criteria were a history of coronary artery bypass graft , cardiogenic shock , atrioventricular block , and contraindication to abciximab or a negative Allen test . Local haemostasis was achieved by manual compression . Results : Baseline characteristics were similar between the two groups . Peripheral arterial complication rates and delays to patient ambulation were significantly lower in the radial group than in the femoral group , whereas in-hospital stay was similar between the two groups . A cross over was more often necessary in the radial group than in the femoral group .  Coronary angiography duration and fluoroscopy time were significantly longer in the radial group than in the femoral group , whereas PCI duration was similar in both groups . Conclusions : The FARMI trial showed that the radial route lowered peripheral arterial complication rates and allowed earlier ambulation , despite no significant benefit on the duration of hospitalisation Background : Bleeding and transfusion after  percutaneous coronary intervention ( PCI )  are known predictors of mortality . Transradial arterial access reduces bleeding and transfusion related to femoral access complications , although its association with mortality is unknown . Objective : To determine the association of arterial access site ( radial or femoral ) with transfusion and mortality in unselected PCIs . Design , setting and patients : By data linkage of three prospect ively collated provincial registries , 38 872 procedures in 32 822 patients in British Columbia were analysed . The association between access site , transfusion and outcomes was assessed by logistic regression , propensity score matching and probit regression . Main outcome measures : 30-Day and 1-year mortality . Results : 1134 
    Output:
    
Radial access reduced major bleeding and there was a corresponding trend for reduction in ischemic events compared to femoral access .