Complete transitioning to the radial approach for primary percutaneous coronary intervention: a real-world single-center registry of 1808 consecutive patients with acute ST-elevation myocardial infarction.

Abstract

OBJECTIVES:

To compare the short- and long-term outcomes of transradial approach (TRA) versus transfemoral approach (TFA) for primary percutaneous coronary intervention (PPCI) during a complete institutional transition from TFA to TRA.

METHODS AND RESULTS:

An all-comer population of ST-elevation myocardial infarction (STEMI) patients (n=1808) who underwent PPCI using TRA (n=1162) and TFA (n=646) from October 2007 to December 2010 were enrolled. TRA was used in 25% of PPCIs by 2007 and in 96% of PPCIs in 2010. Primary endpoints were cardiovascular death and major adverse cardiac event (MACE), defined as a composite of death, stroke, reinfarction, and target vessel revascularization at 30 days and 1 year. At 30 days, TRA compared to TFA was associated with a significant reduction of cardiovascular mortality (5.2% vs 10.5%; P<.001), significant MACE reduction (7.3% vs 12.5%; P<.001), fewer access-site complications (0.9% vs 8.2%; P<.001), and lower TIMI major bleeding (1.1% vs 4.3%; P<.001). At 1 year, the cardiovascular mortality and MACE rates were also in favor of the TRA group (6.9% vs 11.5%; P<.001 and 11.6% vs 20.1%; P<.001), respectively.

CONCLUSION:

Complete transition from femoral access to a preferred radial access is safe and effective for STEMI patients undergoing PPCI, with a favorable effect on short- and long-term outcomes.

• Authors: Sasko Kedev, Oliver Kalpak, Surya Dharma, Slobodan Antov, Jorgo Kostov, Hristo Pejkov, Igor Spiroski
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 26 Issue 9 Pg. 475-82 (Sep 2014) ISSN: 1557-2501 [Electronic] United States
• PMID: 25198492 (Publication Type: Comparative Study, Journal Article, Observational Study)

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors

Topics

• Aged
• Anticoagulants (therapeutic use)
• Cohort Studies
• Death, Sudden, Cardiac (epidemiology)
• Electrocardiography
• Female
• Femoral Artery
• Hemostasis, Surgical
• Humans
• Incidence
• Male
• Middle Aged
• Myocardial Infarction (physiopathology, therapy)
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (therapeutic use)
• Radial Artery
• Registries
• Retrospective Studies
• Stroke (epidemiology)
• Treatment Outcome