17th Interventional Cardiology Workshop New Frontiers in Interventional Cardiology: December 8th, 2016, Krakow, Poland.

Abstract

BackgroundThe utilization of the radial access (RA) for percutaneous coronary intervention (PCI) has gradually increased. Recent studies suggest an advantage over femoral access (FA) in high-risk patients presenting with ST-segment elevation myocardial infarction (STEMI). The aim was to evaluate bleeding complications and periprocedural outcomes with safety and efficacy of RA compared with FA for PCI with stent implantation in “real-world” patients with STEMI presentation from Polish National Registry.MethodsThe study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centers in Poland. All data were stored in electronic database of National PCI Registry (ORPKI). Patients treated with RA and FA were compared using a propensity score analysis to best match between groups. The analysis was done in the “as-treated” manner.ResultsFemoral access and RA were used in 9,334 (40.9%) and 13,478 (59.1%) patients, respectively. After propensity score matching no differences in baseline characteristic between 6,542 matched pairs was found. Significantly higher total amount of contrast (191.8 ±8 ml vs. 174.8 ±68.8 ml, p = 0.0001) and lower radiation doses were used in FA (1279.5 ±1346.3 mGy vs. 1182.6 ±887 mGy, p = 0.02). More bleeding complications at puncture site after both angiography (0.17% vs. 0.02%; p = 0.004) and PCI (0.23% vs. 0.09%, p = 0.049) were reported in FA group. Periprocedural death (1.94% vs. 0.93%, p = 0.0001) and periprocedural cardiac arrest (1.44% vs. 0.96%, p = 0.01) occurred significantly more often after PCI performed with FA.ConclusionsRadial access was associated with lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at access site.