Abstract
Background: The transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI), but is more technically challenging and associated with failure in elderly patients because the elderly may be associated with advanced vascular disease with tortuosity of subclavian artery, aortic root dilation and calcification, and diffuse atherosclerosis. We compared the results of TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods and Results: A total of 1,945 (8.9%) octogenarians were enrolled from 21,815 patients in the Korea Working Group on Myocardial Infarction Registry. TR group was consisted of 336 (17.3%) patients and TF group 1,609 (82.7%) patients. Procedural success and complications, door-to-balloon-time, in-hospital mortality and major adverse cardiovascular event (MACE, defined as death, MI, and revascularization) as well as those of one-year were evaluated. TR group had lower Killip class, but used more drug-eluting stents and longer stents compared to TF group. Extent of coronary disease and lesion severity were similar in both groups. Procedural success was not different (97.7% vs 98.3%), but in-hospital complications were significantly lower in TR group (8.1% versus 20.3%, p<0.0001). Door-to-balloon time was not different in both groups (84.5 vs 87.0 minutes, p=0.372) in 1,170 (60.2%) patients with ST-segment elevation MI. In-hospital mortality and MACE were significantly lower in TR group compared to TF group (3.4% vs 11.4%, p<0.0001; 3.4% vs. 11.4%, P<0.0001, respectively). One-year mortality and MACE were also lower in TR group (9.8% vs. 18.4%, p<0.0001; 13% vs. 21.9%, p=0.001, respectively). Conclusion: This study shows that, in octogenarians with acute MI who underwent PCI, TR approach for PCI was more effective than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.
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