Clinical outcomes of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

Abstract

Purpose: Transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI). However, it 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 clinical outcomes of the TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods: A total of 1,945 (8.9%) octogenarians were selected 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, or revascularization), and the death and total MACE at one-year were evaluated. Results: 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% vs 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). Conclusions: This study showed that, in octogenarians with acute MI who underwent PCI, TR approach was more effective for PCI than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.