Effects of radial versus femoral artery access in patients with acute myocardial infarction: Alarge centre prospective registry.

S Kilic,E Kolkman,J H E Dambrink,A W J Van ’T Hof,R S Hermanides,E Kedhi,A T M Gosselink,J P Ottervanger,V Roolvink

doi:10.1007/s12471-016-0887-6

Abstract

AimThis study sought to assess whether radial artery access improves clinical outcomes in patients presenting with acute myocardial infarction compared with femoral artery access.MethodsThis is a single-centre, prospective observational registry of all STEMI and NSTEMI patients who underwent coronary angiography and/or primary PCI in the period January 2010 to December 2013. Primary endpoint was 30-day all-cause mortality. Choice of access was left to the discretion of the cardiologist. Differences in the risk of death at 30 days between patients undergoing transradial intervention versus transfemoral intervention was assessed on an intention-to-treat comparison.ResultsRetrospective analysis of prospectively collected data was performed in 3580 patients with an acute coronary syndrome who underwent coronary angiography, of which 1310 had radial artery access. PCI was performed in 77 % of the patients. Before propensity score matching, patients who underwent transradial intervention and those intended to undergo transfemoral approach differed significantly in intra-aortic balloon pump use (1.7 % vs. 6.7 %, p < 0.001), and Killip class (Killip 1: 10.8 % vs. 17.3 %, p < 0.001). 30-day mortality rates were 1.7 % in the transradial group and 4.6 % in the transfemoral group (p < 0.001). After matching on the propensity score, the hazard ratio for 30-day mortality in the transradial group was 0.56 (95 % CI: 0.29–1.07, p = 0.08).ConclusionThis registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome. However, this difference was no longer significant after multivariate and propensity score adjustment for differences in baseline characteristics.

Highlights

In patients with acute coronary syndrome (ACS), early and complete restoration of blood flow has been shown to improve long-term outcomes [1, 2]
1 Department of Cardiology, Isala Klinieken Zwolle, Zwolle, The Netherlands. This registry-based study showed that radial access is associated with improved outcome in patients with an acute coronary syndrome
All segment elevation myocardial infarction (STEMI) patients were directly transported to the catheterisation laboratory on arrival, and acute coronary angiography was performed with subsequent primary percutaneous coronary intervention (PCI) when indicated

Summary

Introduction

In patients with acute coronary syndrome (ACS), early and complete restoration of blood flow has been shown to improve long-term outcomes [1, 2]. For both diagnostic coronary angiography and percutaneous coronary intervention (PCI) a transradial approach to vascular access (transradial intervention) is rapidly becoming preferable to traditional transfemoral intervention [3, 4]. The use of radial access has been demonstrated to be feasible in the ACS setting and, compared with femoral access, a reduction in vascular complications and bleeding has been suggested [10, 11] Whether this evident reduction in access-site bleeding may have a positive impact on prevention of further cardiovascular events remains to be defined. The primary aim of this observational study was to evaluate the effect of radial artery access on 30-day allcause mortality in an unselected all-comer ST-segment elevation myocardial infarction (STEMI) and non-ST-segment

Methods

Results

Discussion

Conclusion