Long-term mortality in women with myocardial infarction who underwent PCI using radial versus femoral access

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Abstract Background Radial artery approach (RA) has become the recommended vascular access for percutaneous coronary intervention (PCI). In particular, women are at higher risk of bleeding after PCI. RA reduces the risk of bleeding. However, data on the association between RA and mortality after MI in women undergoing PCI are sparse and long-term data are lacking. Purpose The aim of our study was to assess whether RA per se is associated with long-term mortality in women with MI who underwent PCI at our center. Methods We retrospectively studied 1528 consecutive female patients with MI who underwent PCI between January 2011 and December 2017. RA was performed in 573 (37.5%) patients. Long-term all-cause mortality was observed in the RA and femoral access (FA) groups. The median follow-up time was 3.0 (25th, 75th percentile; 1, 5) years. Data were analyzed using descriptive statistics. Results RA patients had significantly lower long-term unadjusted mortality [107 (18.7%) patients died in the RA group compared to 311 (32.6%) patients in the FA group; p<0.0001] (Figure 1). After adjusting for confounders, the RA patients still had more than a 20% lower mortality risk than the FA patients (adjusted HR: 0.78; 95% CI: 0.62 to 0.99; p=0.042) (Figure 2). Age, diabetes, hypertension, renal function, ST-elevation MI, TIMI flow after PCI, dual antiplatelet therapy, and bleeding additionally predicted mortality. Conclusion RA independently provided a lower long-term all-cause mortality risk in women with MI (ST-elevation MI and non-ST-elevation MI) who underwent PCI. This finding suggests that RA should be preferred in daily practice whenever possible. From a clinical perspective, it is irrelevant whether RA per se is associated with a better outcome or whether the better outcome is related to fewer bleeding events and lower rates of other complications due to RA. This is especially true for patients at higher risk of bleeding (women, elderly patients, underweight patients, and patients with renal dysfunction). Funding Acknowledgement Type of funding sources: None. Figure 1. Unadjusted long-term mortalityFigure 2. Adjusted long-term mortality