Mechanisms by which transradial approach may reduce mortality in ST-segment-elevation myocardial infarction.

Abstract

Radial access for central arterial catheterization was first described in 1948, but it was not until 1989 that Lucien Campeau published his experience of 100 successful coronary angiograms via the radial route.1 In 1993, the transradial approach for coronary angiography took a significant step forward when Kiemeneij and Laarman described the use of radial access for successful percutaneous coronary intervention (PCI).1 Since that time the use of the transradial approach for PCI has become increasingly popular, mainly because of improved patient comfort and observed reductions in periprocedural bleeding and vascular complications.2 Current use of transradial intervention (TRI) in the United States is 16%.3 Although still underused, TRI is becoming increasingly popular in the United States with a 13-fold increase during the past 6 years.3 Currently, TRI is considered not only an effective alternative to transfemoral intervention (TFI) but also in some instances the preferred approach. This may be particularly true in the setting of primary PCI because some studies have shown an association between TRI and reduced mortality when compared with the transfemoral approach. Although this association remains controversial, the purpose of this review is to propose and discuss the mechanisms for a potential reduction in mortality. The most important outcome measured in any cardiovascular study is the effect the intervention of interest has on mortality. Major adverse cardiac events (MACE), which is most commonly a composite of death, myocardial infarction (MI), or revascularization, is also an outcome of interest. Current data suggest that TRI when compared with TFI may be associated with a reduction in MACE and mortality in patients with ST-segment–elevation MI (STEMI). In a post hoc analysis of Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI), 30-day MACE was significantly lower in patients who underwent TRI when compared with …