Trans-radial versus femoral artery access for percutaneous coronary intervention in acute coronary syndrome: A reflection from a five-year experience in the MIG cohort

Abstract

Background: Recent studies demonstrate superior outcomes in regards to mortality, bleeding and vascular complications with trans-radial (TRA) compared to femoral approach (FA) particularly in the ST-elevation myocardial infarction (STEMI) population. We investigated the temporal trends in TRA utilisation over a five-year period in a contemporaneous Victorian cohort, and compared outcomes with FA cases. Method: Utilising prospectively collected data from patients with ACS managed with PCI in the Melbourne Interventional Group (MIG) registry centres between 2009 and 2013, TRA cases were compared to FA cases for patient characteristics, procedural variables and clinical outcomes. Results: The use of TRA increased significantly over the five-year period from 5.2% in 2009 to 37.0% in 2013 (p <0.001). TRA was used more frequently in males, and patients with peripheral vascular disease (p=0.02). TRA was more likely to be used in patients who had received thrombolysis or low-molecular weight heparin prior to PCI (p<0.001), although was less likely to be utilised in patients presenting with ST elevation myocardial infarction, out-of-hospital cardiac arrest or cardiogenic shock (p<0.001). TRA was associated with less post-procedural bleeding (p<0.001) and renal impairment (p=0.006). Multivariate logistic regression analysis demonstrated no difference in 12-month major adverse cardiovascular outcomes (MACE) or mortality between the TRA and FA groups. Conclusion: Across a five-year period there has been a marked increase in trans-radial PCI for ACS management, although TRA remains underutilised in STEMI patients. TRA is associated with reduced post-procedural bleeding and renal impairment with no compromise in cardiovascular outcomes.