Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry.

Abstract

Recent randomized clinical trials demonstrated that transradial approach was a preferred approach for primary percutaneous coronary intervention (PCI) in ST-elevation acute myocardial infarction (STEMI). However, clinical outcomes of transradial approach in STEMI have not been adequately evaluated yet in the real-world practice, which includes hemodynamically unstable high-risk patients. We identified 3662 STEMI patients who had primary PCI within 24h after symptom onset and were treated by transradial (N=471) or transfemoral (N=3191) approach in the CREDO-Kyoto AMI registry. In the current analysis, we compared clinical characteristics and long-term outcomes between the 2 groups of patients treated by transradial approach and transfemoral approach. The prevalence of hemodynamically compromised patients (Killip II-IV) was significantly less in the transradial group than in the transfemoral group (19 vs. 25%, P=0.002). Cumulative 5-year incidences of death/MI/stroke, and major bleeding were not significantly different between the transradial and transfemoral groups (26.7 vs. 25.9%, log-rank P=0.91, and 11.3 vs. 11.5%, log-rank P=0.71, respectively). After adjustment for confounders, the risks of the transradial group relative to the transfemoral group were not significant for both death/MI/stroke [Hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.83-1.59, P=0.41] and major bleeding (HR 1.29, 95% CI 0.77-2.15, P=0.34). In the subgroup of hemodynamically compromised patients, there were also no significant differences in the risks for death/MI/stroke and major bleeding between the 2 groups. Clinical outcomes of transradial approach were not different from those of transfemoral approach in primary PCI for STEMI in the real-world practice.