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

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.

Clinical factors associated with physician choice of femoral versus radial access: A real‐world experience from a single academic center

“…Radial access as the initial choice of vascular access has been increasing in coronary interventional procedures mainly due to decreased incidence of vascular complications and improved patient outcomes when compared to femoral access. 2,5 It has also been suggested that radial approach is more cost effective (in terms of shorter hospital stays and less access site complications) translating to better cost effectiveness. 7 Our retrospective study gives a sample of a real world patient characteristics that influence physician preference of initial femoral versus radial access, and could be helpful in the absence of specific guidelines.…”

“…Radial access as the initial choice of vascular access has been increasing in coronary interventional procedures mainly due to decreased incidence of vascular complications and improved patient outcomes when compared to femoral access . It has also been suggested that radial approach is more cost effective (in terms of shorter hospital stays and less access site complications) translating to better cost effectiveness .…”

“…In the last few decades, there has been a trend toward increasing radial access in cardiac catheterization. When compared to femoral access, radial access has been shown to have decreased bleeding risk and vascular complications, in addition to improved patient comfort . In patients presenting with ST‐elevation myocardial infarction (STEMI), radial access has been shown to have improved outcomes in terms of mortality and access site complications .…”

Concomitant multi-vessel disease is associated with a lower procedural death rate in patients treated with percutaneous coronary interventions within the left main coronary artery (from the ORPKI registry)

“…It has been proven that femoral access is associated with poorer clinical outcomes in patients with ACS treated using PCI [21]. This could be explained mostly by the fact that patients with femoral access are often in a severe clinical state and undergo more complicated and demanding procedures.…”

Routine preprocedural ultrasound in palpation versus ultrasound guided radial access for cardiac catheterization

“…The radial artery (RA) has gained worldwide popularity as the preferred vascular access for cardiac catheterization procedures, 1–5 offering advantages such as reduced cost, bleeding, and complications, along with improved patient comfort and early ambulation, as supported by systematic reviews and meta‐analyses 6,7 . However mastering RA access can be challenging due to its steep learning curve 8 .…”