Radial or femoral access in primary percutaneous coronary intervention (PCI): Does the choice matters?

Abstract

Background This study was conducted with the aim of providing a quantitative appraisal of clinical outcomes of trans-radial access for primary percutaneous coronary interventions (PCI) in patients with ST-segment evaluation myocardial infarction (STEMI). Methods In this study, we compared two propensity-matched cohorts of patients who underwent primary PCI via trans-radial (TRA) and trans-femoral access (TFA) in a 1:1 ratio. The profile of two cohorts was matched for gender, age, and body mass index, diabetes, hypertension, family history, and smoking. The outcomes of primary PCI were compared for the two cohorts which included all-cause in-hospital mortality, heart failure, re-infarction, cardiogenic shock, bleeding, transfusion, cerebrovascular accident, and dialysis. Results This analysis was performed on a total of 2316 patients with 1158 patients each in the TRA and TFA group. We observed significantly lower rates of mortality, 0.8% (9) vs. 3.5% (41); p < 0.001 and bleeding, 0.5% (6) vs.1.6% (19); p = 0.009 with shorter hospital stay, 1.61 ± 1.39 vs. 1.98 ± 1.5 days, in trans-radial vs. trans-femoral. However, both fluoroscopic time and contrast volume were significantly higher in the TRA as compared to TFA group 15.57 ± 8.16 vs. 12.79 ± 7.82 min; p < 0.001 and 143.22 ± 45.33 vs. 133.78 ± 45.97; p < 0.001 respectively. Conclusions Compared with TFA access, TRA for primary PCI is safe for patients with STEMI, it was found to be associated with a significant reduction in in-hospital mortality and bleeding complications.

Access route selection for percutaneous coronary intervention among Vietnamese patients: Implications for in-hospital costs and outcomes

“…Regarding post-procedural outcomes in hospital of patients undergoing PCI, similar findings were found in our study. While the reduction advantage of TRI in bleeding complications was reported in most previous studies [ [5] , [6] , [7] , 16 , 21 ], significant reduction of cardiovascular outcomes such as in-hospital mortality and MACE were also found in TRI group [ 7 , 16 ]. Additionally, patients undergoing TRI in India, China, Australia and USA were found to discharge earlier than their TFI counterparts (from 0.2 day to 2.3 days), which also contribute to the cost reduction [ 5 , 7 , 16 , 21 ].…”

“…While the reduction advantage of TRI in bleeding complications was reported in most previous studies [ [5] , [6] , [7] , 16 , 21 ], significant reduction of cardiovascular outcomes such as in-hospital mortality and MACE were also found in TRI group [ 7 , 16 ]. Additionally, patients undergoing TRI in India, China, Australia and USA were found to discharge earlier than their TFI counterparts (from 0.2 day to 2.3 days), which also contribute to the cost reduction [ 5 , 7 , 16 , 21 ]. Thus, our findings empirically support the recommendations of recent guidelines on adopting TRI in clinical and add economic evidence to promote the use of this approach in the community practice [ 22 , 23 ].…”

“…Compared with TFI, the use of TRI in PCI practice has received more support partly because it was shown to reduce the bleeding associated with access sites and PCI complications [ 1 , 15 , 16 ]. Although few studies have investigated cost differences between two different entry sites, among those reporting costs, similar results were reported.…”

Outcomes of Primary Percutaneous Coronary Intervention in Patients With a Thrombolysis in Myocardial Infarction Score of Five or Higher

“…The rate of adverse events in this cohort was relatively much higher than the outcomes of primary PCI that were previously reported in large registry-based studies from our population. The reported in-hospital rate of mortality and heart failure ranged from 2.2% to 3.04% and 0.7% to 0.9%, respectively, with cardiogenic shock up to 1.3% [ 16 - 18 ].…”

Transradial versus transfemoral approach in STEMI: Choice is with the operator

“…I have read with great interest the article entitled ‘‘Radial or Femoral Access in Primary Percutaneous Coronary Intervention (PCI): Does the Choice Matters?’’ by Batra et al. 1 The authors have compared clinical outcomes in patients of ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI by either Transradial access (TRA) or transfemoral access (TFA). They concluded that TRA had significant reduction in bleeding complications (0.5% vs 1.6%; p = 0.009) and in-hospital mortality (0.8% vs 3.5%; p < 0.001) as compared to TFA.…”