Radial versus femoral access percutaneous coronary intervention in patients with acute myocardial infarction: Experience from a Southeast Asian country PCI registry

Abstract

IntroductionBleeding complications adversely affect patient’s outcomes following percutaneous coronary intervention (PCI). Radial approach PCI was advocated to overcome this complication. The information regarding the safety and feasibility of radial approach PCI in acute myocardial infarction (AMI) in the Southeast Asian population was limited. Hence, we sought to examine the outcome of radial versus femoral approach in this particular cohort.Materials and MethodsThis is an observational retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD – PCI) registry, recruiting patients with AMI from 2007 – 2014. Patients were stratified into radial and femoral groups depending on the PCI access route. The patient's baseline characteristics, lesion, and procedural data, complications, and outcomes are assessed accordingly.ResultsA total of 11,555 (4895 radial and 6660 femoral) cases were included in the analysis. In the radial group, there were predominantly more males (89.2%) with the younger patient (mean age 55.2 ± 10.5 years) as compared to the femoral group. They also had a higher body mass index (BMI) and taller. However, femoral group patients had significantly more premorbid conditions, namely diabetes mellitus, hypertension, previous stroke, heart failure, and chronic kidney disease. Complex lesions were similar in both groups with no difference in fluoroscopy time, although higher contrast load recorded in the femoral group. The adjusted odds ratio of developing in-hospital complications after femoral approach PCI compared to radial approach for death, MACE and vascular complications were OR: 8.21 95% CI 5.38 – 12.54, OR: 3.39 95% CI 2.51 – 4.58, OR: 1.79 95% CI 1.01 – 3.16 respectively. ConclusionPCI via the trans-radial approach has resulted in a significantly lower risk of vascular complications, MACE and death compared to the trans-femoral approach. Our study confirmed the superiority of the trans-radial approach in the setting of primary PCI in the Southeast Asian population and underscores the importance of trans-radial interventions to reduce bleeding complication rates.