Should radial artery access be the "gold standard" for PCI?

Hamon, Martial; Nolan, James

doi:10.1136/hrt.2008.148379

Cited by 18 publications

(10 citation statements)

References 33 publications

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“…Several reports have suggested the advantages of TRI for STEMI in terms of both reduction in site complications and lower reinfarction or mortality rates . To the contrary, several limitations in TRI have been reported such as longer door to balloon time and relatively high cross‐over rate of approach site .…”

Section: Discussionmentioning

confidence: 99%

“…Transradial intervention (TRI) has achieved widespread adoption as an approach site in percutaneous coronary intervention (PCI) . TRI has several advantages compared to transfemoral intervention (TFI), including a low rate of access site bleeding, shortened bed rest time, and earlier hospital discharge . Primary PCI for ST elevation myocardial infarction (STEMI) is known to have a high rate of bleeding complications, which along with the requirement for transfusion is reported as an independent predictor of mortality .…”

Section: Introductionmentioning

confidence: 99%

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Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Fujii

Masuda

Ijichi

et al. 2013

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Fujii

Masuda

Ijichi

et al. 2013

Cathet Cardio Intervent

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show abstract

“…In fact, the use of glycoprotein IIb/IIIa inhibitors and clopidogrel is advised as a class I recommendation in current guidelines for management of ACS, but their wide use increases the risk of perivascular and systemic bleeding. In addition, when femoral access is used, the sheath is frequently removed several hours after the procedure, further raising the risk for local complications [2].…”

Section: Introductionmentioning

confidence: 99%

Transradial versus transfemoral approach for percutaneous coronary procedures

Franchi¹,

Marino²,

Biondi‐Zoccai³

et al. 2009

Curr Cardiol Rep

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Selective coronary angiography was originally performed through open brachial arteriotomy. Thereafter, the percutaneous Seldinger technique and the use of preformed Judkins-type catheters popularized the femoral approach. More recently, after the first report of successful coronary angiography by the transradial approach in 1989, the radial artery has been increasingly used as an alternative access site. The main advantage offered by the transradial approach is represented by the very low (< 1%) incidence of relevant vascular access site complications, which on the contrary occur in about 3% to 7% of patients undergoing procedures through the femoral route. The main disadvantage is a higher incidence of procedural failure that leads to a crossover to the femoral route. In this review, we examine the available evidence on transradial and transfemoral approach advantages, disadvantages, and complications in coronary angiography and intervention. Their use in the acute myocardial infarction setting and other situations is described. Vascular closure device usefulness is also considered.

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“…Data from the National Heart, Lung and Blood Institute Dynamic Registry have documented an independent fourfold increase in in-hospital mortality in patients presenting with STEMI compared with those with non-STEMI as well as greater access site bleeding complications requiring blood transfusion (3.3% vs 2.1%) 15. As STEMI represents the highest bleeding risk in the spectrum of ACS, these data have led some interventionists to recommend that radial access is employed as the primary access site in patients with STEMI as this cohort represents the highest bleeding risk in the spectrum of ACS 16. In contrast, this view is contested by other commentators, who argue that the enthusiasm for the transradial approach in patients with STEMI is not sufficiently justified by the evidence to support such a move towards its use 17…”

Section: Introductionmentioning

confidence: 99%

Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials

Mamas

Ratib

Routledge

et al. 2011

Heart

134

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Objective A meta-analysis of all randomised controlled studies that compare outcomes of transradial versus the transfemoral route to better define best practice in patients with ST elevation myocardial infarction (STEMI). Design A Medline and Embase search was conducted using the search terms 'transradial,' 'radial', 'STEMI', 'myocardial' and 'infarction'. Setting Randomised controlled studies that compare outcomes of transradial versus the transfemoral route. Patients A total of nine studies were identified that consisted of 2977 patients with STEMI. Interventions Studies that compare outcomes of transradial versus the transfemoral route. Main outcome measures The primary clinical outcomes of interest were (1) mortality; (2) major adverse cardiac events (MACE); (3) major bleeding and (4) access site complications. Results Transradial PCI was associated with a reduction in mortality (OR 0.53, 95% CI 0.33 to 0.84; p¼0.008), MACE (OR 0.62, 95% CI 0.43 to 0.90; p¼0.012), major bleeding events (OR 0.63, 95% CI 0.35-1.12; p¼0.12) and access site complications (OR 0.30, 95% CI 0.19 to 0.48; p<0.0001) compared with procedures performed through the femoral route. Conclusions This meta-analysis demonstrates a significant reduction in mortality, MACE and major access site complications associated with the transradial access site in STEMI. The meta-analysis supports the preferential use of radial access for STEMI PCI.

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Should radial artery access be the "gold standard" for PCI?

Cited by 18 publications

References 33 publications

Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Transradial intervention for patients with ST elevation myocardial infarction with or without cardiogenic shock

Transradial versus transfemoral approach for percutaneous coronary procedures

Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials

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