Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction
- 214 Downloads
Transradial access (TRA) in percutaneous coronary intervention (PCI) is a widely used standard technique with lower complication rates compared to transfemoral access (TFA). The aim of this study was to evaluate the impact of TRA versus TFA for PCI on clinically significant vascular access complications in the setting of acute myocardial infarction (AMI).
This multicenter study randomly assigned 250 patients in a 1:1 fashion (TRA vs. TFA) admitted with or without ST-segment elevation AMI undergoing immediate PCI. The primary endpoint was defined as the occurrence of hematoma, pseudo-aneurysm or local bleeding at the access site requiring any further intervention and/or prolonged hospital stay. Radiation exposure to the patient and operator was also investigated.
In the study cohort (N = 250 patients, mean age 62 ± 12.7 years, 76% males) 5 patients (2%) achieved the primary endpoint without a significant difference between groups, 4 out of 125 (3.2%) in the TFA group and 1 out of 125 (0.8%) in the TRA group (p = 0.17). Access site hematoma was significantly more frequent in the TFA group compared to the TRA group (24.8% vs. 8.8%, respectively; p < 0.0007). Local bleeding was only seen in the TFA group (3.2% vs. 0%, p = 0.04). Time intervals from admission to catheter laboratory to first balloon inflation were longer in the TRA compared to the TFA group (34 ± 17 min vs 29.5 ± 13 min, respectively; p = 0.018). Radiation exposure to the patient and operator was identical.
The use of TRA was accompanied by lower rates of access site complications; however, the need for subsequent treatment or prolonged hospital stays was not observed using either of the two access approaches.
KeywordsCoronary angiography Acute myocardial infarction Access site Hematoma
The authors would like to thank Kristen Kopp for her help in language editing of the manuscript.
Compliance with ethical guidelines
Conflict of interest
C. Schernthaner, M. Hammerer, S. Harb, M. Heigert, K. Hoellinger, E. Lassnig, E. Maurer, J. Schuler, P. Siostrzonek, H. Ulmer, A. Winter, and J. Altenberger declare that they have no competing interests.
All studies on human participants reported in this article were carried out with the approval of the responsible ethics committees and in accordance with national law and the Helsinki Declaration form 1964 (in its current revised form). Informed consent was obtained from all participants in the study.
- 3.Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, RIVAL trial group, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409–20. Erratum in: Lancet. 2011;378(9785):30. Lancet. 2011 ;377(9775):1408.CrossRefPubMedGoogle Scholar
- 5.Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481–9.CrossRefPubMedGoogle Scholar
- 7.Chase AJ, Fretz EB, Warburton WP, Klinke WP, Carere RG, Pi D, et al. Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg). Heart. 2008;94:1019–25.CrossRefPubMedGoogle Scholar
- 8.Ratib K, Mamas MA, Anderson SG, Bhatia G, Routledge H, De Belder M, British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research, et al. Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous coronary intervention in the United Kingdom. JACC Cardiovasc Interv. 2015;8:20–9.CrossRefPubMedGoogle Scholar
- 9.Valgimigli M, Saia F, Guastaroba P, Menozzi A, Magnavacchi P, Santarelli A, REAL Registry Investigators, et al. Transradial versus transfemoral intervention for acute myocardial infarction: a propensity score-adjusted and -matched analysis from the REAL (REgistroregionaleAngiopLastichedell’Emilia-Romagna) multicenter registry. JACC Cardiovasc Interv. 2012;5:23–35.CrossRefPubMedGoogle Scholar
- 10.Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349–56. Review.CrossRefPubMedGoogle Scholar
- 12.Vranckx P, Campo G, Anselmi M, Bolognese L, Colangelo S, Biondi-Zoccai G, et al. Multicenter Evaluation of Single High-Dose Bolus Tirofiban vs. Abciximab with Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study. Does the site of bleeding matter? A stratified analysis on location of TIMI-graded bleedings and their impact on 12-month outcome in patients with ST-segment elevation myocardial infarction. EuroIntervention. 2012;8:71–8.CrossRefPubMedGoogle Scholar
- 17.Bradley SM, Rao SV, Curtis JP, Parzynski CS, Messenger JC, Daugherty SL, et al. Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry. Circ Cardiovasc Qual Outcomes. 2014;7:550–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Yeni H, Axel M, Örnek A, Butz T, Maagh P, Plehn G. Clinical and Subclinical Femoral Vascular Complications after Deployment of two Different Vascular Closure Devices or Manual Compression in the Setting of Coronary Intervention. Int J Med Sci. 2016;13(4):255–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, European Association of Percutaneous Cardiovascular Interventions, Working Group on Acute Cardiac Care of the European Society of Cardiology, Working Group on Thrombosis on the European Society of Cardiology, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EuroIntervention. 2013;8:1242–51.CrossRefPubMedGoogle Scholar