Wiener klinische Wochenschrift

, Volume 130, Issue 5–6, pp 182–189 | Cite as

Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction

A randomized prospective multicenter trial
  • Christiana Schernthaner
  • Matthias Hammerer
  • Stefan Harb
  • Matthias Heigert
  • Kurt Hoellinger
  • Elisabeth Lassnig
  • Edwin Maurer
  • Jochen Schuler
  • Peter Siostrzonek
  • Hanno Ulmer
  • Andreas Winter
  • Johann Altenberger
original article

Summary

Background

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).

Methods

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.

Results

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.

Conclusion

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.

Keywords

Coronary angiography Acute myocardial infarction Access site Hematoma 

Notes

Acknowledgements

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.

Ethical standards

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.

Supplementary material

508_2017_1260_MOESM1_ESM.docx (24 kb)
Supplement Table 4. Percentages of radial vs. femoral access experience of participating operators

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Christiana Schernthaner
    • 1
  • Matthias Hammerer
    • 1
  • Stefan Harb
    • 5
  • Matthias Heigert
    • 1
  • Kurt Hoellinger
    • 4
  • Elisabeth Lassnig
    • 3
  • Edwin Maurer
    • 3
  • Jochen Schuler
    • 1
    • 2
  • Peter Siostrzonek
    • 4
  • Hanno Ulmer
    • 7
  • Andreas Winter
    • 4
  • Johann Altenberger
    • 1
    • 6
  1. 1.Department of CardiologyParacelsus Medical University SalzburgSalzburgAustria
  2. 2.Institute of General Practice, Family and Preventive MedicineParacelsus Medical University SalzburgSalzburgAustria
  3. 3.Klinikum Kreuzschwestern WelsWelsAustria
  4. 4.Department of CardiologyKrankenhaus der Barmherzigen SchwesternLinzAustria
  5. 5.Department of CardiologyLandeskrankenhaus Graz WestGrazAustria
  6. 6.Cardiac Rehabilitation Center, Academic Educational Hospital, Paracelsus Medical University SalzburgPensionsversicherungGroßgmainAustria
  7. 7.Department for Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria

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