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