[Comparison of the radial and femoral arterial approaches for coronary angioplasty in acute myocardial infarction].

AIM: As compared to the femoral approach, the use of radial arterial access has been demonstrated to reduce the incidence of access site bleeding complications in staged procedures. The purpose of this study was to evaluate clinical outcomes comparing radial and femoral approaches in the treatment of acute myocardial infarction with emergency angioplasty.

METHODS: Between September 1999 and December 2002, we prospectively enrolled 162 consecutive patients undergoing primary angioplasty with abciximab (n=127) or rescue angioplasty after thrombolysis failure (n=35) comparing in a non-randomized plan radial (n=87) and femoral (n=75) access.

RESULTS: Cannulation time (from patient arrival at the catheterization laboratory to the effective placement of arterial sheath) and procedural time was not significantly different in radial and femoral groups (respectively 8.5 +/- 5.2 vs 9.0 +/- 5.8 minutes, p=0.81, and 42 +/- 28 vs 44 +/- 27 min, p=0.74). Nevertheless, time of radiation (23.1 +/- 11 min vs 16.5 +/- 10.9 min; p=0.01) and dose-area product (229 +/- 133 vs 151 +/- 86 Gy.cm2, p=0.01) were significantly higher in the radial group. Angiographic success rate is comparable in both groups. Freedom from ischemic recurrent events at 1-month follow-up occurred in 84 (96%) and 69 (92%) patients in the radial and femoral groups, respectively (p=0.12). There were no major access site bleeding complications in the radial group, as opposed to six (8%) in the femoral group (p=0.01) all requiring transfusions and surgical repair necessary in four. Uncomplicated clinical course occurred in 83 (92%) of patients in the radial group and 65 (85%) in the femoral group (p=0.03). Total hospital length of stay was significantly higher in the femoral group (5.9 +/- 2.1 days vs 3.5 +/- 1.2 days; p=0.009).

CONCLUSION: In patients with acute myocardial infarction treated with coronary angioplasty, the transradial access is efficacious with fewer major access site complications than transfemoral access. Transradial approach produces a shorter length of stay, as compared to the transfemoral approach although with longer times of radiation and higher dose area-product.