Efficacy of the radial approach for the performance of primary PCI for STEMI

Carlos Cafri, Doron Zahger, Miriam Merkin, Jean Marc Weinstein, Sergio Kobal, Reuvem Ilia
Journal of Invasive Cardiology 2013, 25 (3): 150-3

BACKGROUND: Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is associated with increased bleeding complications, impacting clinical outcome. Transradial PPCI could decrease the risk of bleeding, but concerns about technical difficulties and longer reperfusion times limit its adoption.

AIM AND METHODS: This was a retrospective comparison of reperfusion times and bleeding complications in a large cohort of STEMI patients treated by PPCI through the transradial (TR; n = 244) or transfemoral approach (TF; n = 364) from January 2005 to December 2009. Endpoints were door-to-balloon time, access-site and non-access site bleeding, as well 1-month and 1-year mortality rates.

RESULTS: Patients treated with TR-PPCI were younger than those having TF-PPCI, (57 ± 13 years vs 62 ± 13 years, respectively; P<.01), more frequently males (84% vs 73%, respectively; P<.01), and had less renal failure (9% vs 16%, respectively; P<.01) or hemodynamic compromise, ie, pulmonary edema or cardiogenic shock (1% vs 4%, respectively; P=.01). Angiographic and angioplasty characteristics, including the angiographic success rate, were similar, with the exception of a higher use of aspiration devices in the TR-PPCI group (31% vs 15%, respectively; P<.01). The door-to-balloon time was similar in both groups (76 ± 40 minutes vs 74 ± 41 minutes; P=NS). Significant lower rates of overall bleeding (6% vs 31%; P<.01), access-site bleeding (4% vs 27%; P<.01), non-access site bleeding (1% vs 3%; P=.01) and need for blood transfusion (0% vs 3%; P=.01) were observed in the TR-PPCI group. One-month (3% vs 7%; P<.05) and 1-year mortality rates (4% vs 11%; P<.05) were lower in the TR-PPCI group. Radial PCI was an independent predictor of 1-year mortality.

CONCLUSION: TR-PPCI is feasible in STEMI patients and can be performed efficiently within the time limits recommended. This approach provides advantages in terms of reduction of bleeding that could translate into an improved clinical outcome.

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