Utilization of radial artery access for percutaneous coronary intervention for ST-segment elevation myocardial infarction in New York

Edward L Hannan, Louise Szypulski Farrell, Gary Walford, Peter B Berger, Nicholas J Stamato, Ferdinand J Venditti, Alice K Jacobs, David R Holmes, Samin Sharma, Spencer B King
JACC. Cardiovascular Interventions 2014, 7 (3): 276-83

OBJECTIVES: This study sought to determine the utilization and outcomes for radial access for percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in common practice.

BACKGROUND: Radial access for PCI has been studied considerably, but mostly in clinical trials.

METHODS: All patients undergoing PCI for STEMI in 2009 to 2010 in New York were studied to determine the frequency and the patient-level predictors of radial access. Differences in in-hospital/30-day mortality between radial and femoral access were also studied.

RESULTS: Radial access increased from 4.9% in the first quarter of 2009 to 11.9% in the last quarter of 2010. Significant independent predictors were higher body surface area, non-Hispanic ethnicity, Caucasian race, stable hemodynamic state, ejection fraction <30% and ≥50% onset of STEMI from 12 to 23 h before the index procedure, and peripheral vascular disease. Mortality was not related to access site after adjustment for covariates (for radial vs. femoral access, adjusted odds ratio: 0.86, 95% confidence interval: 0.59 to 1.25), but the radial access site was trending toward lower mortality for the 9 hospitals that used it for more than 10% of their patients (adjusted odds ratio: 0.61, 95% confidence interval: 0.36 to 1.02).

CONCLUSIONS: The use of a radial access site for PCI in STEMI patients increased between 2009 and 2010, but was still infrequent in 2010, and was used for lower-risk STEMI patients. There was no significant difference in mortality by access site, but there was a trend toward a mortality advantage for patients with a radial access site among hospitals that used it relatively frequently.

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