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Comparison between transradial and transfemoral percutaneous coronary intervention in acute ST-elevation myocardial
Uzoma N Ibebuogu1, Bojan Cercek, Rajendra Makkar
1Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Transradial access for percutaneous coronary intervention in ST-segment elevation myocardial infarction is feasible, showing fewer vascular complications and shorter hospital stays compared to transfemoral access.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial (TR) access is increasingly adopted for percutaneous coronary intervention (PCI).
- Concerns exist regarding its complexity and impact on reperfusion times in ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To prospectively evaluate the feasibility and outcomes of transradial access versus transfemoral (TF) access for PCI in patients with acute STEMI.
Main Methods:
- A prospective observational study of 150 consecutive STEMI patients undergoing PCI.
- Comparison of TR access (n=46) versus TF access (n=104).
- Evaluation of door-to-balloon time, contrast volume, fluoroscopy time, TIMI 3 flow, and vascular complications.
Main Results:
- No significant differences in age, gender, or diabetes between groups.
- Comparable door-to-balloon times and contrast volumes.
- TR access showed significantly longer fluoroscopy times (p <0.0001) but no significant difference in TIMI 3 flow (p = 0.15).
- Notably, TR access had zero vascular complications compared to 5.8% in the TF group (p = 0.18).
Conclusions:
- Transradial access is a feasible approach for PCI in STEMI patients.
- TR access is associated with fewer vascular complications and potentially shorter hospital stays.
- While fluoroscopy time is longer, clinical outcomes and reperfusion appear comparable.
Abstract:
Transradial (TR) access is increasingly being used in percutaneous coronary intervention (PCI). However, its role in PCI for ST-segment elevation myocardial infarction remains controversial because of concerns of procedural complexity adversely affecting the promptness of reperfusion. In this study, 150 consecutive patients who underwent PCI for acute ST-segment elevation myocardial infarction over a period of 24 months were prospectively evaluated; 46 had TR access (31%) and 104 (69%) had transfemoral (TF) access. All patients received thienopyridines, aspirin, and heparin per routine management. There were no significant differences between the TR access and TF access groups with respect to age (62.2 ± 11.6 vs 64.7 ± 14.1, p = 0.28), gender (76.1% vs 72.1% men, p = 0.69), or incidence of diabetes (23.9% vs 26.9%, p = 0.84). The TR and TF access groups were comparable with respect to door-to-balloon time (79.2 ± 32.3 vs 86.8 ± 51.8 minutes, p = 0.67) and amount of contrast used (190.5 ± 101.5 vs 172.2 ± 81.7 ml, p = 0.24). Total fluoroscopy time was longer in the TR access group compared to the TF access group (21.7 ± 12.7 vs 14.4 ± 10.4 minutes, p <0.0001). Postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow was comparable for the 2 groups (87% for the TF group and 96% for the TR group, p = 0.15). There were no vascular complications in the TR access group compared to the TF access group (0% vs 5.8%, p = 0.18). In conclusion, this single-center observational study shows that TR access for PCI in STEMI is feasible and that it has fewer vascular complications and shorter length of hospital stay than the TF approach.
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