Transradial versus transfemoral approach for primary percutaneous coronary interventions in elderly patients

The use of transradial approach (TRA) in the STEMI setting is still debated because of the worry that TRA intervention can lead to a delay in the reperfusion time, especially in the elderly, where more advanced atherosclerosis is usually encountered. The aim of this study is to compare the reperfusion time between radial versus femoral approach in patients older than 75 years of age undergoing primary percutaneous coronary intervention (PCI).

From January 2008 to December 2011, a total of 283 consecutive patients older than 75 years of age underwent primary PCI at our institution. Of these, 177 were treated using the TRA while the remaining 106 had the transfemoral approach (TFA). Demographic and procedural data including door-to-balloon time, time of arterial puncture, and inflation of the balloon were recorded.

Door-to-balloon time was 103.1 ± 58.4 minutes in the TRA group compared with 110.3 ± 62.4 minutes in the TFA group (P=NS). Time of arterial puncture was 10.6 ± 4.1 minutes in the TRA group compared with 12.1 ± 4.5 minutes in the TFA group (P<.01). Time of balloon inflation was 19.6 ± 8.7 minutes in the TRA group compared with 24.2 ± 14.9 minutes in the TFA group (P<.01).

Our data suggest that the radial approach does not lead to a lengthening of the door-to-balloon time, suggesting the efficacy of this approach in STEMI patients without cardiogenic shock at presentation.