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Vascular Closure Devices Attenuate Femoral Access Complications of Primary Percutaneous Coronary Intervention
Pedro Beraldo de Andrade1, José de Ribamar Costa, Fábio Salerno Rinaldi
1Santa Casa de Marília, Avenida Vicente Ferreira, 828, Marília - São Paulo, Brazil. pedroberaldo@gmail.com.
Insights
This study found no significant difference in severe complications between radial and femoral artery access for percutaneous coronary intervention (PCI). Both methods, when using vascular closure devices, demonstrated low complication rates, ensuring patient safety.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Femoral artery access remains a standard for acute myocardial infarction treatment.
- Need for comparative studies on modern radial vs. femoral techniques to reduce operator bias.
Purpose of the Study:
- To compare severe complications of radial versus femoral access in primary percutaneous coronary intervention (PCI).
- To evaluate vascular closure device efficacy in both access methods.
Main Methods:
- Randomized study comparing radial access (compression device) with femoral access (vascular closure device).
- Assessment of severe access site complications until hospital discharge.
- Meta-analysis of severe bleeding and major adverse cardiovascular events.
Main Results:
- No significant difference in overall severe vascular access-related complications (8.0% femoral vs. 5.6% radial; P=.45).
- Radial access showed a trend towards fewer vascular complications (RR, 0.64; 95% CI, 0.43-0.95).
- Meta-analysis revealed no impact on severe bleeding or major adverse cardiovascular events.
Conclusions:
- Adherence to femoral artery puncture techniques and routine vascular closure device use resulted in low severe complication rates.
- Both radial and femoral access, when managed appropriately, are safe options for PCI.
Objectives:
To compare severe complications related to radial access and those related to femoral access using vascular closure devices for patients undergoing primary percutaneous coronary intervention (PCI).
Background:
Femoral artery access is still used for acute myocardial infarction management; studies comparing state-of-the-art radial and femoral techniques are required to minimize bias regarding the outcomes associated with operator preferences.
Methods:
We performed a randomized study comparing radial access with a compression device and anatomic landmark-guided femoral access with a hemostatic vascular closure device. The severe complication rates related to the access site were assessed until hospital discharge. A meta- analysis including studies with comparable populations reporting severe bleeding and major adverse cardiovascular event rates was performed.
Results:
A total of 250 patients were included who underwent PCI between January 2016 and February 2019. Mean age was 61.5 ± 12.2 years, 73.2% were men, and 28.4% had diabetes. There were no differences between groups or in vascular access-related severe complication rates (8.0% for femoral group vs 5.6% for radial group; P=.45). Although radial access was associated with decreased vascular complications related to the access site when compared with the femoral approach (relative risk [RR], 0.64; 95% confidence interval [CI], 0.43-0.95), the meta-analysis did not show an impact on severe bleeding (RR, 0.74; 95% CI, 0.37-1.46) or severe cardiovascular adverse events (RR, 0.69; 95% CI, 0.30-1.58).
Conclusions:
Compliance with femoral artery puncture techniques and routine use of a vascular closure device promoted low severe complication rates.
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