Association Between Radial Versus Femoral Access for Percutaneous Coronary Intervention and Long-Term Mortality

Area of Science:

• Cardiology
• Vascular Surgery
• Interventional Cardiology

Background:

• Radial arterial access in percutaneous coronary intervention (PCI) is linked to reduced bleeding.
• Long-term outcomes regarding mortality and major adverse cardiac events (MACE) after PCI with radial versus femoral access remain inconclusive.

Purpose of the Study:

• To compare long-term mortality and MACE in patients undergoing first-ever PCI via radial versus femoral arterial access.
• To evaluate the sustained benefits of radial access beyond the early postoperative period.

Main Methods:

• Retrospective cohort study of 26,022 patients undergoing first-ever PCI in Hong Kong (2010-2017).
• Propensity score matching created a cohort of 14,614 patients (7307 radial, 7307 femoral).
• Analysis of all-cause mortality, MACE, myocardial infarction, unplanned revascularization, and stroke up to 3 years.

Main Results:

• Radial access group showed significantly lower 3-year all-cause mortality (HR 0.70; P<0.001).
• Radial access was associated with reduced risks of MACE (HR 0.78; P<0.001), post-discharge myocardial infarction (HR 0.78; P<0.001), and unplanned revascularization (HR 0.76; P<0.001).
• Stroke risk was similar between radial and femoral access groups (HR 0.96; P=0.655).

Conclusions:

• Radial arterial access significantly reduces 3-year all-cause mortality compared to femoral access.
• Radial access is linked to decreased risks of myocardial infarction and unplanned revascularization, with sustained benefits.
• Stroke risk is comparable between the two access methods.