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Predictors of Radial to Femoral Artery Access Crossover During Primary Percutaneous Coronary Intervention for
Denee Dang1, Lisa Kuhn2, Ensieh Fooladi3
1School of Nursing and Midwifery, Monash University, Melbourne, Vic, Australia; MonashHeart, Monash Health, Melbourne, Vic, Australia; Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
Insights
Radial access for ST-elevation myocardial infarction (STEMI) is preferred, but failure occurs in nearly 10% of patients, increasing door-to-device times. Female sex and hypertension predict radial access failure, informing strategies for successful primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery access for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) reduces mortality and bleeding compared to femoral access.
- However, radial access failure can lead to increased door-to-device (DTD) times, potentially impacting treatment efficacy.
Purpose of the Study:
- To identify predictors of radial access failure requiring crossover to femoral artery access during primary PCI.
- To inform strategies for optimizing radial access success rates in STEMI patients.
Main Methods:
- Prospective recruitment of 2,256 STEMI patients into the Victorian Cardiac Outcomes Registry from 2013-2020.
- Multivariable logistic regression analysis to determine independent predictors of radial-to-femoral artery access crossover.
- 30-day follow-up to assess outcomes related to access strategy.
Main Results:
- Primary radial access was utilized in 78.8% of STEMI patients, with a 9.6% rate of radial-to-femoral crossover.
- Failed radial access was associated with significantly longer DTD times (67 mins vs. 54 mins).
- Independent predictors of radial access failure included female sex (AOR 2.1) and baseline hypertension (AOR 1.5).
Conclusions:
- Nearly 1 in 10 STEMI patients undergoing primary PCI experienced radial artery access failure, leading to prolonged DTD times.
- Female sex and hypertension are key patient characteristics associated with increased risk of radial access failure.
- Identifying these predictors allows for proactive measures to ensure equipment availability and maximize successful primary PCI via radial access.
Background:
Radial access for primary percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) is associated with reduced mortality and bleeding, when compared to femoral access. However, radial access failure may be associated with an increased door-to-device (DTD) time.
Aims:
To identify predictors of radial access failure requiring crossover to femoral artery access during primary PCI.
Methods:
From 2013 to 2020, 2,256 consecutive patients treated for PPCI at a single tertiary hospital were prospectively recruited into the Victorian Cardiac Outcomes Registry and followed for 30 days. Multivariable logistic regression was used to identify independent predictors of radial to femoral access crossover.
Results:
From 2,256 STEMI patients, primary radial access was used in 1,778 (78.8%), with 171 (9.6%) experiencing radial-to-femoral crossover. Patients with failed versus successful radial access experienced longer DTD times (67 mins, interquartile range [IQR] 46-99 vs 54 mins [IQR 39-78]; p<0.001). Independent predictors of radial-to-femoral access crossover included female sex (Adjusted Odds Ratio [AOR] 2.1, 95% Confidence Interval [CI] 1.4-3.0; p<0.001) and baseline hypertension (AOR 1.5, 95% CI 1.1-2.1; p=0.018).
Conclusion:
In a real-world STEMI registry, almost 1 in 10 patients experienced access crossover from the radial to femoral artery which resulted in longer DTD times. Independent predictors of radial access failure included female sex and baseline hypertension. Knowing which patient characteristics are associated with increased risk of radial artery failure enables catheter laboratory staff to ensure equipment is readily available to maximise successful primary PCI are available.
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